Vistaril / Atarax Tapering Guide
hydroxyzine
Overview
Hydroxyzine is a first-generation antihistamine used as an anxiolytic, antipruritic, and pre-anesthetic. Non-controlled, non-dependence-forming, often chosen as a benzodiazepine-sparing option for short-term anxiety.
10mg, 25mg, 50mg, 100mg tablets/capsules; 10mg/5mL syrup
Tablets/capsules: 10mg, 25mg, 50mg, 100mg; Syrup: 10mg/5mL; IM injection
Category C
Mechanism of Action
Potent histamine H1 antagonist; mild muscarinic and 5-HT2A antagonism. The active metabolite cetirizine accounts for some of the long-acting effect.
Taper Notes
Most patients can stop with a brief 1-week step-down or directly. No benzodiazepine-style withdrawal.
Hyperbolic Tapering Guidance
A genuinely low-risk discontinuation profile compared with benzodiazepines or Z-drugs.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Withdrawal Timeline
1-3 days
3-7 days
1-2 weeks
Rare
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- Other CNS depressants — additive sedation
- Anticholinergics — additive burden
- QT-prolonging drugs — additive risk
Contraindications
- Known QT prolongation
- Severe sedation risk patients
Toxicity
Sedation, dry mouth, dizziness, blurred vision, urinary retention. QT prolongation at higher doses or in combination with other QT-prolonging drugs.
Pharmacokinetics
ADME Profile
Hepatic to cetirizine and other metabolites.
~93%
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Other Drug Profiles
Sources & References
Vistaril / Atarax (hydroxyzine) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Regulatory sources
Official prescribing information and safety notices.
Peer-reviewed research
Primary literature cited in this taper guide.
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- Deprescribing.org — Evidence-based deprescribing algorithms from the Bruyère Research Institute
- Royal College of Psychiatrists — Stopping antidepressants — UK clinical guidance on safely discontinuing antidepressants
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — tapering forum — Long-running community archive of antidepressant taper experiences
- Inner Compass Initiative — Withdrawal Project — Peer-led resources for psychiatric drug withdrawal
- Mad in America — antidepressant withdrawal archive — Journalism and personal narratives on SSRI/SNRI discontinuation
- RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.