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Hydroxyzine (brand names Vistaril, Atarax) is a first-generation antihistamine of the diphenylmethane and piperazine class. It was initially synthesized in 1956 and thereafter marketed in the U.S. by the pharmaceutical juggernaut, Pfizer. Although a relatively ancient medication by today’s standards, hydroxyzine is still commonly prescribed: as a preoperative anesthetic, analgesic, and anxiolytic adjunct; as an antiallergic agent for atopic dermatitis, chronic hives, and pruritus; and on occasion, as a neuropsychiatric intervention for generalized anxiety disorder, and alcohol withdrawal.

Upon administration, hydroxyzine functions principally as an inverse agonist of the H1 histamine receptor. However, dissimilar to other first-generation antihistamine agents, it doesn’t significantly impact mACh (muscarinic acetylcholine receptors); this is favorable in reducing occurrence of anticholinergic side effects. Hydroxyzine also elicits antiserotonergic effects, meaning it inhibits action at serotonin (5-HT) receptors, which in turn, yields a therapeutic anxiolytic response.

Research of hydroxyzine (Atarax, Vistaril) for the treatment of anxiety suggests that it is equally effective and tolerable to FDA approved anxiolytics such as Buspar and benzodiazepines. In fact, some speculate that it may be a safer option than benzodiazepines due to its low propensity for abuse, dependence, and toxicity. These findings have lead many individuals with severe anxiety disorders to actively pursue hydroxyzine as a pharmacological intervention.

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