By a practising Australian GP
If you are over 30 and living in Australia, you may know the frustration of lying awake at 2 a.m. with your mind racing, your skin itching from psoriasis, or your heart still pounding from a stressful day. Many patients tell me they feel trapped between medications that are addictive, antidepressants that take weeks to work, and over-the-counter sleep aids that leave them groggy the next day.
There is another option that has been quietly helping Australians for decades: hydroxyzine. As a doctor, I see it as a valuable tool because it treats several problems at once — anxiety, itch, sleep disturbance, nausea, and even some symptoms of long COVID — without the high dependence risk of benzodiazepines.
Hydroxyzine is a prescription-only medicine in Australia (Schedule 4). It belongs to the antihistamine family, but unlike hay fever antihistamines, it crosses into the brain more strongly. It works by blocking histamine H1 receptors, which helps reduce alertness, itching, nausea, and the physical sensations of anxiety. It usually starts working within 30–60 minutes, making it useful for acute flare-ups rather than daily prevention.
Because it is not a benzodiazepine and does not act on the same GABA receptors, hydroxyzine has a much lower risk of dependence. This is one of the main reasons I often prefer it for short-term relief in patients who are worried about addiction.
Psoriasis is not just a skin condition — it is an inflammatory condition that is strongly driven by stress and sleep deprivation. Many Australians with psoriasis know the vicious cycle: stress causes a flare, the itch keeps you awake, poor sleep increases stress, and the flare worsens.
Hydroxyzine can help break this cycle in three ways:
Hydroxyzine is not a substitute for prescribed psoriasis creams, phototherapy, or biologic medicines, but as an adjunct, it can significantly improve quality of life during a flare, especially when itch and sleep disturbance are prominent.
Many patients ask how hydroxyzine compares with other anxiety treatments. The table below summarises the key differences from a prescriber’s perspective.
| Medication | Onset of effect | Addiction potential | Common use in Australia | Doctor’s note |
|---|---|---|---|---|
| Hydroxyzine | 30–60 min | Low | Short-term anxiety, sleep, itch, travel sickness | Can be used as needed rather than daily |
| Benzodiazepines (diazepam, alprazolam) | 15–45 min | High | Severe acute anxiety, but short courses only | Risk of dependence, withdrawal, tolerance |
| SSRIs/SNRIs (sertraline, escitalopram, venlafaxine) | 2–6 weeks | Low | Long-term anxiety and depression | Not for immediate relief |
| Beta-blockers (propranolol) | 30–60 min | Low | Performance anxiety, tremor, palpitations | Does not treat the mental worry itself |
| Melatonin | 30–60 min | Low | Sleep-wake regulation | Not an anxiolytic; mainly for sleep timing |
Hydroxyzine offers rapid relief without the dependence risk of benzodiazepines, making it especially attractive for people who need help on difficult nights, before medical procedures, or during short-term stress periods.
If you already use over-the-counter or prescription sleep aids, you must discuss this with your GP. The main concern with hydroxyzine is additive sedation — combining sedatives can make you excessively drowsy, unsteady, or slow your breathing.
| Sleep aid | Interaction with hydroxyzine | Doctor’s advice |
|---|---|---|
| Melatonin | Mild additive drowsiness | Often safe at low doses, but monitor next-day grogginess |
| Doxylamine (Restavit, Dozile) | Increased sedation and anticholinergic load | Avoid combining; choose one or the other |
| Benzodiazepines / z-drugs (zolpidem, zopiclone) | Profound sedation, possible respiratory depression | Usually avoid combining |
| Alcohol | Severe sedation, impaired coordination | Avoid alcohol while taking hydroxyzine |
| Opioids (codeine, tramadol, oxycodone) | Increased drowsiness, dizziness, respiratory risk | Use only under close medical supervision |
| Sedating antidepressants (amitriptyline, mirtazapine) | Additive drowsiness and anticholinergic effects | Dose adjustment may be needed |
Many Australians with long COVID report persistent anxiety, insomnia, palpitations, brain fog, and histamine-related symptoms such as itching, flushing, or gastrointestinal upset. Because hydroxyzine blocks histamine H1 receptors and has calming properties, some doctors use it off-label to help manage the sleep–anxiety–itch cluster in long COVID.
It is not a cure for long COVID, but it can improve quality of life while other rehabilitation strategies — such as pacing, physiotherapy, and breath retraining — continue. If you are struggling with long COVID symptoms, ask your GP whether a short course of hydroxyzine might help you sleep and feel calmer.
For Australians who travel frequently or are planning a long-haul flight, air sickness can ruin a holiday. Hydroxyzine has antiemetic and antihistamine properties, so it can reduce nausea and vomiting associated with motion sickness. Taking a low dose 30–60 minutes before boarding may also reduce flight-related anxiety and help you rest on the plane.
Be aware that hydroxyzine can cause drowsiness, so do not drive immediately after landing until you know how it affects you. For air sickness, it is usually best taken before departure, not after nausea has already started.
A common concern I hear is: “Will this medication increase my risk of dementia?” This is an important question. The evidence on dementia risk is strongest for long-term, high-dose use of strongly anticholinergic medications. Hydroxyzine has mild-to-moderate anticholinergic activity, so in older adults or anyone with memory concerns, I use the lowest effective dose for the shortest possible time — and I often avoid it in patients over 65 or those with diagnosed dementia.
The key difference from benzodiazepines is that hydroxyzine is generally not used for months or years. Short, targeted use under medical supervision is a very different risk profile from daily, indefinite use. If you are concerned about dementia, talk to your GP about your individual risk before starting any sedating medicine.
If you are trying to reduce or stop benzodiazepines, you may experience rebound anxiety, insomnia, restlessness, sweating, and agitation. Hydroxyzine can be a useful non-addictive bridge during a medically supervised taper. It does not act on GABA receptors like benzodiazepines, so it does not simply substitute one dependence for another.
Instead, hydroxyzine can take the edge off anxiety and improve sleep while your nervous system adjusts. This must always be done with your GP or an addiction medicine specialist, as benzodiazepine withdrawal can be serious if not managed properly.
Some patients notice blurred vision, dry eyes, or difficulty focusing when starting hydroxyzine. This is due to its anticholinergic effect on the eye muscles. It is usually dose-related and often improves as your body adjusts. However, if you experience blurred vision, do not drive or operate machinery, and tell your doctor.
Hydroxyzine should be used with caution if you have glaucoma or raised eye pressure. Lubricating eye drops may help with dryness, but always seek medical advice if visual changes persist.
Hydroxyzine offers several advantages for Australians over 30 who are juggling work, family, and health concerns:
Imagine being able to break the cycle of a stressful day, itchy skin, and sleepless night with one calm conversation with your GP. Hydroxyzine is not a magic cure, but for many people it is a practical, effective, and safer short-term option.
Hydroxyzine is a prescription-only medicine in Australia, so you cannot buy it over the counter. But you can take these steps:
Do not self-medicate or share medicines. Your GP will help you weigh the benefits and risks, including concerns about blurred vision, sedation, and long-term anticholinergic burden.
Take control of your nights, your skin, and your peace of mind — ask your doctor about hydroxyzine today.
Disclaimer: This article is general information only and does not replace individual medical advice. Always consult a qualified health professional before starting or changing any medication.
