Hydroxyzine alternatives: What can I take instead of hydroxyzine?

In this article:

• Compare hydroxyzine alternatives
• Second-generation antihistamines
• SSRIs
• SNRIs
• Benzodiazepines
• First-generation antihistamines
• Natural alternatives
• How to switch meds

In this article

• Compare hydroxyzine alternatives
• Second-generation antihistamines
• SSRIs
• SNRIs
• Benzodiazepines
• First-generation antihistamines
• Natural alternatives
• How to switch meds

Hydroxyzine (available as the brand name Vistaril) is a prescription medication used to relieve anxiety and manage itching (pruritus) related to allergic conditions or chronic hives. Hydroxyzine is available as a generic medication in various dosage forms, including capsules, tablets, and oral syrup. As an antihistamine, hydroxyzine blocks histamine in the body at certain receptor points, alleviates allergic reactions, and causes sedation. As a first-generation antihistamine, hydroxyzine has the potential to cause a wide variety of adverse effects, including drowsiness, sedation, fatigue, and headache. While dosing varies based on the intended use (up to three or four times daily), hydroxyzine is often used at bedtime for insomnia associated with anxiety, chronic itching, or hives (urticaria).

While an effective treatment for some people, hydroxyzine may not be the best and safest treatment for everyone treating either anxiety or pruritus. People with concerns about drowsiness and dizziness, which are common side effects of hydroxyzine, should consider less sedating alternatives due to hydroxyzine’s soothing properties. These people who are at a greater risk of serious side effects may include older adults, those who drink alcohol, or those who take other sedating medications. Some people may experience better relief of symptoms with other treatment options or prefer medications with less frequent dosing.

What can I take in place of hydroxyzine?

There are other options available to relieve anxiety and manage pruritis that do not improve with the use of hydroxyzine. Depending on the condition being treated, these alternative medications can include other antihistamines, oral steroids, topical steroids, antidepressants, benzodiazepines, and anti-anxiety agents. Over-the-counter (OTC) antihistamines can be effective for some people with pruritus. It is important to note that alternative medications may only treat anxiety or pruritus, so it is best to check what type of therapy is needed. These options may be more suitable for certain individuals due to their different uses, side effect profiles, dosages, and costs.

Compare hydroxyzine alternatives
Drug name	Uses	Dosage	Savings options
Hydroxyzine	Anxiety Pruritus Urticaria	Take 25 to 50 mg by mouth up to 4 times daily as needed Nightly Dosing: Take 25 to 50 mg by mouth once daily as needed at bedtime	Hydroxyzine coupons
Allegra (fexofenadine)	Upper respiratory allergies Urticaria	Once-daily formulation: Take 180 mg by mouth once daily  Twice-daily formulation: Take 60 mg by mouth twice daily	Allegra coupons
Ativan (lorazepam)	Anxiety Chemotherapy-induced nausea and vomiting Vertigo	Take 0.5 to 2 mg by mouth every 4-6 hours as needed (up to 10 mg/day)	Ativan coupons
Benadryl (diphenhydramine)	Symptomatic relief of allergy symptoms Nausea and vomiting associated with pregnancy Urticaria Vertigo	Take 10 to 50 mg by mouth per dose every 6 hours as needed Nightly Dosing: Take 25 to 50 mg by mouth at bedtime	Benadryl coupons
Buspirone	Generalized anxiety disorder Unipolar depression	Take 20 to 30 mg by mouth per day in 2-3 divided doses	Buspirone coupons
Celexa (citalopram)	Major depressive disorder (unipolar) Generalized anxiety disorder Panic disorder Post-traumatic stress disorder (PTSD) Binge eating disorder Obsessive-compulsive disorder (OCD) Vasomotor symptoms associated with menopause	Take 10 to 40 mg by mouth once daily	Celexa coupons
Clarinex (desloratadine)	Allergic rhinitis Urticaria	Take 5 mg by mouth once daily	Clarinex coupons
Claritin  (loratadine)	Allergic rhinitis or conjunctivitis Urticaria	Take 10 mg by mouth once daily	Claritin coupons
Cymbalta (duloxetine)	Generalized anxiety disorder Major depressive disorder (unipolar) Chronic musculoskeletal pain Fibromyalgia Neuropathic pain associated with diabetes mellitus	Take 60 to 120 mg by mouth once daily	Cymbalta coupons
Effexor  (venlafaxine)	Generalized anxiety disorder  Major depressive disorder (unipolar) Panic disorder Social anxiety disorder Migraine prevention Neuropathic pain associated with diabetes mellitus Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder Premenstrual dysphoric disorder Vasomotor symptoms associated with menopause	Take 37.5 mg to 225 mg by mouth once daily	Effexor coupons
Prozac  (fluoxetine)	Major depressive disorder (unipolar) Panic disorder Bipolar disorder Obsessive-compulsive disorder (OCD) Bulimia nervosa Premenstrual dysphoric disorder Generalized anxiety disorder Post-traumatic stress disorder (PTSD) Social anxiety disorder	Take 10 to 60 mg by mouth once daily	Prozac coupons
Valium (diazepam)	Anxiety disorders  Alcohol withdrawal syndrome Muscle spasm, spasticity, or rigidity  Active seizures Vertigo Opioid withdrawal	Take 2 to 10 mg by mouth every 3-6 hours as needed (up to 40 mg/day)	Valium coupons
Xanax (alprazolam)	Anxiety disorders Vertigo	Take 2 to 6 mg by mouth per day in 3-4 divided doses	Xanax coupons
Zoloft (sertraline)	Major depressive disorder (unipolar) Panic disorder Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder (PTSD) Social anxiety disorder Premenstrual dysphoric disorder Generalized anxiety disorder	Take 25 to 200 mg by mouth once daily	Zoloft coupons
Zyrtec (cetirizine)	Allergic rhinitis Urticaria	Take 10 mg by mouth once daily	Zyrtec coupons

Other alternatives to hydroxyzine

Other alternatives to either relieve anxiety or manage itching include prescription and OTC medications. Some of these options for relieving anxiety include other SSRIs, other SNRIs, and other benzodiazepines. Some of these options for itching management include oral steroids and topical steroids.

Other Selective Serotonin Reuptake Inhibitors (SSRIs):

• Lexapro (escitalopram)
• Luvox (fluvoxamine)
• Paxil (paroxetine)

Other Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs):

• Fetzima (levomilnacipran)
• Pristiq (desvenlafaxine)

Other Benzodiazepines:

• Klonopin (clonazepam)

Other Antihistamines:

• Chlorphen (chlorpheniramine)

Oral Steroids:

• Dexamethasone
• Medrol (methylprednisolone)
• Prednisolone
• Prednisone

Topical Steroids:

• Clobetasol
• Hydrocortisone
• Triamcinolone

Top 5 hydroxyzine alternatives

The following are some of the most common alternatives to hydroxyzine. Keep in mind that alternative medications may only treat anxiety or only treat urticaria and pruritus, so it is best to check what type of therapy is needed when considering alternative medications.

1. Second-generation antihistamines

Second-generation antihistamines are recommended over first-generation antihistamines as a first-line treatment for chronic urticaria and pruritus because of their better safety profile. These alternatives also last longer in the body than hydroxyzine (four to six hours), working for 12 to 24 hours. A second-generation antihistamine may be a suitable alternative for people treating urticaria or pruritus who experience unwanted side effects from hydroxyzine. They do not easily cross the blood-brain barrier (which allows passing into the brain), and therefore, their side effect profile is far more limited.

Examples of second-generation antihistamines include Allegra (fexofenadine), Clarinex (desloratadine), Claritin (loratadine), and Zyrtec (cetirizine). 

2. Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are a drug class commonly used to treat depression. These medications can also be used to treat generalized anxiety disorder and panic disorder. These alternatives are the preferred first-line medications for generalized anxiety disorder and panic disorder as they are effective and well-tolerated. SSRIs are typically taken once per day.

These medications are available in multiple forms, including tablets, capsules, and liquids. Common side effects include nausea, headache, dry mouth, insomnia, drowsiness, and sexual dysfunction. An SSRI may be better suited for those treating generalized anxiety disorder who want the convenience of once-daily dosing and have not experienced improved symptoms with hydroxyzine.

Examples of SSRIs include Celexa (citalopram), Lexapro (escitalopram), Luvox (fluvoxamine), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline). 

3. Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another class of medications often used to treat depression. Like SSRIs, these medications are the preferred first-line medications to treat generalized anxiety disorder and panic disorder. SNRIs are typically taken once per day. Common adverse effects include nausea, dizziness, fatigue, dry mouth, and sexual dysfunction. An SNRI may be a suitable alternative for generalized anxiety disorder treatment in those who have not experienced improved symptoms with hydroxyzine.

Examples of SNRIs include Cymbalta (duloxetine), Effexor (venlafaxine), Fetzima (levomilnacipran), and Pristiq (desvenlafaxine).

4. Benzodiazepines

Benzodiazepines are a class of medications that work in the body’s central nervous system for a variety of conditions, including anxiety disorders. While these alternatives can be effective for the treatment of anxiety, SSRIs and SNRIs are preferred to use first. Benzodiazepine medications are used for anxiety disorders. Common side effects include nausea, vomiting, headache, respiratory depression, drowsiness, confusion, fainting, diarrhea, and tremors. 

Benzodiazepines are associated with greater risks than some alternatives as they can cause slow, shallow breathing that can be serious and require immediate medical attention. Additionally, benzodiazepines are controlled substances that have the risk of being abused and can increase fall risk. Controlled substances are drugs or other substances tightly controlled by the government due to abuse potential or risk of addiction. A benzodiazepine may be a suitable alternative for anxiety disorder treatment in those who have not experienced improved symptoms with hydroxyzine and prefer as-needed therapy.

Examples of benzodiazepines include Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam).

5. First Generation Antihistamines

Along with hydroxyzine, other first-generation antihistamines can be used for urticaria and pruritus. First-generation antihistamines are sedating and can be effective when these conditions are exacerbated at night to help with sleep. Along with sedative effects, common side effects include dry mouth, dizziness, and headache. First-generation antihistamines are well-suited alternatives for those who experience night-time urticaria or pruritus and who would like an option to improve symptoms at bedtime.

Examples of first-generation include over-the-counter antihistamines, such as Benadryl (diphenhydramine) and Chlorphen (chlorpheniramine).

Natural alternatives to hydroxyzine

Alternative remedies for hydroxyzine used for anxiety symptoms include therapy and lifestyle changes that can improve mood and overall well-being. A few remedies include regular exercise and cognitive behavioral therapy.

Aerobic exercise is a form of physical activity that increases the heart rate and the body’s use of oxygen. It is effective in treating patients with anxiety. A study found that aerobic exercise lowered the anxiety scores of people with anxiety, especially when doing higher-intensity exercise. Higher-intensity exercises include jogging and treadmill exercises, while low-intensity exercises include walking and stretching exercises.

Anxiety and panic attacks are often associated with sudden symptoms, and the 3-3-3- rule may be a useful tool. This technique involves looking around and naming three things one sees, naming three sounds one hears, and moving three body parts such as an ankle, finger, or arm. Cognitive behavioral therapy is often recommended for mental health conditions like anxiety, depression, substance use, and phobias. This therapy can help pick out thinking patterns that cause distress to manage overwhelming emotions and unhelpful behaviors.

Alternative remedies for hydroxyzine used for urticaria and pruritus include easy-at-home treatment. The American Academy of Dermatology suggests avoiding overheating and wearing loose-fitting cotton clothes. Other remedies include applying a cold compress, such as ice cubes wrapped in a washcloth, to the itchy skin several times a day (unless cold triggers hives) and preventing dry skin by using a fragrance-free moisturizer several times a day.

How to switch to a hydroxyzine alternative

1. Discuss all health conditions with a healthcare provider

Before switching from hydroxyzine to an alternative, the healthcare provider must be aware of all medical history and conditions. Some alternatives should be used with caution or avoided with certain medical conditions.

2. Do not suddenly stop taking hydroxyzine without medical advice

Only stop taking hydroxyzine if the healthcare provider has been consulted and decided stopping the medication is appropriate. People who have taken hydroxyzine long-term and stop suddenly may notice an increase in symptoms and experience adverse effects such as anxiety, agitation, headache, nausea, sleep problems, and dizziness. Discuss with the healthcare professional about either slowly discontinuing the medication or lowering the dose gradually to discontinuation to avoid withdrawal symptoms.

3. Discuss all prescription and over-the-counter medications with a healthcare provider

Before switching from hydroxyzine to an alternative, the healthcare provider must review a complete medication list, including prescription drugs, OTC medications, and supplements. Certain alternatives have dangerous drug interactions that must be avoided.