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Key takeaways
Hydroxyzine is a prescription medication that can manage anxiety and itching (pruritus) related to allergic conditions or chronic hives (urticaria).
Hydroxyzine can cause drowsiness and sleepiness, which can be unwanted side effects and prompt the need for an alternative medication.
Alternative anxiety medications include antidepressants, benzodiazepines, and anti-anxiety agents.
Alternative pruritus or urticaria medications can include other antihistamines, oral steroids, and topical steroids.
Hydroxyzine is a generic prescription medication used to relieve anxiety and manage itching (pruritus) related to allergic conditions or chronic hives. Hydroxyzine is a first-generation antihistamine, so it alleviates allergic reactions, such as itching and hives. It is also a sedative, so it calms anxiety. Because of its sedative effects, hydroxyzine may be a good choice for people who can’t sleep because of anxiety. For others, sedation, drowsiness, impairment, and dizziness may be too much to tolerate. People with concerns about hydroxyzine’s sedative effects can take less sedating alternatives.
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What can I take instead of hydroxyzine?
There are other options available to relieve anxiety and manage pruritus when hydroxyzine doesn’t work, or side effects are a problem. For anxiety, alternatives include antidepressants and benzodiazepines. Itching can be treated with other antihistamines, oral steroids, or topical steroids. Lower-priced over-the-counter (OTC) antihistamines can be effective for some people with pruritus.
Hydroxyzine alternatives cost comparison |
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|---|---|---|---|
| Drug name | Price without insurance | SingleCare price | Savings options |
| Hydroxyzine | $40 per 30, 25 mg tablets | $5 per 30, 25 mg tablets at Walmart | See latest prices |
| Allegra Allergy (fexofenadine) | $28 for 30, 180 mg tablets | $4 for 30, 180 mg tablets of generic fexofenadine at Walmart | See latest prices |
| Benadryl Itch Relief (diphenhydramine) | $7 per 1, 14 mL of 2-0.1% bottle | $4 per 1, 14 mL of 2-0.1% bottle of brand-name Benadryl Itch Relief at Kroger | See latest prices |
| Celexa (citalopram) | $407 for 30, 20 mg tablets | $6 for 30, 20 mg tablets of generic citalopram at Kroger | See latest prices |
| Duloxetine | $247 for 30, 60 mg capsules | $8 for 30, 60 mg capsules of generic duloxetine at Kroger | See latest prices |
| Ativan (lorazepam) | $1,357 per 30, 0.5 mg tablets | $8 per 30, 0.5 mg tablets of generic Ativan at Walgreens | See latest prices |
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing in ZIP code 23666 as of 02/01/2026. Click the link under “See our lowest price” to see the latest drug prices.
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 (hives) and pruritus because they are less likely to cause sedation, drowsiness, and dizziness. 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. These alternatives also last longer in the body than hydroxyzine (4 to 6 hours), with effects lasting 12 to 24 hours.
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 are also first-line treatments for generalized anxiety disorder and other types of anxiety, such as panic disorder. 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), Paxil (paroxetine), 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 duloxetine and Effexor (venlafaxine).
4. Benzodiazepines
Benzodiazepines are a type of sedative used for a variety of conditions, including anxiety disorders. While these alternatives can be effective for the treatment of anxiety, they do cause noticeable sedation and impairment. SSRIs and SNRIs are usually the first choice. 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 the risk of falls and injuries. Benzodiazepines are typically used at low doses and for the shortest amount of time possible. They are sometimes given together with SSRIs or SNRIs until anxiety symptoms improve.
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. Some itch relief antihistamines are sold in topical formulations, so side effects are minimal. First-generation antihistamines are well-suited alternatives for those who experience nighttime 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
For anxiety, the natural substitute for hydroxyzine is therapy and lifestyle changes, including 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.
Cognitive behavioral therapy is often recommended for mental health conditions like anxiety, depression, substance use, and phobias. This therapy can help people recognize thinking patterns that cause distress and learn to manage overwhelming emotions and unhelpful behaviors.
For urticaria and pruritus, alternatives include lifestyle changes and treatments that can be done at home. The American Academy of Dermatology suggests avoiding overheating and wearing loose-fitting cotton clothes. Other remedies include applying a cold compress 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 your 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 that 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. The dose may need to be gradually reduced 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 drug interactions that must be avoided.
- 10 ways to get relief from chronic hives, American Academy of Dermatology Association (2024)
- Antihistamines, StatPearls (2025)
- Benzodiazepines, StatPearls (2024)
- Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis, BMC Health Services Research (2018)
- Selective serotonin reuptake inhibitors, StatPearls (2023)
- Vistaril hydroxyzine capsule prescribing information, DailyMed (NIH National Library of Medicine) (2024)