Hydroxyzine alternatives: what to try for allergy, itch and anxiety

Hydroxyzine helps with itching, allergies and short-term anxiety, but it can make you sleepy and has anticholinergic effects older people should avoid. If hydroxyzine isn’t the best fit, here are practical alternatives and when each makes sense.

Non-drowsy and OTC antihistamines (for allergies)

If your main problem is seasonal allergies or hives, try second-generation antihistamines. Cetirizine and loratadine are common choices that cause much less drowsiness than hydroxyzine. Cetirizine works fast for many people and is good for hives; loratadine lasts long and rarely makes you sleepy. Both are available OTC and are easy to take daily.

For quick, short-term relief at night, first-generation options like diphenhydramine work but cause sleepiness similar to hydroxyzine, so they’re only useful when sedation is okay. For nasal symptoms, intranasal antihistamines or steroid sprays often beat oral blockers for congestion and runny nose.

Options for chronic itch and more complex cases

Chronic or neuropathic itching may need different drugs. Doxepin (a tricyclic antidepressant with strong antihistamine action) is sometimes used in low doses for severe itch. Gabapentin or pregabalin help when the itch has a nerve cause—your doctor may suggest these if antihistamines fail. For visible skin inflammation, topical steroids and regular emollients can reduce itching without systemic side effects.

Some antidepressants work for itch and mood at the same time. Mirtazapine can reduce itch and help with sleep in certain patients, but it has its own side effects, so discuss risks and benefits with your prescriber.

When anxiety is the issue, hydroxyzine is often a short-term option because it calms quickly. Safer long-term choices are different: selective serotonin reuptake inhibitors (SSRIs) or SNRIs treat generalized anxiety reliably but take weeks to kick in. Benzodiazepines (like lorazepam) act fast but should only be used short-term because of dependence risk. Non-drug approaches—CBT, breathing exercises, and sleep hygiene—work very well long-term and have no drug interactions.

Practical tips: pick an alternative based on the problem (allergy vs itch vs anxiety), expected speed of relief, and safety needs. Avoid combining multiple sedating drugs and skip alcohol while using sedating meds. Older adults should avoid antihistamines with strong anticholinergic effects because of confusion, dry mouth and falls.

Always check interactions with your current meds and tell your clinician if you’re pregnant or breastfeeding. If symptoms are severe, sudden, or don’t respond to OTC options, see a doctor—sometimes a simple switch or a short course of a different class makes a big difference.