Hives Medication: Which Medicines Work, What to Avoid and When You Need a Prescription
Several kinds of medicine can relieve hives, and which one is right for you depends on how severe your hives are, how long they have lasted, and your overall health. Some are available over the counter, while others require a prescription. This guide explains each type of medicine for hives, what it does, and which common medications can actually make hives worse.
Non-Sedating Antihistamines: The First-Choice Medicine
Second-generation (non-sedating) antihistamines block histamine, the chemical that causes itching and swelling. They are the standard first medicine for hives and are available over the counter. Common choices include cetirizine, levocetirizine, loratadine and fexofenadine. Several are sold in versions labeled specifically for hives. Our guide to the best antihistamine for hives compares them.
Antihistamines reduce hives and relieve itching, but they do not prevent every outbreak. Over-the-counter labels typically say to stop use and see a doctor if symptoms do not improve after 3 days or hives last more than 6 weeks.
Sedating (First-Generation) Antihistamines
Older antihistamines such as diphenhydramine (Benadryl), chlorpheniramine and hydroxyzine can ease itching, but they cause drowsiness, dry mouth, and slowed thinking, and they wear off in a few hours. Guidelines do not recommend them as routine treatment. A doctor may occasionally suggest one for short-term use at bedtime.
Higher-Dose Antihistamines
If a standard dose does not control hives, doctors may increase the antihistamine dose, up to four times the usual amount, according to international guidelines. This should be done only under a doctor’s direction.
H2 Blockers and Other Add-Ons
Medicines such as famotidine (an H2 blocker) or montelukast are sometimes added to an antihistamine. The evidence supporting them is limited, and results are mixed, so they are not a standard step.
Corticosteroids (Prednisone)
Doctors sometimes prescribe a short course of oral corticosteroids to calm a severe flare of hives or swelling. They work quickly, but they should not be used for long periods because of side effects such as weight gain, high blood pressure, high blood sugar, mood changes and bone loss.
Prescription Medicines for Chronic Hives
For chronic hives that do not respond to antihistamines, doctors can prescribe targeted treatments, including omalizumab (Xolair), dupilumab (Dupixent) and remibrutinib (Rhapsido), as well as cyclosporine in select cases. See chronic hives treatment for details.
Epinephrine for Severe Allergic Reactions
Epinephrine is the emergency medicine for anaphylaxis, which is a severe allergic reaction. Antihistamines do not replace it. People who have had anaphylaxis are usually prescribed an auto-injector and taught when to use it.
Creams and Lotions
Topical products can soothe skin but do not treat the underlying hives. Cooling lotions with calamine or menthol may help with itching, while steroid creams are usually not effective for hives. Read more about creams for hives.
Medicines That Can Cause or Worsen Hives
Some common medications are known triggers. If your hives started after beginning one, tell your doctor before you stop taking it:
- Aspirin and other NSAIDs, such as ibuprofen and naproxen
- Antibiotics, especially penicillins and sulfa drugs
- ACE inhibitors used for blood pressure, which can cause swelling
- Opioid pain medicines, such as codeine and morphine
Learn more about the causes of hives.
Medicine for Hives in Children and During Pregnancy
Dosing for children depends on age and weight, so check the product label and confirm with a pediatrician or pharmacist. If you are pregnant or breastfeeding, talk to your doctor or obstetrician before taking any medicine for hives.
When to Call 911
Call 911 or go to the nearest emergency room right away if hives come with trouble breathing, wheezing, tightness in the throat, swelling of the tongue or lips, dizziness or fainting. These can be signs of anaphylaxis, a severe allergic reaction that needs immediate treatment.
When to See a Doctor
See a doctor if over-the-counter medicine is not helping after a few days, your hives last 6 weeks or longer, or you have swelling of the lips, eyelids or face. Dr. Tiffany Young’s Hives Treatment Center in San Francisco offers online and in-person consultations for patients whose hives need more than over-the-counter care.
Frequently Asked Questions
What is the best medicine for hives?
For most people, a non-sedating antihistamine. If it does not control your hives, a doctor can adjust or add medicines.
Can I take two antihistamines together?
Do not combine antihistamines on your own. Doing so can cause side effects without extra benefit, and any change in dose should come from your doctor.
Do I need a prescription for hives?
Not always. Many people manage short-term hives with over-the-counter medicine, but persistent or severe hives usually need a prescription plan.
Find the Medicine That Fits You
The right medicine can mean the difference between constant itching and real relief. Visit our hives treatment page to see the latest treatment options for your outbreak.
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. If you think you are having a medical emergency, call 911.
