Letzte Aktualisierung am 27. February 2025 von Dr. Michael Zechmann-Khreis
Histamine is a biogenic amine that plays an important role in various bodily functions, particularly in the immune system, in gastric acid production and as a neurotransmitter. In this context, medications are of particular interest as they can influence the histamine level or enhance or inhibit the histamine effect and thus a reciprocal effect is possible. The information in this article is for information purposes only. Any intake of medication must always be discussed with the doctor treating you. Please never change your medication on your own. Please do not take medication without consulting a doctor.
Which medications affect the histamine balance?
This list does not mean that you should not take these substances. However, you should be aware of the possible side effects and take measures against them if necessary.
Histamine-releasing drugs
Some medications can directly or indirectly promote the release of histamine. These include
- Painkillers: acetylsalicylic acid (ASA, aspirin), ibuprofen, diclofenac …
- Antibiotics: Some antibiotics, but not all
- Muscle relaxants: In particular, agents used in anesthesia such as atracurium
- Contrast media: X-ray contrast media can trigger the release of histamine in sensitive people
Drugs that inhibit the breakdown of histamine
The body breaks down histamine mainly via the enzymes diamine oxidase (DAO), MAO and histamine N-methyltransferase (HNMT). Some medications inhibit these enzymes and can therefore increase histamine levels:
- MAO inhibitors (monoamine oxidase inhibitors): Are used for depression and can slow down the breakdown of histamine.
- Antibiotics: A few antibiotics can reduce the activity of the DAO
- Contraceptives with oestrogen: Can reduce DAO activity and thus influence the breakdown of histamine.
Antihistamines – medication against histamine effects
There are drugs that specifically inhibit the effect of histamine by blocking the receptors for histamine. These are known as antihistamines and are divided into two main groups:
H1 antihistamines
These block the histamine effect on H1 receptors and help with allergies and hay fever, for example:
- First generation: often make you tired
- Second generation: less tiring
H2 antihistamines
These block the H2 receptors in the stomach and thus reduce gastric acid production.
Table with various antihistamines
| H1 blocker, 1st gen. | H1 blocker, 2nd gen. | H2 blocker |
|---|---|---|
| Bamipin | Azelastine | Ranitidine (currently not approved in the EU)1) |
| Chlorphenoxamine | Bilastine | Famotidine |
| Clemastine | Cetirizine | Nizatidine |
| Dexchlorpheniramine | Desloratadine | Cimetidine (hardly used any more due to strong interactions) |
| Dimetindene | Ebastine | |
| Doxylamine | Fexofenadine | |
| Diphenhydramine | Levocabastine | |
| Emedastin | Levocetirizine | |
| Hydroxyzine | Loratadine | |
| Ketotifen | Mizolastine | |
| Meclozine | Rupatadine | |
| Promethazine | Terfenadine |
DAO preparations
These preparations contain the enzyme diamine oxidase, which breaks down histamine in the intestine. They are taken in capsule form, ideally shortly before histamine-rich meals. You can find out more about these products in the HIT therapy section.
What does this mean for people with histamine intolerance?
People with a histamine intolerance should pay particular attention to medications that inhibit the breakdown of histamine or release histamine. It is recommended:
- Consult a doctor or pharmacist before taking new medication.
- Discuss alternatives to histamine-releasing medications with pharmacists and doctors.
- Finding an individually tailored medication to minimize symptoms.
- Consider taking antihistamines, especially if other medications release histamine or block enzymes.
Histamine plays a central role in the body, but can be influenced by certain medications. While some medications promote the release of histamine or inhibit its breakdown, antihistamines can be used specifically to counteract the effects of histamine. Anyone who is sensitive to histamine or has a histamine intolerance should inform themselves about possible interactions and always seek medical advice.
Sources
- Federal Institute for Drugs and Medical Devices (BfArM). 02/21 Information from institutions and authorities: BfArM: Ranitidine-containing medicinal products: Temporary suspension of all marketing authorizations ordered – Update. ABDA (2024).
- Zechmann-Khreis, M. “Understanding and mastering histamine intolerance”, MZK Verlag, 2025 (in press)
- Jarisch, R.: “Histamin-Intoleranz, Histamin und Seekrankheit”, Thieme Verlag, 2004, ISBN 3-13-105382-8.
