Some Therapeutic Approaches to Itching

Topical therapy

Capsaicin creamCapsaicin cream

May require ≥ 2 weeks for effect

Vegetable oil can help with removal

Initial burning sensation dissipates with time

Corticosteroid creams or ointments

Avoid face, moist skinfolds

Should not be used for prolonged periods of time (> 2 weeks)

Menthol-containing and/or camphor-containing creamsMenthol-containing and/or camphor-containing creams

These preparations have strong odors

Pramoxine creamPramoxine cream

Can cause dryness or irritation at application site

Tacrolimus ointment or pimecrolimus creamTacrolimus ointment or pimecrolimus cream

Should not be used for long periods of time or on children < 2 years

Ultraviolet B therapy

Sunburn-like adverse effects can occur

Long-term risk of skin cancer, including melanoma

Systemic therapy

Cetirizine*Cetirizine*

Rarely can have a sedating effect in older patients

Cholestyramine (cholestatic pruritus)Cholestyramine (cholestatic pruritus)

Adherence can be poor

Constipating, unpalatable

Can interfere with absorption of other drugs

Cyproheptadine†Cyproheptadine†

Sedating, also helpful when given before bedtime

Diphenhydramine†Diphenhydramine†

Sedating, also helpful when given before bedtime

DoxepinDoxepin

Helpful in severe and chronic itching

Very sedating so taken at bedtime; reduce dose for older adults

Fexofenadine*Fexofenadine*

Headache can be an adverse effect

Gabapentin (uremic pruritus)Gabapentin (uremic pruritus)

Given after hemodialysis

Sedation can be a problem

Low doses to start and titrated up to clinical effect

Hydroxyzine†Hydroxyzine†

Sedating, also helpful when given before bedtime

Loratadine*Loratadine*

Rarely can have a sedating effect in older adults

Naltrexone (cholestatic pruritus)Naltrexone (cholestatic pruritus)

Can lead to withdrawal symptoms in patients with tolerance to opioids