Some Therapeutic Approaches to Pruritus
Medication/Agent | Comments |
|---|---|
Topical therapy | |
Capsaicin cream | May require ≥ 2 weeks for effect Vegetable oil can help with removal Initial burning sensation dissipates with time |
Glucocorticoid creams or ointments (eg, hydrocortisone, triamcinolone) | Avoid face, moist intertriginous areas Should not be used for prolonged periods of time (> 2 weeks) |
Menthol-containing and/or camphor-containing creams | These preparations have strong odors |
Pramoxine cream | Can cause dryness or irritation at application site |
Calcineurin inhibitors (tacrolimus 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* | Rarely can have a sedating effect in older adults |
Cholestyramine (cholestatic pruritus) | Adherence can be poor Constipating, unpalatable Can interfere with absorption of other medications |
Cyproheptadine† | Sedating, also helpful when given before bedtime |
Diphenhydramine† | Sedating, also helpful when given before bedtime |
Doxepin | Helpful in severe and chronic pruritus Very sedating so taken at bedtime; reduce dose for older adults |
Fexofenadine* | Headache can be an adverse effect |
Gabapentin (uremic pruritus) | Given after hemodialysis Sedation can be a problem Low doses to start and titrated up to clinical effect |
Hydroxyzine† | Sedating, also helpful when given before bedtime |
Loratadine* | Rarely can have a sedating effect in older adults |
Naltrexone (cholestatic pruritus) | Can lead to withdrawal symptoms in patients with tolerance to opioids |
* Nonsedating antihistamine. | |
† Sedating antihistamine. | |
