TREATMENT | MECHANISM OF ACTION | INDICATION(S) | CONSIDERATIONS | |
---|---|---|---|---|
POSITIVE | NEGATIVE | |||
Nonpharmacologic | ||||
General skin care2,5,7,20
| Soothes inflamed skin and prevents futher abrasions, eruptions, or irritations | Dry skin | Dry skin is associated with many other causes of pruritus | NA |
UVB light therapy5,21 | Decreases the number of mast cells and free nerve endings in the skin | Cholestasis Uremia Malignant skin infiltration | NA | Procedure often required 3 times/wk; impractical at end of life |
Biliary stenting5,6,8,9,18 | Relieves obstruction in the bile ducts | Cholestasis due to biliary obstruction | Might negate need for pharmacotherapy | NA |
Pharmacologic | ||||
Lidocaine 2.5% cream (topical anesthetic)18 | Anesthetizes sensory nerve endings | Localized areas of itch | Appropriate regardless of cause of pruritus | Large quantities of cream can cause toxicity when absorbed |
Paroxetine (antidepressant)5,10,11,21,22 | 5-HT3 reuptake inhibition | Cholestasis Uremia Opioid-induced pruritus Malignancy | Effects within 24 to 48 h Few side effects | NA |
Mirtazapine (antidepressant)10,11,21,22 | 5-HT2, 5-HT3, and H1 receptor antagonists | Cholestasis Uremia Opioid-induced pruritus Malignancy | Effective | Sedation Weight gain |
Ondansetron (antiemetic)5,14,15,17,22 | 5-HT3 receptor antagonist | Cholestasis Uremia Opioid | NA | Expensive Constipation |
Dipenhydramine (antihistamine)5,7,8,9 | H1 receptor antagonist | Allergy Histamine-mediated pruritus | Inexpensive | Sedation Rarely effective |
Naloxone or naltrexone (opioid antagonist)5,16,17,22 | μ-Opioid receptor antagonist | Cholestasis Uremia Opioid-induced pruritus | NA | Reverses analgesia Expensive |
5-HT—5-hydroxytryptamine (serotonin), H1—histamine–type 1, NA—not applicable, UVB—ultraviolet B.