Table 3.

Systemic treatments of pruritus

MEDICATION	DOSE	NOTES
Antihistamines	Variable depending on medication	No direct effect on pruritus except in urticaria, sedating antihistamines may be useful through their soporific effects
Antidepressants
SNRIs	Mirtazapine 7.5 - 15 mg PO qhs	Useful in nocturnal pruritus, may cause increased weight and appetite
SSRIs	Paroxetine 10 mg - 40 mg PO qd	Consider in psychiatric patients with pruritus and paraneoplastic pruritus
	Fluvoxamine 25 -150 mg PO qd	Consider in psychiatric patients with pruritus and paraneoplastic pruritus
	Sertraline 75 -100 mg PO qd	Useful in cholestatic pruritus
μ-opioid receptor antagonists	Naltrexone 25 – 50 mg PO qd	Useful in patients with cholestatic and CKD-associated pruritus, may cause nausea, vomiting and drowsiness
κ-opioid receptor agonists	Butorphanol 1 – 4 mg intranasally qd	Useful in nocturnal and intractable pruritus, may cause nausea and vomiting as well as drowsiness
	Nalfurafine 2.5 - 5 μg PO qd	Useful in CKD-associated pruritus, may cause insomnia, approved in Japan only
Neuroleptics	Gabapentin 100 – 3600 mg PO qd	Useful in neuropathic pruritus, may cause drowsiness and weight gain
	Pregablin 150 – 300 mg PO qd
Substance P antagonist	Aprepitant 80 mg PO qd	Benefical in pruritus associated with the Sézary syndrome, expensive
Immunosuppressants	Cyclosporin 2.5 – 5 mg/kg PO qd	Consider in atopic dermatitis patients with treatment refractory pruritus, monitor blood pressure and renal function, short term use
	Azathioprine 2.5 mg/kg PO qd	Consider in atopic dermatitis patients with treatment refractory pruritus, monitor for myelosuppression