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. 2019 Jul 28;11(7):e5256. doi: 10.7759/cureus.5256

Table 2. Systemic therapies for pruritus.

CKD - chronic kidney disease; SNRI - selective neuroepinephrine reuptake inhibitor; SSRI - selective serotonin reuptake inhibitor.

* Immunosuppressive agents such as cyclosporine, azathioprine, and mycophenolate mofetil may be beneficial for pruritus in severe atopic dermatitis.

¶ All doses are for adult patients, oral administration, unless noted otherwise.

Medication* Dose range Notes
Antihistamines Variable depending on the medication No direct effect on pruritus except in urticaria; sedating antihistamines may be useful through their soporific effects
Antidepressants
SNRIs Mirtazapine 7.5 to 15 mg at night Useful in nocturnal pruritus, may cause increased weight and appetite
SSRIs Paroxetine 10 to 40 mg per day Consider in psychiatric patients with pruritus and paraneoplastic pruritus
Fluvoxamine 25 to 150 mg per day Consider in psychiatric patients with pruritus and paraneoplastic pruritus
Sertraline 75 to 100 mg per day Useful in cholestatic pruritus
µ-opioid receptor antagonists Naltrexone 25 to 50 mg per day Useful in patients with cholestatic and CKD-associated pruritus; may cause nausea, vomiting and drowsiness; reverses analgesia and may precipitate acute withdrawal in patients receiving opioid analgesics
κ-opioid receptor agonist/µ-opioid receptor antagonist Butorphanol 1 to 4 mg intranasally per day Useful in nocturnal and intractable pruritus; may cause nausea and vomiting as well as drowsiness; may precipitate acute withdrawal in patients receiving opioid analgesics; some potential for abuse due to concomitant weak µ-opioid receptor agonist activity
Selective κ-opioid receptor agonist Nalfurafine 2.5 to 5 micrograms per day Useful in CKD-associated pruritus; may cause insomnia; approved in Japan only
Anticonvulsants Gabapentin 100 to 3600 mg per day Applies to both: useful in neuropathic pruritus, may cause drowsiness and weight gain; usually given in two to three divided daily doses; dose alteration for renal insufficiency may be needed
Pregabalin 150 to 300 mg per day
Substance P antagonist Aprepitant 80 mg per day Beneficial in pruritus associated with the Sézary syndrome; expensive
 Thalidomide 100 mg at night  Primarily used for prurigo nodularis