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 |