Waikato DHB Palliative Care Guidelines

12. Itch/Pruritis

Management

• Treat/ remove cause(s).
• Night sedation may be helpful.
• Apply topical agents e.g. D.P.Lotion (no part-charge on prescription), Alpha-Keri™ lotion, aqueous cream.
• Use emulsifying ointment or Pinetarsol instead of soap.
• Oily creams – some patients may find helpful  (keeping the skin moist is most important).
• Biliary stenting may be the most effective management if appropriate.
  
  

Consider drug treatment

• Anti-histamines e.g. promethazine HCl 10-25mg nocte or a non-sedating alternative for daytime use.  
• Cholestyramine (Questran Light™) ½ - 1 sachet bd/ tds for obstructive jaundice.
• H2 Antagonist (acting via histamine receptors in the skin) e.g. Cimetidine 400mg bd.
• Steroids – particularly for lymphoma or other active malignancies.
• Low dose Paroxetine (5mg) – beware of nausea.
• Rifampicin for chronic cholestasis.
• NSAIDs e.g. diclofenac.
• Ondansetron has been reported to be helpful (beware of cost and constipation).