- Drug allergy.
- Hepatic disease (Obstructive Jaundice).
- Uraemia - See Advanced or End-stage Kidney Disease.
- Active Lymphoma especially Non Hodgkins Lymphoma.
- Drugs, e.g. vasodilators, opioids.
- Treat/ remove cause(s).
- Apply topical agents, e.g. D.P.Lotion (no part-charge on prescription), Alpha-Keri™ lotion, 0.25-1% Menthol in aqueous cream.
- Night sedation may be helpful.
- Use emulsifying ointment or Pinetarsol instead of soap.
- Evening primrose oil 100 mg bd may be helpful.
- Biliary stenting may be the most effective management if appropriate.
- UVB phototherapy may be helpful for uraemic itch.
Consider drug treatment
- Anti-histamines, e.g. Promethazine HCl 10-25 mg nocte or a non-sedating alternative for daytime use. Cetirizine if there is liver involvement as it is not liver metabolised.
- Cholestyramine (Questran Light™) ½ - 1 sachet BD/TDS for obstructive jaundice as it binds bile salts.
- H2 Antagonist (acting via histamine receptors in the skin), e.g. Cimetidine 400 mg BD. (Note: check drug interactions.)
- Steroids – particularly for lymphoma or other active malignancies.
- Low dose Paroxetine (5 mg) – beware of nausea.
- Rifampicin for chronic cholestasis.
- NSAIDs, e.g. diclofenac.
- Ondansetron has been reported to be helpful (beware of constipation).
- Uraemic Pruritus:
- Gabapentin is approved for this indication via special authority for chronic kidney disease associated pruritis.
- Must dose reduce for degree of renal failure and use of dialysis.
- Evening primrose oil may also be beneficial.
Topic Code: 4134