Pruritus (PDQ®): Supportive care - Health Professional Information [NCI] - Interventions
Sedative or tranquilizing agents may be indicated, especially if relief is not provided by other agents. Antidepressants can have strong antihistamine and antipruritic effects.[Level of evidence: IV] Diazepam may be useful in some situations to alleviate anxiety and promote rest.
Sequestrant agents may be effective in relieving pruritus associated with renal or hepatic disease through binding and removing pruritogenic substances in the gut and reducing bile salt concentration. Cholestyramine is not always effective and produces gastric side effects.
Aspirin seems to have reduced pruritus in some individuals while increasing pruritus in others. Thrombocytopenic cancer patients should be cautioned against using aspirin. Cimetidine alone or in combination with aspirin has been used with some effectiveness for pruritus associated with Hodgkin lymphoma and polycythemia vera.[Level of evidence: III]
Alternatives to scratching for the relief of pruritus can help the patient interrupt the itch-scratch-itch cycle. Application of a cool washcloth or ice over the site may be useful. Firm pressure at the site of itching, at a site contralateral to the site of itching, and at acupressure points may break the neural pathway. Rubbing, pressure, and vibration can be used to relieve itching.[Level of evidence: IV]
There are anecdotal reports of the use of transcutaneous electronic nerve stimulators (TENS) and acupuncture in the management of pruritus. Ultraviolet phototherapy has been used with limited success for pruritus related to uremia.
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