From the Guidelines
For generalized pruritus due to a nonspecific rash, nonsedative antihistamines such as fexofenadine 180 mg or loratadine 10 mg, or mildly sedative agents like cetirizine 10 mg orally are recommended as first-line treatment. When considering treatment options, it's essential to weigh the benefits and risks of each medication. According to the British Association of Dermatologists' guidelines 1, nonsedative antihistamines like fexofenadine and loratadine, or mildly sedative agents like cetirizine, can provide relief for generalized pruritus of unknown origin (GPUO). Some key points to consider when treating generalized pruritus due to a nonspecific rash include:
- The use of sedative antihistamines, such as hydroxyzine, is recommended only in the short-term or palliative setting 1
- Combination therapy with H1 and H2 antagonists, such as fexofenadine and cimetidine, may also be considered 1
- Other oral medications like paroxetine, fluvoxamine, mirtazapine, naltrexone, butorphanol, gabapentin, pregabalin, ondansetron, or aprepitant may be considered for treatment 1 It's crucial to note that identifying and addressing the underlying cause of the rash is essential while using these medications for symptomatic relief. Additionally, maintaining good skin hydration with fragrance-free moisturizers and avoiding potential irritants like harsh soaps or extreme temperatures can help alleviate symptoms.
From the FDA Drug Label
ACTIVE INGREDIENT(S) (in each 5 mL teaspoonful) Loratadine USP, 5mg PURPOSE Antihistamine Purpose Antihistamine For generalized pruritus due to a nonspecific rash, antihistamines can be given orally.
- Loratadine (PO) 2 and diphenhydramine (PO) 3 are options as they are classified as antihistamines 2.
From the Research
Oral Medications for Generalized Pruritus
- For generalized pruritus due to a nonspecific rash, several oral medications can be considered, including:
- Antihistamines (H1 receptor antagonists) 4
- Steroid-sparing agents such as azathioprine 5
- Gabapentin, an anticonvulsant that can be used to treat neuropathic pruritus 6
- Antidepressants such as sertraline or doxepin, which can be used to treat neuropathic pruritus 6
- Opioid receptor agonist/antagonists such as naltrexone or butorphanol, which can be used to treat neuropathic pruritus 6
- It's essential to note that the choice of oral medication depends on the underlying cause of the pruritus and the presence of any underlying systemic diseases 7, 8
Considerations for Treatment
- A thorough diagnostic workup is necessary to determine the underlying cause of the pruritus, including a complete blood count, liver function tests, and thyroid function tests 8, 6
- Topical treatments such as corticosteroids and emollients may also be used in conjunction with oral medications to manage pruritus 8, 6
- In some cases, referral to a specialist such as a dermatologist may be necessary to manage chronic pruritus 6