From the Guidelines
Selective serotonin reuptake inhibitors (SSRIs) like sertraline (50-200 mg daily) or fluoxetine (20-80 mg daily) are the first-line oral medication treatment for psychogenic pruritus, as they have been shown to be effective in managing symptoms of psychogenic pruritus, according to the British Association of Dermatologists' guidelines 1.
Key Considerations
- These medications typically require 4-6 weeks for full effect and should be continued for at least 6-12 months if effective.
- Tricyclic antidepressants such as doxepin (10-75 mg at bedtime) or amitriptyline (10-75 mg at bedtime) can be used as alternatives, particularly when sleep disturbance accompanies the pruritus.
- For patients who don't respond to these options, low-dose antipsychotics like olanzapine (2.5-5 mg daily) or gabapentinoids such as pregabalin (75-300 mg twice daily) may be considered, as suggested by the guidelines 1.
Mechanism of Action
- These medications work by modulating neurotransmitters involved in both mood regulation and itch perception pathways, addressing the psychological factors that trigger or exacerbate the pruritus.
Additional Recommendations
- Combining medication with cognitive behavioral therapy often yields better results than medication alone.
- Patients should be monitored for side effects, particularly during the initial weeks of treatment, and dosages should be started low and gradually increased as needed.
- Other options such as paroxetine, fluvoxamine, mirtazapine, naltrexone, butorphanol, gabapentin, pregabalin, ondansetron, or aprepitant may also be considered, as mentioned in the guidelines 1.
From the FDA Drug Label
For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested: adults, 50 to 100 mg q.i.d. ; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses. For use in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus: adults, 25 mg t.i.d. or q.i.d. ; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses. For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested. Useful in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus
The oral medication treatment for psychogenic pruritus is hydroxyzine (PO). The dosage for adults is 25 mg t.i.d. or q.i.d. and for children, it varies based on age and weight. However, it is essential to note that the provided drug labels do not explicitly mention psychogenic pruritus, but rather pruritus due to allergic conditions and histamine-mediated pruritus. Therefore, the use of hydroxyzine for psychogenic pruritus is not directly supported by the provided drug labels 2, 2.
From the Research
Oral Medication Treatments for Psychogenic Pruritus
The following oral medications are used to treat psychogenic pruritus:
- H1-antihistamines (hydroxyzine, chlorpheniramine, cyproheptadine, diphenhydramine, promethazine) 3
- Tricyclic antidepressants (doxepin) 3, 4
- Tetracyclic antidepressants (mirtazapine) 3
- Selective serotonin reuptake inhibitors (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) 3, 5, 4, 6, 7
- Antipsychotic drugs (pimozide) 3
- Anticonvulsants (topiramate) 3
- Benzodiazepines (alprazolam) 3
Efficacy and Safety of Oral Medications
The efficacy and safety of these oral medications vary:
- Selective serotonin reuptake inhibitors have been shown to be effective in reducing pruritus in some patients 7
- However, they can also cause adverse cutaneous effects, such as papular and purpuric erythema 6
- Tricyclic antidepressants and anticonvulsants may also be effective in treating psychogenic pruritus, but their use may be limited by side effects 3, 4