From the Guidelines
To manage itchiness caused by Endone (oxycodone), I recommend taking an antihistamine such as diphenhydramine (Benadryl) 25-50mg every 6 hours as needed or cetirizine (Zyrtec) 10mg once daily, as suggested by the most recent guidelines 1. Itchiness (pruritus) is a common side effect of opioid medications like Endone (oxycodone). These medications block histamine receptors that mediate itching sensations. Some key points to consider when managing pruritus include:
- Assessing for other causes of pruritus, such as use of other medications 1
- Considering the use of mixed opioid agonist-antagonists (eg, nalbuphine) or mu-opioid receptor antagonists (eg, naloxone) if antihistamines are not effective 1
- Staying well-hydrated and moisturizing the skin regularly to provide relief
- Contacting a healthcare provider immediately if the itching is severe or accompanied by a rash, as this could indicate an allergic reaction rather than a typical side effect Opioids cause itching by triggering histamine release from mast cells and by directly activating opioid receptors in the skin, which is why antihistamines are often effective in managing this side effect. For more severe cases, switching to a different opioid medication like hydromorphone or fentanyl may help, as different opioids can cause varying degrees of histamine release 1. Careful titration of medications and monitoring of symptoms is crucial in managing opioid-induced adverse effects, including pruritus 1.
From the Research
Analgesia and Itchiness
- Opioids can cause pruritus (itchiness) as a side effect, which can be challenging to manage in pain treatment 2.
- The mechanisms of opioid-induced pruritus are complex and involve both peripheral and central pathways, including the spinal dorsal horn 2.
- Opioid receptor antagonists and mixed agonist and antagonists, such as μ-opioid antagonists and κ-opioid agonists, have been shown to be effective in relieving opioid-induced pruritus 2.
Treatment Options
- Nalbuphine has been found to be effective in treating opioid-induced pruritus without attenuating analgesia or increasing adverse outcomes 3.
- Oxycodone, a semi-synthetic opioid, has been shown to cause less pruritus than morphine, but its use can still be associated with itchiness 4.
- Selective κ-opioid receptor agonists, such as nalfurafine, have emerged as potential treatments for opioid-induced pruritus, with preclinical studies demonstrating their effectiveness 5.
Opioid-Specific Considerations
- Oxycodone has a similar mechanism of action to other opioids, but its pharmacology and neurobiology are distinct, with differences in receptor binding and metabolism 6.
- The use of oxycodone has been associated with a lower incidence of pruritus compared to morphine, but its abuse potential is still a concern 4, 6.
- Endone, a brand name for oxycodone, may be associated with itchiness as a side effect, but the incidence and severity of this effect can vary depending on the individual and the specific formulation used 4.