Medicinal pruritus

Very common problem with drug therapy. With certain substances such as opioids, pruritus is almost obligatory.

Akut

Chronic (> 6 weeks present)

In the chronic stage, it is often difficult to establish the connection between the drug administration and the pruritus. If, on the other hand, pruritus occurs within a few days of starting a medication, then the interpretation is simple.

Pruritus may be caused by an idiosyncratic reaction, or by a specific immune reaction, or finally by a dermatosis triggered by the drug.

• Histamine release
• Opioid system imbalance
• Leukotriene overproduction
• Phototoxic reaction
• Type I reaction according to Coombs and Gell
• Type IV reaction according to Coombs and Gell
• Type IV reaction after activation by light (photoallergy)
• Psoriasis or other dermatoses triggered by drug
• Cholestasis
• Liver toxicity
• Xerosis cutis (statins)
• Other poorly understood mechanisms such as chemotherapy-induced pruritus or aquagenic pruritus associated with antimalarial drugs

The list of medications should be systematically reviewed for frequently pruritogenic substances. We have listed the most important classes first, followed by an alphabetical list of known individual substances, which can be used to review the patient's medication list.

Drug classes:

• ACE inhibitors and AT2 blockers
• Anti-arrhythmics
• Antibiotics
• Antidepressants
• Antidiabetics
• Antihypertensives: amlodipine
• Anticonvulsants
• Biologics (TNF-alpha antagonists)
• Broncholytics
• Chemotherapeutics
• Diuretics
• Miscellaneous (HAES, pentoxyfilline)
• Hormone preparations
• Immunosuppressants
• Lipid-lowering drugs
• Neuroleptics
• NSAIDs
• Opioids and antagonists
• Uricosurics: allopurinol

Single substances:

Acebutolol
Acetylsalicylic acid
Allopurinol
Alprazolam
Amiloride
Amiodarone
Amitryptyline
Amlodipine
Amodiaquine
Amoxicillin
Amoxicillin/clavulanate
Ampicillin
Aspirin
Atenolol
Bisoprolol
Aminophylline
Candesartan
Captopril
Carbamazepine
Carboplatin
Cefotaxime
Ceftazidime
Ceftriaxone
Celecoxib
Cetuximab
Chlorambucil
Chloramphenicol
Chlordiazepoxide
Chloroquine (almost all patients have itching)
Chlorpromazine
Ciprofloxacin
Cisplatin
Citalopram
Clarithromycin
Clindamycin
Clofibrate
Clomiphene
Clomipramine
Clonazepam
Clonidine
Clonidine
Co-trimoxazole
Codeine
Colchicine
Cyclophosphamide
Cyclosporine
Danazol
Desipramine
Diclofenac
Diltiazem
Disopyramide
Doxapram
Doxazosin
Doxepin
Hydroxyethyl starch
Enalapril
Enoxaparin
Erlotinib
Erythromycin
Etanercept
Ethylene oxide
Felodipine
Fenofibrate
Fentanyl
Flecainide
Fluoxetine
Fluvastatin
Fluvoxamine
Furosemide
Gabapentin
Gefitinib
Gemcitabine
Gentamycin
Gliclazide
Glimepiride
Haloperidol
Hydralazine
Hydrochlorothiazide
Hydroxychloroquine
Ibuprofen
Imatinib
Imipramine
Indometacin
Infliximab
Ipilimumab
Ipratropium bromide
Irbesartan
Isradipine
Ketoprofen
Lamotrigine
Levomethadone
Lisinopril
Lithium salts
Lorazepam
Losartan
Lovastatin
Maprotiline
Metformin
Methotrexate
Methyldopa
Metoprolol
Metronidazole
Minocycline
Minoxidil
Mirtazapine
Mitomycin C
Morphine
Mycophenolate mofetil
Nadolol
Naloxone
Naproxen
Nifedipine
Nilotinib
Nimodipine
Nisoldipine
Nortriptyline
Ofloxacin
Oestrogens
Oxazepam
Oxycodone
Paclitaxel
Panitumumab
Paroxetine
Penicillin G
Pentazocine
Pentoxifylline
Phenobarbital
Phenothiazine
Phenytoin
Pindolol
Piroxicam
Plasma expander
Pravastatin
Prazepam
Prazosin
Probenecid
Progesterone
Propranolol
Reserpine
Rifampicin
Risperidone
Rituximab
X-ray contrast media
Salmeterol
Sertraline
Simvastatin
Spironolactone
Steroids
Sufentanil
Tacrolimus
Tamoxifen
Tamsulosin
Temsirolimus
Terbutaline
Testosterone
Tetracyclines
Thalidomide
Tiopronin
Tolbutamide
Topiramate
Tramadol
Triamterene
Trimethoprim/sulfamethoxazole
Valproic acid
Valsartan
Vancomycin
Vemurafenib
Verapamil