Pruritus hydroxyzine

Pharmacologic Therapy Topical emollients have been used as treatment for pruritus in patients with dry skin, but are often not effective in relieving pruritus associated with CKD. Antihistamines, such as hydroxyzine 25 to 50 mg or diphenhydramine 25 to 50 mg orally or intravenously, are used as... 

Antihistamines are frequently used, but few clinical studies support their efficacy. A sedating antihistamine (e.g., hydroxyzine, diphenhydramine) can offer an advantage by facilitating sleep because pruritus is often worse at night. 

Hydroxyzine Hydroxyzine also is indicated for sedation (oral only) analgesia, adjunctive therapy (parenteral only) antiemetic (parenteral only) as adjunctive therapy in allergic conditions with strong emotional overlay, such as asthma, chronic urticaria, and pruritus (parenteral only). 

A double-blind safety and efficacy study was conducted to compare the safety and efficacy of cetirizine, doxepine, and hydroxyzine as a treatment of chronic pruritus in SM-exposed victims. Though sedation was reported in cetirizine, doxepine, and hydroxyzine groups, hydroxyzine and doxepine gave better results than cetirizine (Shohrati et al, 2007b, c). 

Shohrati, M., Davoudi, S.M., Keshavarz, S., Sadr, B., Tajik, A. (2007b). Cetirizine, doxepine, and hydroxyzine in the treatment of pruritus due to sulfur mustard a randomized clinical trial. Cutan. Ocul. Toxicol. 26 249-55. 

A 35-year-old woman complained of nausea, fatigue, pruritus, dark urine, pale stools, and jaundice after taking a supplement containing chromium picohnate for weight loss (14). Infectious hepatitis was excluded and a liver biopsy was consistent with toxic liver damage. Hepatic chromium concentrations were more than 10 times normal. The chromium supplement was withdrawn and she received supportive treatment with a suspension containing natural products, colestyramine 1 g qds, and hydroxyzine 25 mg tds. She fully recovered in 3 months. 

Nerve blocks can be given in cases of very painful outbreaks. A mixture of lidocaine with adrenaline (epinephrine) and ropivacaine or bupivacaine" can be used. In some cases, the doctor will have to prescribe opioids to relieve severe pain. However, treatment with opioids might well get rid of the pain but will not affect the itching. It could even aggravate the pruritus. The itching sometimes resists hydroxyzine and diphenhydramine. Asken reported that he once had to inject propanolol intravenously to relieve unbearable pruritus. 

Antihistamines are used to attempt to break the itch-scratch cycle that results from the pruritus of AD. Despite frequent use of antihistamines, few clinical studies support their efficacy, most likely because not all pruritus is mediated by histamine. Because pruritus is worse at night, the sedating antihistamines (i.e., hydroxyzine or diphenhydramine) can offer an advantage by facilitating sleep, whereas the newer nonsedating antihistamines have shown variable results. 

Oral hydroxyzine (50 to 100 mg q.i.d.) is indicated for symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifest. Hydroxyzine is used for the management of pruritus due to allergic conditions such as chronic urticaria, atopic and contact dermatoses, and in histamine-mediated pruritus. It is also used as a sedative, as a preanesthetic medication, and following general anesthesia. 

Nervous system A 72-year-old man developed involuntary movements about 3 weeks after having started to take regular oral hydroxyzine, azelastine, and emedastine for pruritus due to an allergic dermatitis [2" ]. He had chorea affecting the face, neck, and limbs, which improved at rest and disappeared during sleep. He stopped taking the antihistamines and the chorea improved within 7 days and resolved soon after. 

Non-sedating antihistamines generally suffice to control the symptoms (Cap et al. 1985). At night, higher than usual doses of these drugs or the potent sedating Hi-blocker hydroxyzine may be used in patients with severe pruritus (Breathnach et al. 1983). In co-operative patients, a low-pseudoallergen diet (Henz et al. 1997) can be tried for about 4-6 weeks since it occasionally induces remissions (own unpublished results). 

Application of hydrophilic ointment was permitted in those patients who required a topical lubricant. Hydroxyzine hydrochloride was given to a few patients for control of pruritus. White petrolatum was used for the cheilitis resulting from treatment with 13-cis retinoic acid. Oral erythromycin or cloxacillin was necessary to control the recurrent cutaneous infections of 2 patients with Darier s disease and the one with nevus comedonicus. 

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