11/30/2023 0 Comments Strong anti itch medicationIn regard to mechanism of itching and medications, penicillin and trimethoprim-sulfamethoxazole are thought to be secondary to inflammatory skin eruptions or cholestatic liver injury. Skin eruption with pruritus was highest for patients receiving cephalosporins (52.1%) and opioid analgesics (50.6%). About half of patients who developed pruritus also developed skin eruption during the same period. Interestingly, heparin was associated with a high rate of pruritus (1.11%). 4 Cardiovascular drugs were associated with higher rates of pruritus with 0.69% in angiotensin converting enzyme inhibitors (ACEI), 0.75% in beta blockers, 0.68% in hydrochlorothiazide, 0.62% in amiodarone, and 0.67% in statins. In contrast, psychiatric and neurological drugs as a class were associated with the lowest rates of pruritus: 0.1% in tricyclic antidepressants (TCA), 0.03% in selective serotonin reuptake inhibitors (SSRI), 0.05% in antiepileptics drugs (AED), and 0.05% in opioid analgesics. 4 Among antimicrobials, higher rates of pruritus are seen with penicillin antibiotics (0.73%) and trimethoprim-sulfamethoxazole (1.06%) versus lower rates for cephalosporins (0.77%), quinolones (0.02%), and tetracyclines (0.05%). In a retrospective study evaluating inpatient, outpatient, and emergency departments, authors assessed those who were on a medication of interest (as defined as associations with pruritus in previous literature) and with a chief complaint of “pruritus” or a diagnosis of “itching” within 3 months of receiving medication of interest. Many previous studies have evaluated only small case series or have been narrow in scope by focusing on a single healthcare setting or a single drug/drug class. Unfortunately, there are sparse data available on the association of pruritus with many commonly used medications. 3 It is imperative to obtain a detailed medication list to discern the cause of pruritus. Pruritus can be attributable to systemic medications and can be classified into three separate categories: pruritus with a transient eruption or with no rash pruritus due to drug-induced cholestasis and pruritus with skin eruption or rash. While other causes of pruritus may be prevalent, this review aims to discuss drug-related causes of pruritus, treatment, and the role of the pharmacist. Additionally, a detailed medication history should be taken, as medications are a common cause of pruritus. Given there are multiple causes for this distressing syndrome, identifying the cause will help with potential treatment options. The cause of pruritus should be delineated, and a medical history should detail the severity and location of pruritus. Considering these causes of itching can help providers effectively treat pruritus. Thirdly, age-related neuropathy can contribute to pruritus. Secondly, immunosenescence is the proinflammatory state of the skin that may contribute to the high frequency of eczematous and other inflammatory skin reactions. With age, the rate of repair and the function of this barrier are reduced. 3 The first is loss of barrier function, for which the retainment of water is the most important function of the skin. A combination of three age-related biological processes can contribute to itching. While medication-induced pruritus is the focus of this review, understanding the changes in skin barrier with elderly patients is imperative. Elderly patients are often faced with severe pruritus due to changes in their skin barrier. 3 Unfortunately, chronic pruritus is often refractory to therapy, leading to hopelessness and despair in patients. 2 This distressing symptom is reported by patients in more than 7 million outpatient visits per year in the United States of these, 1.8 million visits are by patients aged 65 and older. A population-based study in France estimated the prevalence of pruritus of 12.4% during a 2-year period. 2 Pruritus is thought to be the most commonly encountered skin problem in dermatology. 1 Pruritus can be caused by various systemic, psychiatric, and neurological conditions, as well as a result of drug and medication intake. Additionally, chronic pruritus has a substantial impact on quality of life that may be comparable to that of pain. Pruritus is a common symptom that can be problematic among patients and lead to excessive scratching. This review aims at discussing medication-induced pruritus and the topical and systemic treatment of pruritus. The treatment of pruritus is largely dependent upon the identifiable cause, which may be due to systemic, psychiatric, and neurological conditions, as well as drug and medication intake. Unfortunately, chronic pruritus is often refractory, which can lead to severe distress. ABSTRACT: Pruritus is a commonly seen dermatologic symptom that can lead to excessive scratching and substantially impact quality of life.
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