Drug-induced pruritus

Last Updated: 2020-11-19

Author(s): Navarini A.

ICD11: EC90.2

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

  • Acute
  • Chronic (> 6 weeks present)

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

Pruritus can be caused by an idiosyncratic reaction, or by a specific immune response, or finally by a dermatosis caused by the medication.

  • Histamine release
  • Imbalance of the opioid system
  • 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 medication
  • Cholestasis
  • Liver toxicity
  • Xerosis cutis (Statine)
  • Other, less understood mechanisms such as chemotherapy-induced pruritus or aquagenic pruritus in malaria drugs

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

Medication classes:

  • ACE inhibitor and AT2 blocker
  • Anti-Arrhythmics
  • Antibiotics
  • Antidepressants
  • Antidiabetics
  • Antihypertensives: Amlodipine
  • Anticonvulsants
  • Biologics (TNF-alpha antagonists)
  • Broncholytics
  • Chemotherapeutics
  • Diuretics
  • Various (HAES, Pentoxyfillin)
  • Hormone preparations
  • Immunosuppressive drugs
  • Lipid reducers
  • Neuroleptics
  • NSAIDS
  • Opioids and antagonists
  • Uricosuric: Allopurinol

Individual substances:

  • Acebutolol
  • Acetylsalicylic acid
  • Allopurinol
  • Alprazolam
  • Amiloride
  • Amiodarone
  • Amitriptyline
  • Amlodipine
  • Amodiaquine
  • Amoxicillin
  • Amoxicillin/Clavulanate
  • Ampicillin
  • Aspirin
  • Atenolol
  • Bisoprolol
  • Aminophylline
  • Candesartan
  • Captopril
  • Carbamazepine
  • Carboplatinum
  • 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
  • Indomethacin
  • 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
  • Estrogens
  • 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 medium
  • 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

Discontinuation of the causal medication.