13.3 Topical local anaesthetics and antipruritics

General Guidance
 

• Pruritis may have an underlying cause (e.g. drug or other hypersensitisation obstructive jaundice, certain malignant diseases) such underlying causes should be sought and if possible treated before resorting to antipruritic therapy.
• If the pruritis is due to dry skin, an emollient is the treatment of choice. Pruritis in otherwise healthy elderly people can also often be treated with an emollient.
• The additional benefits of crotamitron containing preparations is questionable.
• Preparations containing calamine are also often ineffective.
• A short course of systemic sedating antihistamine is often more effective.
• In biliary obstruction oral colestyramine is the treatment of choice.
• Topical doxepin can cause drowsiness and there is a risk of sensitisation, it should be avoided.

Recommended drugs

Aqueous cream

Emulsifying ointment

Chlorphenamine oral

Hydroxyzine oral

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low