Localized: treat rash, fungal/bacterial infection

Systemic: secondary to organ failure and cancer

Non-histaminergic receptors transmit signals to spinal cord. Similar to pain, itch can undergo central sensitization.


  1. Treat dry skin
  2. Lidocaine 2-10% ointment/lotion used for localized itch. Toxicity possible if used over large areas
  3. Camphor 0.5% Menthol 0.5% in ointment base PRN
  4. Gabapentin 100-300mg daily / pregabalin 25 –50mg daily (adjust dose for renal failure)
  5. Sertraline 50-100mg daily/ paroxetine 5-10mg daily at bedtime
  6. Mirtazapine 7.5 – 15mg daily
  7. Rifampicin 300-600mg daily in cholestatic itch

Refractory itch: consider aprepitant 80mg/day, naltrexone 50mg / montelukast 10mg in uremic itch