Algorithm for the Treatment of Uremic Pruritus

Nonpharmacologic Treatments:

 • Daily topical emollient

 • Avoidance of extremes of temperature

Evidence-Based Off-Label Pharmacologic Treatments of Uremic Pruritus:

 • Gabapentin 100 mg after HD or every other day - Increase by 100 mg, up to max 300 mg QHS

 • Prebabalin 25 mg after HD or QOD

 • Increase by 25 mg up to max 75 mg daily

Treatments with Limited Effcacy Data:

 • Topical capsaicin 0.025% + menthol 4%

 • Topical cromolyn sodium 4%

 • UV-B phototherapy

 • Evening primrose oil 1000 mg/d 

 • Sertraline 50 mg/d

 • mu- opioid receptor antagonist/k-receptor agonists (nalbuphine 120 mg/d)

 • k-opioid receptor agonists (nalfurafine 2.5 mcg/d)



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