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There is currently no standardized algorithm for the treatment of chronic pruritus (CP), or itch lasting more than 6 weeks, in adults aged ≥ 65 years. The antiepileptic agents gabapentin and pregabalin, however, are gaining popularity in the dermatologic community for their efficacy in treating CP of neuropathic origin. Yet the lack of literature specifically looking at the safety and We started local calamine and oral gabapentin at a lower dose and titrated the dose to 1 g a day, which was effective. the use of gabapentin and pregabalin as antipruritic agents are explored. They are found to be promising alternative treatments for the relief of several forms of chronic pruritus, particularly uremic pruritus and neuropathic or neurogenic itch, in patients who fail conservative therapies. (J Am Acad Dermatol 2016;75:619-25.) The results of individuals who have been previously taking gabapentin for itch and/or neuropathic pain relief and then have been switched to treatment with pregabalin will be assessed. The study should help document average doses given to reach effectiveness and note any serious side effects from the medications. There is currently no standardized algorithm for the treatment of chronic pruritus (CP), or itch lasting more than 6 weeks, in adults aged ≥ 65 years. The antiepileptic agents gabapentin and pregabalin, however, are gaining popularity in the dermatologic community for their efficacy in treating CP of neuropathic origin. In the present study, the use of oral gabapentin 300 mg a day for the treatment of itching caused by NP showed to be efficient and led to a significant improvement in rates of itching intensity as assessed by the VAS. "After suffering ferocious, unrelenting neuropathic itching for 7 years, I came across the use of gabapentin. Started on 300 mg 3 times a day for 10 days but didn't really help. Doubled the dose 3 days ago & haven't had any itching since can't even explain the relief." Gabapentin is approved by the UD Food and Drug Administration for the treatment of seizures and PHN, 52 and is effective in the treatment of neuropathic forms of itch, such as brachioradial pruritus, prurigo nodularis, and notalgia paresthetica. 53 There are promising case reports regarding the use of gabapentin in scalp dysesthesia, 20 Use: For the treatment of moderate-to-severe primary RLS in adults. Maximum dose: 2400 to 3600 mg/day; doses up to 2400 mg/day have been well tolerated in long-term studies; doses of 3600 mg/day have be used in a small number of patients for a relatively short duration and have been well tolerated. the gabapentinoids’ role in itch could be due to their modulation of these two key inflamma-tory neuropeptides. One of the earliest reports on the use of gabapentin for neuropathic itch was that of Bueller et al. [17] in 1999, who treated a 54-year-old woman with brachioradial pruritus. At the time of their report she had remained asymp- Gabapentin was initiated at 300 mg daily, and increased to 900 mg daily. This dose was well tolerated and pruritis substantially improved. In a follow up visit 1 month later, patient's dose was escalated to 1200 mg PO daily which was well tolerated, resulting in only minimal residual pruritis. Most patients with itch, whether it's inflammatory or neuropathic, will require at least 2,400 mg daily.” Another voltage-gated calcium channel blocker, pregabalin, has shown utility in treating uremic, iatrogenic, idiopathic and drug-induced itch, Dr. Elmariah says. 10 mg/kg once daily (max. per dose 300 mg) on day 1, then 10 mg/kg twice daily (max. per dose 300 mg) on day 2, then 10 mg/kg 3 times a day (max. per dose 300 mg) on day 3; usual dose 25–35 mg/kg daily in 3 divided doses, some children may not tolerate daily increments; longer intervals (up to weekly) may be more appropriate, daily dose Herein, the use of gabapentin and pregabalin, 2 medications well known for treating neuropathic pain and epilepsy that are occasionally used for relieving chronic pruritus is explored. The findings from original sources published to date to evaluate the use of gabapentin and pregabalin as antipruritic agents are explored. Gabapentin is a well-established treatment option for itch with a reassuring safety profile that does not require continued lab monitoring. Generalized itching is a common cause of visits to the dermatologist and can be difficult to treat, leading to sleepless nights and inability to function. The recommendations on management of itch are based on the British Association of Dermatologists' publication Guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018 [Millington, 2018], the European consensus publication European S2k guideline on chronic pruritus [Weisshaar, 2019], a Cochrane systematic review Interventions for Second-line therapies for generalized or severe neuropathic itch include gabapentin, pregabalin, amitriptyline, carbamazepine, or oxcarbazepine. They should be started at lower doses and increased as needed while monitoring for adverse effects. The use of gabapentin for neuropathic pain/pruritus is recommended only in patients over 18 years of age. The starting dose is 900mg/day (given as 300mg 3 times daily) and increased if necessary based on response. In this review we discuss the safety and efficacy of the gabapentinoids, and advocate for their use not just in neuropathic, but also in multifactorial, itch. Gabapentin and pregabalin were initially developed as antiepileptics, but are now also used for treating neuropathic pain such as that caused by diabetic neuropathy and postherpetic neuralgia. 17, 18 Among the array of agents that can be used for these indications, gabapentin is favored because of its low adverse-effect profile, broad therapeutic index, absence of drug-drug interactions
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