SOURCE: Matsuda K, Sharma D, Schonfeld AR, Kwatra SG. Gabapentin and pregabalin for the treatment of chronic pruritus. J Am Acad Dermatol 2016;75:619-625.

Clinicians usually are successful when they treat pruritus with antihistamines. Some categories of pruritus prove somewhat refractory to intervention, such as uremic pruritus and neurogenic pruritus. When traditional antihistamines (e.g., diphenhydramine, hydroxyzine, cetirizine, loratadine) have failed, what else might work?

Gabapentin and pregabalin are analogues of gamma-aminobutyric acid, but do not actually interact with gamma-aminobutyric acid receptors. They generally are well tolerated, and although originally investigated for their antiepileptic potential, the authors addressed 37 different randomized, controlled trials of gabapentin, pregabalin, or the combination in a variety of different itch syndromes. Gabapentin and pregabalin were demonstrated to produce substantial clinical success in syndromes as far ranging as uremic pruritus, notalgia paresthetica, post-spinal cord pruritus, and cancer chemotherapy-related pruritus.

The tolerability of gabapentin and pregabalin was reflected in the modest discontinuation rates due to adverse effects (6-8%). Although most of the trials were small and lacked long-term follow-up, the promising results support consideration of gabapentin, pregabalin, or both for patients presenting with refractory pruritus.