Antidepressants for undifferentiated or other causes of itch in palliative care
A number of antidepressants are effective for itch. Although paroxetine has more evidence to support its use, mirtazapine and doxepin are options, particularly if other effects caused by the drug (eg sedation) are beneficialMillington, 2018 Wilcock A, 2020. Suitable regimens are:
1doxepin 10 mg orally, at night, increasing if necessary and as tolerated up to 50 mg at night doxepin
OR
1mirtazapine 7.5 to 15 mg orally, at night mirtazapine
OR
1paroxetine 10 to 20 mg orally, at nightZylicz, 2003. paroxetine
The anti-itch effects of antidepressants are usually apparent within 24 to 48 hours but may be short-lived and wear off after 4 to 6 weeks. If this occurs, gradually reduce the dosage to slowly stop therapy before trying an alternative drug.