Opioid-induced itch in palliative care

For patients with palliative care needs who develop opioid-induced itch, in addition to general skincare measures, consider changing to a different opioid or adding an antihistamine or ondansetron.

For information on antihistamines, see Undifferentiated or other causes of itch in palliative care.

If ondansetron is used for opioid-induced itch, a suitable regimen is:

Be aware of the constipating effects of the 5-HT₃ receptor antagonists; anticipatory prescribing of laxatives may be required (see Constipation in palliative care).

Assess the effectiveness of therapy and consider stopping ondansetron if no benefit is apparent after 1 week, or sooner if the patient experiences adverse effects.