Antihistamines for undifferentiated or other causes of itch in palliative care

Sedating antihistamines (eg cyproheptadine, dexchlorpheniramine, promethazine) can be used for itch when sedation is useful or acceptable (eg for itch at night); for dosages, see the Dermatology guidelines.

Less-sedating antihistamines (eg cetirizine, desloratadine, fexofenadine, loratadine) are less likely to be effective for itch, unless it is mediated by histamine (eg urticaria), but may be tried if sedation is not desirable or the risk of falls, severe anticholinergic effects or delirium are a concern; for dosages, see the Dermatology guidelines.

Response to antihistamines varies widely; if one is not effective or poorly tolerated, another can be tried.