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Examples of drugs that may cause pruritus
Group of drugs Examples Possible mechanism of pruritus Frequency of pruritus
Anti-arrhythmic drugs Amiodarone Cholestatic liver injury Case reports
Antibiotics Penicillins Secondary to skin lesions or cholestatic liver injury 2 to 20%
Cephalosporins Unknown or secondary to skin lesions <2%
Macrolides Secondary to skin lesions or cholestatic liver injury <0.3%
Carbapenemes Cholestatic liver injury Rare
Monobactams Secondary to skin lesions Rare
Quinolones Unknown or secondary to skin lesions 1 to 4%
Tetracyclines Unknown or cholestatic liver injury 1 to 2%
Lincosamides Secondary to skin lesions or cholestatic liver injury Rare
Streptogramins Secondary to skin lesions 2.5%
Metronidazole Unknown or secondary to skin lesions <5%
Rifampin Unknown Case report
Tiamphenicol Unknown <0.1%
Trimethoprim/sulphamethoxazole Secondary to skin lesions 2 to 10%
Cholestatic liver injury Rare
Antimalarials Unknown, but genetic background is important; release of histamine or activation of mu-receptors were postulated Up to 60 to 70% of Black Africans, uncommon in Caucasians or Asians
Anticoagulants Ticlopidine Cholestatic liver injury Case reports
Fractionated heparins Urticarial reaction Case reports
Anti-diabetic drugs Biguanides Cholestatic liver injury Case reports
Sulphonylurea derivates Unknown <5%
Anti-epileptics Carbamazepine, fosphenytoin, oxcarbazepine, phenytoin, topiramate Secondary to skin lesions, allergic reaction Rare
Antihypertensive drugs Angiotensin-converting enzyme inhibitors Increase of bradykinin level or cholestatic liver injury or secondary to skin lesions 1 to 15%
Angiotensin II antagonists (sartans) Cholestatic liver injury Case reports
Beta-adrenergic blockers Secondary to skin lesions Frequent, if administered transdermally
Cholestatic liver injury Rare
Calcium channel blockers Secondary to skin lesions or unknown <2%
Cholestatic liver injury Case reports
Methyldopa Unknown or secondary to skin lesions <2%
Sildenafil Cholestatic liver injury Case report
BRAF inhibitors Vemurafenib Unknown 19%
Cytokines, growth factors and monoclonal antibodies Granulocyte-macrophage colony-stimulating factor Unknown Common
Interleukin 2 Direct pruritogenic effect of interleukin 2 Very common
Matuzumab Unknown <10%
Lapatinib Unknown or urticarial reaction 3%
Cytostatics Chlorambucil Secondary to skin lesions Case reports
Paclitaxel Unknown or secondary to skin lesions 10 to 14%
Tamoxifen Sebostasis/xerosis 3 to 5%
Epidermal growth factor inhibitors Cetuximab Unknown 22%
Erlotinib Unknown 18%
Panitumumab Unknown 58%
Hypolipaemic drugs Statins Unknown or secondary to skin lesions 16%
Monoclonal antibody to CTLA-4 Ipilimumab Unknown 31%
Plasma volume expanders Hydroxyethyl starch (HES) Deposition of HES in small peripheral nerves or in Schwann's cells of cutaneous nerves 12.6 to 54%
Psychotropic drugs Tricyclic antidepressants Cholestatic liver injury Rare
Selective serotonin re-uptake inhibitors Activation of peripheral serotonin receptors or secondary to skin lesions Rare
Neuroleptics Cholestatic liver injury Rare
Others Anti-thyroid agents Cholestatic liver injury Rare
Nonsteroidal antiinflammatory drugs Increased synthesis of leukotrienes 1 to 7%
Cholestatic liver injury Rare
Corticosteroids Cholestatic liver injury Very rare
Sex hormones Cholestatic liver injury Rare
Opioids Centrally mediated process via mu-opioid receptor 2 to 100%
Inhibitors of xanthine oxidase Secondary to skin lesions 0.8 to 2.1%
CTLA-4: cytotoxic T-lymphocyte associated protein 4.
Reference:
  1. Fischer A, Rosen AC, Ensslin CJ, et al. Pruritus to anticancer agents targeting the EGFR, BRAF, and CTLA-4. Dermatol Ther 2013; 26:135.

Reproduced with permission from: Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: A review. Acta Derm Venereol 2009; 89:236.
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