Unbearable Pruritus After Withdrawal of (Levo)cetirizine

Ekhart, Corine; Horst, Petra van der; Hunsel, Florence van

doi:10.1007/s40800-016-0041-9

Cited by 2 publications

(3 citation statements)

References 9 publications

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“…We identified 146 FAERS and literature cases meeting inclusion and exclusion criteria. 4 Table 1 provides descriptive characteristics of these 146 cases. Cases in the FAERS database were initially sparse and primarily submitted by manufacturers until 2008; there was an increase in reporting thereafter, driven mostly by reports ( n = 115) submitted directly to FDA from consumers or healthcare providers (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…It has been theorized that high occupancy of H1 receptors by circulating antihistamine results in itch after discontinuation of antihistamines with shorter half-lives (such as cetirizine and levocetirizine). 4 Beyond half-life, there are other differences in the structure and pharmacokinetic properties of cetirizine and levocetirizine compared with other SGAs, including piperazine chemical structure, lower volume of distribution, and higher selectivity for H1 receptors. 5,6 It is unclear if any of these properties contribute to the mechanism by which post-discontinuation pruritus occurs.…”

Section: Discussionmentioning

confidence: 99%

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Pruritus after discontinuation of cetirizine

Chung

Grenade

Harinstein

2019

Therapeutic Advances in Drug Safety

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Background: Intense pruritus or itching emerging after discontinuation of cetirizine has been the subject of postmarketing reports submitted to the U.S. Food and Drug Administration (FDA), published in the medical literature, and discussed on the internet. To better understand and further investigate this adverse event, we analyzed cases of pruritus occurring after discontinuation of cetirizine in the FDA Adverse Event Reporting System (FAERS) database and medical literature. Methods: We conducted a retrospective study to identify and describe cases of pruritus occurring after discontinuation of cetirizine in the FAERS database and medical literature through April 24, 2017. Data collected from the reports included demographic information, reason for use, serious outcome, report source, duration of cetirizine use, time to onset of pruritus after cetirizine discontinuation, presence of associated urticaria, treatment for pruritus, concomitant comorbidities and medications associated with pruritus, rechallenge information, and patient outcome information. Results: We identified 146 cases of pruritus after discontinuation of cetirizine. Reporting frequency increased starting in 2008. The median patient age was 38 years ( n = 141), ranging from 6 to 71 years, and cases were predominantly reported in females ( n = 110). Most cases ( n = 115) were submitted directly to the FDA from consumers or healthcare providers. The median duration of use of cetirizine prior to discontinuation was 24 months ( n = 130), ranging from 0.3 to 172.2 months. The median time to onset of pruritus from discontinuation was 2 days ( n = 91), ranging from 0.5 to 5 days. Of the 55 cases that reported discontinuation of cetirizine again after restarting, 54 reported pruritus recurrence. Conclusions: Our case series provided evidence of an association between the discontinuation of cetirizine and the development of pruritus. The mechanism by which cetirizine causes pruritus upon discontinuation is unknown. Patients and prescribers should have knowledge of this adverse event, given the widespread use and availability of cetirizine, and potential impact on patient quality of life.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pruritus after discontinuation of cetirizine

Chung

Grenade

Harinstein

2019

Therapeutic Advances in Drug Safety

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“…Of note, there have been published case reports of second-generation antihistamines, which are highly selective for the H 1 receptor, causing unbearable pruritus within 1 to 3 days after medication discontinuation 6. The patients described pruritus without rash or urticaria, and in some cases, pruritus lasted for several weeks 6. Although there are informal patient forums that identify “intense itching” as a result of mirtazapine discontinuation, this is the first peer-reviewed report of such a case.…”

Section: Discussionmentioning

confidence: 99%

Pruritus associated with abrupt mirtazapine discontinuation: Single case report

Spitznogle¹,

Gerfin²

2019

Mental Health Clinician

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It is well known that antidepressants have the potential to cause withdrawal symptoms upon abrupt discontinuation. At the time of this case report, no literature has identified intense, body-wide pruritus as a result of abrupt mirtazapine discontinuation. However, there is literature to suggest that mirtazapine may be used as a treatment for pruritus at doses as low as 15 mg/d due to its high affinity for central and peripheral histamine H1 receptors. Considering this information, it is suspected that the abrupt discontinuation of mirtazapine in the following patient case resulted in pruritus due to the reversal of antagonism at histamine receptors.

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Unbearable Pruritus After Withdrawal of (Levo)cetirizine

Cited by 2 publications

References 9 publications

Pruritus after discontinuation of cetirizine

Pruritus after discontinuation of cetirizine

Pruritus associated with abrupt mirtazapine discontinuation: Single case report

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