Try and identify the cause. If secondary to obstructive jaundice, biliary stenting may be appropriate. Exclude common causes such as changes in washing powder, additives to the bath etc. Review medication and, where possible, stop drugs that may be contributing to the problem. If morphine sulphate is a suspected cause consult the local specialist palliative care team about alternative opioids.
Encourage good skin care and regular use of emollients.
Consider using a sedating anti-histamine such as chlorpheniramine 4mg every 4 to 6 hours as needed, or as a single dose of 4mg at night.
If jaundiced secondary to biliary obstruction and where biliary stenting is not an option, cholestyramine 4-8g as a daily dose may help, although many patients cannot tolerate it.
If itch persists consider starting stanazolol 5-10mg as a once daily dose. Other options include oral ondansetron 4-8mg daily, but this is beyond its product licence and should only be initiated after discussion with the specialist palliative care service.
