Oral nalmefene therapy reduces scratching activity due to the pruritus of cholestasis: a controlled study.
BACKGROUND
Intravenous naloxone frequently ameliorates the pruritus of cholestasis, but its low oral bioavailability precludes its use as a long-term therapy. Nalmefene is an orally bioavailable opiate antagonist.


OBJECTIVE
We assessed the efficacy of oral nalmefene in ameliorating the pruritus of cholestasis.


METHODS
In a prospective controlled study conducted in a tertiary referral hospital, 11 patients with generalized pruritus complicating chronic liver disease were randomized to receive either nalmefene or placebo in a double-blinded fashion for 2-month periods. Scratching activity was measured continuously for 24-hour periods at baseline and at the end of each treatment period.


RESULTS
Data on 8 patients who received at least 1 course of nalmefene were available for comparison with corresponding control data, which consisted of observations obtained during a course of placebo and/or at baseline. Nalmefene therapy was associated with a 75% reduction in the geometric mean hourly scratching activity (P <.01) and a decrease in the mean of a visual analogue score of the perception of pruritus in all 8 patients (mean decrease 77%, P <.01).


CONCLUSIONS
Oral administration of nalmefene can ameliorate pruritus complicating chronic liver disease.
Bergasa
N V
NV
Liver Diseases Section, Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
Alling
D W
DW
Talbot
T L
TL
Wells
M C
MC
Jones
E A
EA
D000284:Administration, Oral; D000328:Adult; D000982:Antipruritics / Q000008:administration & dosage* / Q000009:adverse effects; D002779:Cholestasis / Q000150:complications*; D004311:Double-Blind Method; D006801:Humans; D009271:Naltrexone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology; D013607:Tablets; D013997:Time Factors
D000982:Antipruritics; D009292:Narcotic Antagonists; D013607:Tablets; D009271:Naltrexone; C038981:nalmefene