Preliminary observation with dronabinol in patients with intractable pruritus secondary to cholestatic liver disease.
Pruritus due to cholestatic liver disease can be particularly difficult to manage and frequently is intractable to a variety of medical therapies. The aim of our study is to evaluate the efficacy of delta-9-tetrahydrocannabinol (delta-9-THC) for intractable cholestatic related pruritus (ICRP) that has failed conventional (and unconventional) remedies. Three patients were evaluated for plasmapheresis because of ICRP. All 3 patients had previously been extensively treated with standard therapies for ICRP including: diphenhydramine, chlorpheniramine, cholestyramine, rifampicin, phenobarbital, doxepin, naltrexone, UV therapy, and topical lotions. Even multiple courses of plasmapheresis were performed without any benefit for the intractable pruritus. All patients reported significant decreases in their quality of life, including lack of sleep, depression, inability to work, and suicidal ideations. All patients were started on 5 mg of delta-9-THC (Marinol) at bedtime. All 3 patients reported a decrease in pruritus, marked improvement in sleep, and eventually were able to return to work. Resolution of depression occurred in two of three. Side effects related to the drug include one patient experiencing a disturbance in coordination. Marinol dosage was decreased to 2.5 mg in this patient with resolution of symptoms. The duration of antipruritic effect is approximately 4-6 hrs in all three patients suggesting the need for more frequent dosing. Delta-9-tetrahydrocannabinol may be an effective alternative in patients with intractable cholestatic pruritus.
Department of Medicine, University of Miami, Florida, USA.
Guy W
GW
Neff
Christopher B
CB
O'Brien
K Rajender
KR
Reddy
Nora V
NV
Bergasa
Arie
A
Regev
Enrique
E
Molina
Rafael
R
Amaro
Miguel J
MJ
Rodriguez
VeEtta
V
Chase
Lennox
L
Jeffers
Eugene
E
Schiff
D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D002780:Cholestasis, Intrahepatic / Q000150:complications* / Q000628:therapy; D002908:Chronic Disease; D013759:Dronabinol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology
D018712:Analgesics, Non-Narcotic; D013759:Dronabinol