A comparative study on the effects of naltrexone and loratadine on uremic pruritus.
BACKGROUND
Two recent studies have provided opposite results on the efficacy of naltrexone on uremic pruritus. We have performed a third study.


OBJECTIVE
To compare the efficacy and tolerance of naltrexone and loratadine in uremic pruritus.


METHODS
Among 296 hemodialyzed patients, 65 suffered from uremic pruritus. Fifty-two patients participated in the study. The patients were treated for 2 weeks with naltrexone (50 mg/day; 26 patients) or loratadine (10 mg/day; 26 patients), after a washout of 48 h. Pruritus intensity was scored by a visual analogue scale (VAS). Adverse events were carefully searched for. The two groups were statistically equivalent.


RESULTS
There was no significant difference in the mean VAS scores after treatment, but naltrexone allowed a dramatic decrease in VAS scores (Delta >3/10) in 7 patients. Adverse events (mainly nausea and sleep disturbances) were observed in 10/26 patients.


CONCLUSIONS
Naltrexone is effective only in a subset of patients. Adverse events are very frequent. The differences of efficacy and tolerance between patients might be due to metabolism. Naltrexone might be considered as a second-line treatment.
Legroux-Crespel
Emmanuelle
E
Department of Dermatology, University Hospital, Brest, France.
Clèdes
Jacques
J
Misery
Laurent
L
D000982:Antipruritics / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D017336:Loratadine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D011537:Pruritus / Q000188:drug therapy* / Q000473:pathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014511:Uremia / Q000188:drug therapy* / Q000473:pathology
D000982:Antipruritics; D009271:Naltrexone; D017336:Loratadine