title: Severe pruritus of cholestasis in disseminated cancer: developing a rational treatment strategy. A case report.
abstract: Severe pruritus is a frequent complication of cholestasis. Both serotonin and opioids play an important role in the development of this symptom. Guidelines to provide rational management of pruritus of cholestasis do not exist. We describe a patient with complex and malignant course of pruritus. She responded to several measures proposed (among other naltrexone), but rapidly became tolerant to them. Buprenorphine with an ultra low dose of naloxone was able to control her symptoms without development of tolerance until her death.
authors.affiliation: Comprehensive Cancer Center, University of Nijmegen, Nijmegen, The Netherlands. z.zylicz@chello.nl
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Zylicz
authors.forename: Neeltje
authors.initials: N
authors.lastname: Stork
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Krajnik
mesh_terms: D000368:Aged; D002047:Buprenorphine / Q000008:administration & dosage*; D002779:Cholestasis / Q000150:complications*; D003110:Colonic Neoplasms / Q000473:pathology; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000556:secondary; D009270:Naloxone / Q000008:administration & dosage; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine