Severe pruritus of cholestasis in disseminated cancer: developing a rational treatment strategy. A case report.
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.
Zylicz
Zbigniew
Z
Comprehensive Cancer Center, University of Nijmegen, Nijmegen, The Netherlands. z.zylicz@chello.nl
Stork
Neeltje
N
Krajnik
Małgorzata
M
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
D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine