Effect of oral naltrexone on pruritus in cholestatic patients.
OBJECTIVE
To determine the efficacy and potential complications of oral naltrexone used in the treatment of pruritus in cholestatic patients and to compare them with other studies.


METHODS
Thirty-four enrolled cholestatic patients complaining of pruritus were studied. In the initial phase, pruritus scores during day and night were evaluated. Subsequently, patients were given a placebo for one week followed by naltrexone for one week. In each therapeutic course (placebo or naltrexone) day and night pruritus scores were distinguished by a visual analogue scale (VAS) system and recorded in patients' questionnaires.


RESULTS
Both naltrexone and placebo decreased VAS scores significantly. Naltrexone was more effective than placebo in decreasing VAS scores. Both day and night scores of pruritus decreased by half of the value prior to therapy in thirteen patients (38%). Daytime pruritus improved completely in two patients (5.9%), but no improvement in the nighttime values was observed in any patient. Sixteen patients (47%) suffered from naltrexone complications, eleven (32%) of them were related to its withdrawal. Complications were often mild. In the case of withdrawal, the complication was transient (within the first 24-28 h of therapy) and self-limited. We had to cease the drug in two cases (5.9%) because of severe withdrawal symptoms.


CONCLUSIONS
Naltrexone can be used in the treatment of pruritus in cholestatic patients and is a safe drug showing few, mild and self-limited complications.
Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Sardar-Jangle Ave, Razi Hospital, Rasht 41448 - 95655, Iran. ghanaei@gums.ac.ir
Fariborz
F
Mansour-Ghanaei
Amir
A
Taheri
Hossein
H
Froutan
Hadi
H
Ghofrani
Mohsen
M
Nasiri-Toosi
Amir-Hossein
AH
Bagherzadeh
Mohammad-Jafar
MJ
Farahvash
Shahram
S
Mirmomen
Naser
N
Ebrahimi-Dariani
Elham
E
Farhangi
Zahra
Z
Pourrasouli
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002779:Cholestasis / Q000150:complications* / Q000503:physiopathology; D004244:Dizziness / Q000139:chemically induced; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced; D009271:Naltrexone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009325:Nausea / Q000139:chemically induced; D010147:Pain Measurement; D010919:Placebos; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016037:Single-Blind Method; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000503:physiopathology; D011795:Surveys and Questionnaires
D010919:Placebos; D009271:Naltrexone