Pruritus and fatigue associated with liver disease: is there a role for ondansetron?
BACKGROUND
Complications of liver disease include pruritus and fatigue. Increased central opioidergic tone, which is modulated by serotoninergic pathways, contributes to the former; increased central serotoninergic tone may contribute to the latter.


OBJECTIVE
To examine non-clinical and clinical data relevant to the hypothesis that ondansetron, a 5-HT(3) receptor subtype antagonist, ameliorates pruritus and fatigue in liver disease.


METHODS
Non-clinical findings supporting the hypothesis are discussed and all trials of ondansetron for pruritus or fatigue in liver disease are reviewed.


CONCLUSIONS
That ondansetron ameliorates pruritus in liver disease is strongly supported by subjective observations, but is not confirmed by objective findings in two controlled trials. Anecdotal observations also suggest that ondansetron ameliorates fatigue in liver disease, but in only one of two randomized controlled trials, that used subjective end points, is a similar conclusion possible.
Jones
E Anthony
EA
Academic Medical Center, Department of Gastrointestinal and Liver Diseases, Amsterdam, The Netherlands. evan.a.jones@btinternet.com
D000818:Animals; D000982:Antipruritics / Q000627:therapeutic use*; D002490:Central Nervous System / Q000187:drug effects* / Q000378:metabolism; D019317:Evidence-Based Medicine; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D017294:Ondansetron / Q000627:therapeutic use*; D018847:Opioid Peptides / Q000378:metabolism; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D012701:Serotonin / Q000378:metabolism; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D016896:Treatment Outcome
D000982:Antipruritics; D018847:Opioid Peptides; D012702:Serotonin Antagonists; D012701:Serotonin; D017294:Ondansetron