Pathogenesis and treatment of pruritus in cholestasis.
Pruritus is an enigmatic, seriously disabling symptom accompanying cholestatic liver diseases and a broad range of other disorders. Most recently, novel itch-specific neuronal pathways, itch mediators and their relevant receptors have been identified. In addition, new antipruritic therapeutic strategies have been developed and/or are under evaluation. This review highlights recent experimental and clinical findings focusing on the pathogenesis and actual treatment of pruritus in cholestatic liver disease. Evidence-based therapeutic recommendations, including the use of anion exchange resins cholestyramine, colestipol and colesevelam, the microsomal enzyme inducer rifampicin, the opioid receptor antagonists naltrexone and naloxone, and the serotonin reuptake inhibitor sertraline, are provided.
Liver Center, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. a.e.kremer@amc.uva.nl
Andreas E
AE
Kremer
Ulrich
U
Beuers
Ronald P J
RP
Oude-Elferink
Thomas
T
Pusl
D000818:Animals; D000982:Antipruritics / Q000627:therapeutic use*; D002779:Cholestasis / Q000150:complications* / Q000378:metabolism; D006801:Humans; D009434:Neural Pathways / Q000187:drug effects / Q000503:physiopathology; D010146:Pain / Q000503:physiopathology; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology
D000982:Antipruritics