Low-dose doxepin for treatment of pruritus in patients on hemodialysis.
BACKGROUND
Pruritus is one of the frequent discomforting complications in patients with end-stage renal disease. We prospectively evaluated the effectiveness of doxepin, an H1-receptor antagonist of histamine, in patients with pruritus resistant to conventional treatment.


METHODS
A randomized controlled trial with a crossover design was performed on 24 patients in whom other etiologic factors of pruritus had been ruled out. They were assigned into 2 groups and received either placebo or oral doxepin, 10 mg, twice a day for 1 week. After a 1-week washout period, the 2 groups were treated conversely. Subjective outcome was determined by asking the patients described their pruritus as completely improved, relatively improved, or remained unchanged/worsened.


RESULTS
Complete resolution of pruritus was reported in 14 patients (58.3%) with doxepin and 2 (8.3%) with placebo (P < .001). Relative improvement was observed in 7 (29.2%) and 4 (16.7%), respectively. Overall, the improving effect of doxepin on pruritus was seen in 87.5% of the patients. Twelve patients (50.0%) complained of drowsiness that alleviated in all cases after 2 days in average. One patient refused to continue the treatment due to its sedative effect.


CONCLUSIONS
We suggest that doxepin, a tricyclic antidepressant with anti-H1 receptor effect, can help improve pruritus resistant to antihistamines in end-stage renal disease patients who undergo hemodialysis. A low dose of doxepin is safe while effective and its main adverse effect, drowsiness, is temporary and can be easily tolerated by the patients.
Department of Nephrology, Shaheed Labbafinejad Medical Center & Urology and Nephrology Research Center, Shaheed Beheshti Medical University, Tehran, Iran. pourrezagholi@unrc.ir
Fatemeh
F
Pour-Reza-Gholi
Alireza
A
Nasrollahi
Ahmad
A
Firouzan
Ensieh
E
Nasli Esfahani
Farhat
F
Farrokhi
D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004316:Doxepin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006633:Histamine Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology; D006435:Renal Dialysis; D016896:Treatment Outcome
D006633:Histamine Antagonists; D004316:Doxepin