Montelukast for treatment of refractory pruritus in patients on hemodialysis.
BACKGROUND
One of the most common complaints in patients with end-stage renal disease (ESRD) is uremic pruritus. In the recent years, many drugs have been proposed for its treatment which have had paradoxical outcomes. We studied the antipruritus effect of montelukast sodium, a leukotriene receptor antagonist, in patients on hemodialysis.


METHODS
The study was conducted as randomized, single-blind, placebo-controlled crossover study in 5 hemodialysis centers. Sixteen patients with refractory pruritus were selected and were divided into 2 groups to receive firstly montelukast and then placebo, or vice versa. Patients were treated by montelukast tablets, 10 mg daily, for 20 days and the washout period was 14 days.


RESULTS
Of 16 patients whom were included in the study, 1 died during the placebo period of myocardial infarction and another patient who received montelukast for 20 days faced hemoglobin decrease during the placebo period diagnosed as myelodysplastic syndrome. At the end of the treatment with montelukast, pruritus was reduced by 35% (95% CI, 9.5% to 62.5%), while it was reduced 7% (95% CI, 0.5% to 15.9%) with placebo (P = .002). The patients' compliance was assessed satisfactory, except for 1 patient who exited the study due to anemia.


CONCLUSIONS
Montelukast is more effective than placebo in the treatment of uremic pruritus not responding to the currently available antipruritus drugs, and it can be considered as a new and rather safe and effective treatment option in uremic patients.
Division of Nephrology, Department of Internal Medicine, Shohada-e-Tajrish Hospital, Shaheed Beheshti Medical University, Tehran, Iran.
Ali Reza
AR
Nasrollahi
Amirhosein
A
Miladipour
Esmat
E
Ghanei
Parvin
P
Yavari
Farshid
F
Haghverdi
D000085:Acetates / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D003521:Cyclopropanes; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology; D011804:Quinolines / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects*; D013440:Sulfides; D055815:Young Adult
D000085:Acetates; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; C093875:montelukast