title: Antipruritic treatment with systemic μ-opioid receptor antagonists: a review.
abstract: During the past two decades, systemic μ-opioid receptor antagonists (MORA) have been used in the treatment of various forms of chronic pruritus. In a number of case reports, case series, and controlled trials, treatment with MORA has demonstrated considerable antipruritic effects. In double-blind controlled studies, significant antipruritic relief has been achieved by MORA in cholestatic pruritus, chronic urticaria, and atopic dermatitis. In case reports and case series, antipruritic efficacy of MORA has been reported in prurigo nodularis, mycosis fungoides, postburn pruritus, aquagenic pruritus, hydroxyethyl starch-induced pruritus, and pruritus of unknown origin. However, most of the evidence remains anecdotal, the design of these trials varies, and comparison of results is difficult. In this review we aim to present an overview of these reports and to assess the evidence for the antipruritic action of the drugs naloxone, nalmefene, and naltrexone, which are currently in use for the treatment of chronic pruritus of different origins. We will also evaluate recommendations for the use of MORA in daily medical practice.
authors.affiliation: Competence Center Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany.
authors.forename: Ngoc Quan
authors.initials: NQ
authors.lastname: Phan
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bernhard
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Luger
authors.forename: Sonja
authors.initials: S
authors.lastname: Ständer
mesh_terms: D000284:Administration, Oral; D000982:Antipruritics / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009270:Naloxone / Q000009:adverse effects / Q000627:therapeutic use; D009271:Naltrexone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D011537:Pruritus / Q000175:diagnosis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D017450:Receptors, Opioid, mu / Q000037:antagonists & inhibitors* / Q000627:therapeutic use*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000982:Antipruritics; D017450:Receptors, Opioid, mu; D009270:Naloxone; D009271:Naltrexone; C038981:nalmefene