title: Systemic kappa opioid receptor agonists in the treatment of chronic pruritus: a literature review.
abstract: Chronic pruritus is frequently refractory to currently available treatments. Studies suggest that pruritus may arise from an imbalance of the mu- and kappa-opioid receptor system activity in either the skin or the central nervous system. Stimulation of kappa-opioid receptors by their agonists inhibits pruritus in both animals and humans. The antipruritic effect of kappa-opioid receptors agonists can currently be assumed to be related to their binding to kappa-opioid receptors on keratinocytes and cutaneous and/or central itch neurones. To date, several case reports and 2 controlled trials have demonstrated a beneficial effect of systemic kappa-opioid receptor agonists in the treatment of uraemic pruritus, prurigo nodularis, paraneoplastic and cholestatic pruritus. Nalfurafine hydrochloride (Remitch(®)), a selective kappa-opioid receptor agonist, is approved for the treatment of chronic pruritus in Japan. The aim of this review is to provide an overview of the promising role of kappa- opioid receptors and their agonist in the pathophysiology and treatment of pruritus.
authors.affiliation: Competence Center for Chronic Pruritus, Department of Dermatology, University Hospital, Münster, Germany.
authors.forename: Ngoc Quan
authors.initials: NQ
authors.lastname: Phan
authors.forename: Tobias
authors.initials: T
authors.lastname: Lotts
authors.forename: Attila
authors.initials: A
authors.lastname: Antal
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bernhard
authors.forename: Sonja
authors.initials: S
authors.lastname: Ständer
mesh_terms: D000818:Animals; D000982:Antipruritics / Q000627:therapeutic use*; D002077:Butorphanol / Q000627:therapeutic use; D002908:Chronic Disease; D006801:Humans; D009019:Morphinans / Q000627:therapeutic use; D011537:Pruritus / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D017473:Receptors, Opioid, kappa / Q000819:agonists* / Q000378:metabolism; D013141:Spiro Compounds / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000982:Antipruritics; D009019:Morphinans; D017473:Receptors, Opioid, kappa; D013141:Spiro Compounds; C111212:TRK 820; D002077:Butorphanol