The role of ondansetron in the management of cholestatic or uremic pruritus--a systematic review.
BACKGROUND
Pruritus associated with hepatic or renal failure can be a troublesome symptom, refractory to treatment and associated with significant physical and emotional distress and a reduction in quality of life for patients already burdened with chronic disease. Serotonin has been implicated as a possible pathological mediator, and, therefore, 5HT(3) antagonists have been suggested as a possible therapeutic intervention.


OBJECTIVE
This review of the literature systematically explores the role of ondansetron in the management of cholestatic or uremic pruritus.


METHODS
Electronic databases were systematically searched for randomized controlled trials examining the role of ondansetron in cholestatic or uremic pruritus between 1966 and 2008.


RESULTS
Five randomized controlled trials were included in this systematic review: three for cholestatic pruritus and two for uremic pruritus. All trials examined ondansetron vs. placebo, with differing treatment protocols. Overall, three studies showed no benefit to ondansetron over placebo; however, two studies in cholestatic pruritus showed small reductions in pruritus with questionable clinical significance.


CONCLUSIONS
Ondansetron was demonstrated to have negligible effect on cholestatic or uremic pruritus on the basis of a limited number of studies.
Discipline, Palliative & Supportive Services, Flinders University, Daw Park, South Australia, Australia.
Timothy H M
TH
To
Katherine
K
Clark
Lawrence
L
Lam
Tania
T
Shelby-James
David Christopher
DC
Currow
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002779:Cholestasis / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use*; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D017211:Treatment Failure; D014511:Uremia / Q000150:complications*
D012702:Serotonin Antagonists; D017294:Ondansetron