title: Drug treatments for pruritus in adult palliative care.
abstract: BACKGROUND
  Pruritus is a rare but troublesome symptom in palliative-care patients with a variety of underlying diseases. The pharmacotherapy of pruritus is often off-label, and an evidence-based evaluation is needed.
  
  
  METHODS
  A Cochrane Review published in 2013 was updated with a systematic literature search up to January 2014. Randomized and controlled trials (RCTs) with adult palliative-care patients were included.
  
  
  RESULTS
  In the 43 RCTs that were analyzed, three of which were more recent than the Cochrane Review, 8 clinically relevant active substances were investigated in a total of 19 RCTs. Effective drugs for pruritus in palliative-care patients included paroxetine for pruritus of diverse origins (1 RCT; strong effect) and indomethacin for HIV-induced prutitus (1 RCT; median effect = moderate reduction). Effective drugs for pruritus in uremia were gabapentin (2 RCTs; strong effect), nalfurafin (3 RCTs; moderate effect), naltrexone (3 RCTs; heterogeneous effects, ranging from weak to strong), and cromoglicic acid (2 RCTs; moderate to strong effect). Effective drugs for cholestatic pruritus were rifampicin (3 RCTs; moderate effect), flumecinol (2 RCTs; weak to moderate effect), and naltrexone (2 RCTs; moderate to strong effect). Undesired effects were most common with naltrexone (dizziness: 0% -50% , nausea: 0% -50% ) and nalfurafin (nasopharyngitis: 8% -12% , insomnia: 7% -15%).
  
  
  CONCLUSIONS
  In view of the diverse etiologies of pruritus in palliative-care patients, careful consideration should be given to the choice of drug used to treat it. The substances listed here have moderate to strong antipruritic effects and merit further study in RCTs of high methodological quality.
authors.affiliation: Department of Palliative Care, Freiburg University Medical Center, Freiburg, Freiburg University Medical Center, German Cochrane Center, Freiburg, These two authors have contributed equally to the manuscript and share first authorship.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Siemens
authors.forename: Carola
authors.initials: C
authors.lastname: Xander
authors.forename: Joerg J
authors.initials: JJ
authors.lastname: Meerpohl
authors.forename: Gerd
authors.initials: G
authors.lastname: Antes
authors.forename: Gerhild
authors.initials: G
authors.lastname: Becker
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D015984:Causality; D015897:Comorbidity; D003879:Dermatologic Agents / Q000008:administration & dosage*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011537:Pruritus / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents