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Review
. 2014 Dec 12;111(50):863-70.
doi: 10.3238/arztebl.2014.0863.

Drug treatments for pruritus in adult palliative care

Waldemar Siemens  1 , Carola Xander, Joerg J Meerpohl, Gerd Antes, Gerhild Becker
Affiliations
Review

Drug treatments for pruritus in adult palliative care

Waldemar Siemens et al. Dtsch Arztebl Int. .

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%).

Conclusion: 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.

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Figures

Figure
Figure
Selection of analyzed studies
eFigure
eFigure
Assessment of bias risk (modifed from 12) – This figure summarizes the risks of the different biases in the analyzed studies.
See this image and copyright information in PMC

References

    1. Rothmann S. Physiology of itching. Physiol Rev. 1941;21:357–381.
    1. Bernhard JD. Itch and pruritus: what are they, and how should itches be classified? Dermatol Ther. 2005;18:288–291. - PubMed
    1. Summey B Walsh DT CAFRea (ed.) Pruritus. Palliative Medicine. Philadelphia. Saunders Elsevier. 2009
    1. Zylicz Z, Twycross R, Jones AE. New York: Oxford University Press; 2004. Pruritus in advanced disease.
    1. Langner MD, Maibach HI. Pruritus measurement and treatment. Clin Exp Dermatol. 2009;34:285–288. - PubMed

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