Effect of oral naltrexone on pruritus in cholestatic patients
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AIM: To determine the efficacy and potential complications of oral naltrexone used in the treatment of pruritus in cholestatic patients and to compare them with other studies. METHODS: Thirty-four enrolled cholestatic patients complaining of pruritus were studied. In the initial phase, pruritus scores during day and night were evaluated. Subsequently, patients were given a placebo for one week followed by naltrexone for one week. In each therapeutic course (placebo or naltrexone) day and night pruritus scores were distinguished by a visual analogue scale (VAS) system and recorded in patients' questionnaires. RESULTS: Both naltrexone and placebo decreased VAS scores significantly. Naltrexone was more effective than placebo in decreasing VAS scores. Both day and night scores of pruritus decreased by half of the value prior to therapy in thirteen patients (38%). Daytime pruritus improved completely in two patients (5.9%), but no improvement in the nighttime values was observed in any patient. Sixteen patients (47%) suffered from naltrexone complications, eleven (32%) of them were related to its withdrawal. Complications were often mild. In the case of withdrawal, the complication was transient (within the first 24-28 h of therapy) and self-limited. We had to cease the drug in two cases (5.9%) because of severe withdrawal symptoms. CONCLUSION: Naltrexone can be used in the treatment of pruritus in cholestatic patients and is a safe drug showing few, mild and self-limited complications.
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Guideline-recommended drugs for cholestatic pruritus, including cholestyramine, rifampicin, naltrexone, and sertraline, have limited efficacy and/or tolerability.
“Current guideline-recommended medical treatment options for pruritus of cholestasis include the anion exchange resin cholestyramine, the pregnane X receptor (PXR) agonist rifampicin, the opioid antagonist naltrexone, and the selective serotonin reuptake inhibitor sertraline.4,7 Efficacy or tolerability of these drugs, or both, are limited.8,9”
From Fibrates for Itch (FITCH) in Fibrosing Cholangiopathies: A Double-Blind, Randomized, Placebo-Controlled Trial (2021) · cites this paper as [9]
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References 53 · Cited by 89
Research works printed but not linked: 3
- Khandelwal M, Malet PF. Pruritus associated with cholestasis. A review of pathogenesis and management. Dig Dis Sci 1994; 39: 1-8
- Gonzalez JP, Brogden RN. Naltrexone. A review of its phar- macodynamic and pharmacokinetic properties and therapeu- tic efficacy in the management of opioid dependence. Drugs 1988; 35: 192-213
- Brune A, Metze D, Luger TA, Ständer S. [Antipruritic therapy with the oral opioid receptor antagonist naltrexone. Open, non-placebo controlled administration in 133 patients]. Hau- tarzt 2004; 55: 1130-1136
- Authors
- Mansour-Ghanaei, F.
- Venue
- World Journal of Gastroenterology
- Publisher
- Baishideng Publishing Group Inc.
- Published
- 2006
- Volume
- 12
- Issue
- 7
- Pages
- 1125
- ISSN
- 1007-9327 (ISSN-L)
- PMC
- PMC4087908
- OpenAlex
- W1568521174
- Cited by
- 89
- References
- 53
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 6 · 2023: 5 · 2022: 9 · 2021: 7 · 2020: 3 · 2019: 5 · 2018: 1 · 2017: 4 · 2016: 5 · 2015: 3 · 2014: 4 · 2013: 2 · 2012: 2
- FWCI
- 4.97
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- World Journal of Gastroenterology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Gastrointestinal and Liver Diseases Research Center
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Gallbladder and Bile Duct Disorders
- Keywords
- naltrexone, pruritus, cholestasis, cholestatic pruritus, opioid antagonists, drug withdrawal symptoms, drug safety
- MeSH terms
- Administration, Oral, Adult, Aged, Cholestasis, Dizziness, Headache, Humans, Middle Aged, Naltrexone, Nausea, Pain Measurement, Placebos, Pruritus, Surveys and Questionnaires, Substance Withdrawal Syndrome, Single-Blind Method, Muscle Weakness
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