A controlled trial of ondansetron in the pruritus of cholestasis

O’Donohue, John; Pereira, Stephen P.; Ashdown, A. C.; Haigh, C. G.; Wilkinson, James; Williams, Ruth

doi:10.1111/j.1365-2036.2005.02430.x

Cited by 68 publications

(34 citation statements)

References 29 publications

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“…8 Two studies found reductions in VAS assessed cholestatic and uraemic pruritus by 21 and 16% with ondansetron, however this was matched by reductions in the placebo group of 22 and 25% respectively. 7,11 In contrast, one study showed a modest improvement of 1.34 points in peak VAS assessed cholestatic pruritus with ondansetron compared to placebo, 9 and one study showed minimal improvement of 0.21 points in mean NRS assessed cholestatic pruritus. 10 Five of thirteen participants also had a 27% decrease in subjective assessor-rated pruritus on a 0-3 NRS, with the remaining eight showing no difference with placebo.…”

Section: Outcome Measuresmentioning

confidence: 87%

“…7 Whilst one study showed a small reduction in NRS assessed pruritus, there was no associated reduction in scratching activity. 10 There was no reduction in the use of rescue oral or topical antihistamine as an outcome in the two studies that examined this.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…The study by O'Donohue et al varied from this by using a loading intravenous ondansetron /placebo dose followed by oral maintenance ondansetron/placebo with no crossover. 7 …”

Section: Interventionmentioning

confidence: 99%

“…7,10 Two studies incorporated measurement of additional antihistamine use (one oral, one topical) as a surrogate for improvement in pruritus. 8,9 Outcomes One study found no difference in VAS assessed uraemic pruritus with ondansetron.…”

Section: Outcome Measuresmentioning

confidence: 99%

See 3 more Smart Citations

The Role of Ondansetron in the Management of Cholestatic or Uremic Pruritus—A Systematic Review

Clark

Lam

et al. 2012

Journal of Pain and Symptom Management

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Please note that any alterations made during the publishing process may not appear in this version."NOTICE: this is the authors' version of a work that was accepted for publication in the Journal of Pain and Symptom Management. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Cities. Published Journal Articles (PJAs)Definition: A published journal article (PJA) is the definitive final record of published research that appears or will appear in the journal and embodies all value-adding publisher activities including copy-editing, formatting and (if relevant) pagination.Policy: Elsevier guarantees each PJA's authenticity, we work with others (e.g. national libraries) to preserve them for posterity and in perpetuity, and we invest to drive their usage. We strictly apply an absolute guideline regarding their location: every PJA will reside only on a completely controlled site because this is the only way that we as the publisher can guarantee each PJA's permanence, authenticity and that it is not altered. The continued viability of scholarly journals and their PJAs is also important to the research community. Publishers invest significant time, money and resources to create, maintain and develop both journals' reputations and the publishing process. The distribution of PJAs is therefore also subject to strict guidelines so that journals' ability to recoup the investments required to create them are not compromised.An author may use the PJA for personal use and internal institutional use (see above for definitions of these terms). In the interest of safeguarding the correct scientific record, however, Elsevier does not permit the posting of PJAs (Elsevier-provided PDF or HTML files) on any open websites. This is to ensure that the final published version of an article, which has been edited and peer-reviewed according to the publishing standards of an Elsevier journal, is always recognized as such only via the journal itself, whether in print or electronic format. PJAs may not be used for commercial use or for systematic distribution (see above for definitions of these terms). Abstract ContextPruritus associated with hepatic or renal failure can be a troublesome symptom, refractory to treatment, associated with significant physical and emotional distress, and reduction in quality of life for patients already burdened with chronic disease. Serotonin has been implicated as a possible pathological mediator, and therefore 5HT3 antagonists have been suggested as a possible therapeutic intervention.

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Section: Outcome Measuresmentioning

confidence: 87%

Section: Outcome Measuresmentioning

confidence: 99%

“…The study by O'Donohue et al varied from this by using a loading intravenous ondansetron /placebo dose followed by oral maintenance ondansetron/placebo with no crossover. 7 …”

Section: Interventionmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

See 2 more Smart Citations

The Role of Ondansetron in the Management of Cholestatic or Uremic Pruritus—A Systematic Review

Clark

Lam

et al. 2012

Journal of Pain and Symptom Management

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“…35 In contrast to other symptoms, the sensation of pruritus invariably results in scratching behavior 36 ; accordingly, changes in this behavior as a result of an investigational intervention define the end points in clinical trials. Instruments to record scratching behavior independently from gross body movements have been developed 35 and adapted 37,38 making it possible to design studies that yield objective, analyzable, and interpretable data.…”

Section: Commentsmentioning

confidence: 99%

Treatment of the pruritus of cholestasis: From unbearable lightness to substance

Bergasa

2004

Hepatology

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Treatment of the Pruritus of Cholestasis: From Unbearable Lightness to SubstanceTerg R, Coronel E, Sorda J, Munoz AE, Findor J. Efficacy and safety of oral naltrexone treatment for pruritus of cholestasis, a crossover, double blind, placebo-controlled study. J Hepatol 2002;37:717-722. (Reprinted with permission from Elsevier.) AbstractBackground & Aims: To assess the efficacy and safety of naltrexone for the short and long term treatment of pruritus of cholestasis. Methods: Twenty patients with pruritus and cholestasis were included. A baseline pruritus score was obtained over 1 week. Patients were then randomized to receive 50 mg/day of naltrexone or placebo for 2 weeks. Subsequently, a 1-week washout period ensued and patients were crossed over to the other therapy for 2 additional weeks. Pruritus was assessed daily with a visual analogue scale (VAS) from 0 to 10. Patients whose pruritus decreased >50% of basal with naltrexone received naltrexone 50 mg/day for 2 additional months. Results: Mean basal VAS was similar in both groups. VAS showed greater and more significant changes with naltrexone than with placebo (P < .0003). In nine out of 20 patients (45%) receiving naltrexone, pruritus decreased >50% compared to basal value, including five whose pruritus disappeared completely. No significant changes were observed in serum biochemistry. Most of the adverse events that occurred during the first 48 h of naltrexone therapy were consistent with opioid withdrawal-like phenomena and spontaneously disappeared 2 days after starting treatment. Conclusions: Naltrexone can be considered as an alternative option to treat pruritus of cholestasis. In the current study, side effects were transient and did not require specific medication.

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