Drug Treatments for Pruritus in Adult Palliative Care

Abstract

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.

Alpha2delta ligands, gabapentin, pregabalin and mirogabalin: a review of their clinical pharmacology and therapeutic use

“…According to a recent meta-analysis, two RCTs indicate that gabapentin has a strong effect on pruritus associated with uremia in patients with chronic kidney disease and deserves further research [116].…”

Luftnot, Jucken und Depression in der Palliativmedizin

“…Urämisches (renales) Jucken kann auch unter Dialysebehandlung mit dem überwiegend hepatisch eliminierten Ondansetron behandelt werden. Zur Therapie des hepatischen und cholestatischen Pruritus eigenen sich Colestyramin zur Bindung von Gallensäuren im Darm, Rifampicin, Naltrexon, Naloxon, aber auch Mirtazapin, das wie die Setrone (5-HT3-Rezeptor-Antagonisten) bei verschiedenen Ätiologien des Juckens eingesetzt werden kann und mit seiner zentralen Wirksamkeit gleichzeitig schlafanstoßend ist [38,39,40].…”

Practice Gaps in Pruritus

“…Gabapentin has been found to be effective in uremic pruritus, [13][14][15] burns, 16 notalgia paresthestica, 17 neuropathic itch, 14 and itch occurring in palliative patients. 13,18 Additional agents that should be considered for the treatment of itch include pregabalin, mirtazapine, butorphenone, naltrexone, aprepitant, and narrow-band ultraviolet B.…”

“…Gabapentin has been found to be effective in uremic pruritus, [13][14][15] burns, 16 notalgia paresthestica, 17 neuropathic itch, 14 and itch occurring in palliative patients. 13,18 Additional agents that should be considered for the treatment of itch include pregabalin, mirtazapine, butorphenone, naltrexone, aprepitant, and narrow-band ultraviolet B. 9,13,14,[19][20][21][22] Of note, placebo effects on itch are common, 23 which may explain why some patients report improvement of their itch even with several non-evidence-based treatments.…”

“…13,18 Additional agents that should be considered for the treatment of itch include pregabalin, mirtazapine, butorphenone, naltrexone, aprepitant, and narrow-band ultraviolet B. 9,13,14,[19][20][21][22] Of note, placebo effects on itch are common, 23 which may explain why some patients report improvement of their itch even with several non-evidence-based treatments. Nevertheless, health care professionals should use evidence-based treatments wherever possible.…”