Methylnaltrexone to Palliate Pruritus in Terminal Hepatic Disease

Hohl, Christopher M; Wong, Jonathan; Harlos, Mike

doi:10.1177/082585971503100209

Cited by 8 publications

(3 citation statements)

References 32 publications

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“…149 Sertraline should be the third-line choice before naltrexone. Nalmefene (0Á25-1 lg kg À1 per day intravenously) may be an alternative opioid antagonist to naltrexone, 150,151 as may methylnaltrexone 152 and naloxone. 153 Ondansetron was found to be helpful in hepatic pruritus in two early RCTs, 154,155 but not in two more recent RCTs.…”

Section: Hepatic Pruritusmentioning

confidence: 99%

British Association of Dermatologists’ guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018

Millington¹,

Collins²,

Lovell³

et al. 2018

Br J Dermatol

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SummaryPruritus (or itch) is a common and distressing symptom of many skin diseases, systemic illnesses and psychological disorders. Itch is perhaps the commonest presenting symptom of skin disorders. In any two week period, 8 to 9% of the population suffer from significant pruritus. The focus of this guideline is not itchy rashes, but rather the situation where itch is present without rash. The guidelines also do not cover itch in children, in pregnancy, nor do they detail the science of the cause of itch. The study group consist mostly of dermatologists (skin specialists) from a number of hospitals in the U.K., but a number of other hospital doctors, a nurse and a general practitioner (GP) are also part of the team. There may be an underlying cause of pruritus, such as blood disorders, iron deficiency or excess, kidney problems, liver problems, cancer, infections, medications, behavioural factors, dry skin or any combination of these with old age. This can be significant in 20 to 30% of cases of itchy skin without rash. There remain a small number of individuals with itch and no apparent underlying cause or rash. It is always important to look for an underlying causative condition, as the most effective management of pruritus without rash depends on the treatment of any underlying disease. The management of itch appears to be very situation specific, even if the underlying cause cannot be treated. The management of true pruritus of unknown cause is different again.

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Section: Hepatic Pruritusmentioning

confidence: 99%

British Association of Dermatologists’ guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018

Millington¹,

Collins²,

Lovell³

et al. 2018

Br J Dermatol

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“…Антагоністи опіоїдів мають значно більше побічних ефектів, ніж холестирамін та рифампіцин, і це обмежує їх використання при печінковому свербежі [63,67]. У цьому випадку гарною альтернативою застосуванню антагоністів опіоїдів, таких як налтрексон [69,70), метилналтрексон [71] та налоксон [72], може виступати Налмефен (0,25-1 мг/кг на день внутрішньовенно). Також досліджувалось застосування сертраліну в дозі 75-100 мг при печінковому свербежі.…”

Section: печінковий свербіжunclassified

Itching as the onset of pain (part 2)

Kushnir

Dmytrenko

Katilov

et al. 2020

PMJUA

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Itching of the skin is a particularly unpleasant subjective sensation that causes the need to scratch. Physiological itching occurs in response to environmental irritants (friction, insect crawling, temperature changes, etc.) and disappears after elimination of the cause. Pathological itching is caused by changes in the skin or throughout the body and causes a strong need to get rid of itching by combing or any other method. Itching is a common symptom of local (dermatological) or general (systemic) disease. It can be limited (localized) or diffuse (generalized).One of the causes of itching is often noted endocrine diseases and metabolic disorders: hyper- and hypofunction of the thyroid gland, diabetes mellitus and hyperparathyroidism. In thyroid hyperfunction, generalized (inconstant and little-pronounced) itching of the skin is observed in the clinical picture only in 10 % of patients. It is accepted that itching of the skin in thyrotoxicosis syndrome is due to increased activity of kinin in combination with an increase in major metabolism and an increase in body and skin temperature (123).Itching caused by impaired bile secretion is characteristic of many diseases of the liver: primary biliary cirrhosis, sclerosing cholangitis, viral hepatitis caused by cholestasis medications and other causes of obstructive jaundice. It is in these cases that prurigo is usually generalized, but in some typical cases it is more pronounced on the feet and palms. With this pathology, itching is caused by obstruction of the biliary tract, however, and to this day, no close correlation has been found between serum bilirubin and the severity of itching.If it was previously thought that itching in pathology of the peripheral or central nervous system, such as multiple sclerosis, neuropathy, compression or irritation of nerves (e.g., paraesthetic dorsalgia, brachioradial itching) is also a significant symptom, then modern studies prove that in more cases, itching is not characteristic of most pathologies of the nervous system, so after a detailed anamnesis, examination and initial research, the patient should be referred to a related specialist, except in cases of about obvious postherpetic neuropathy, painless paresthesia, or brachioradial itching, which can often be guided in the provision of primary care.Instead, there are some psychological conditions and a number of psychiatric illnesses (obsessive-compulsive disorders, depression, and parasite illusions) that are most commonly diagnosed with the exclusion method. Neurotic squabbles are scattered on the body of the excorii, covered with scales that may occur in any area of the body that the patient may reach, but are often limited by limbs.

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“…Sertraline should be the third‐line choice before naltrexone. Nalmefene (0·25–1 μg kg −1 per day intravenously) may be an alternative opioid antagonist to naltrexone, as may methylnaltrexone and naloxone …”

Section: Investigation Of Generalized Pruritus Without Rash and Intermentioning

confidence: 99%

British Association of Dermatologists’ guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018

et al. 2018

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Methylnaltrexone to Palliate Pruritus in Terminal Hepatic Disease

Cited by 8 publications

References 32 publications

British Association of Dermatologists’ guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018

British Association of Dermatologists’ guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018

Itching as the onset of pain (part 2)

British Association of Dermatologists’ guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018

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