Ondansetron to Treat Pruritus Due to Cholestatic Jaundice

Abstract

Intractable itching is a symptom of cholestatic liver disease of various causes that is bothersome and difficult to manage. Although treatment of the primary cause of cholestasis is paramount in resolving the issue, given the debilitating consequences of pruritus, symptomatic treatment is frequently necessary. Although many medications including cholestyramine, rifampin, opioid antagonists (i.e., naloxone, naltrexone), phenobarbital, and antihistamines have been used to treat cholestatic-induced pruritus, none has resulted in uniform success. We report anecdotal success with the use of ondansetron to treat pruritus associated with cholestasis following prolonged intensive care unit course of a 16-year-old. The theories accounting for pruritus with cholestasis are presented, treatment options are reviewed, and the role of ondansetron in the treatment of pruritus is discussed. INDEx TERMS

BAM8-22 and its receptor MRGPRX1 may attribute to cholestatic pruritus

“…Antihistamines are often clinically prescribed to cure or alleviate pruritus. However, owing to the existence of histamine-independent itch pathways, antihistamines are mostly ineffective for various chronic itch conditions such as cholestasis 2,26,27 . Till date, various histamine-independent pruritogens have been reported, such as chloroquine 28 , β-alanine 29 , TSLP 30 , IL-31 31 , SLIGRL-NH 2 32 , and BAM8-22 32 .…”

Peripheral and spinal 5-HT receptors participate in cholestatic itch and antinociception induced by bile duct ligation in rats

“…Several clinical observation showed that administration of 5-HT 3 receptor antagonist ondansetron3435363738 or selective serotonin reuptake inhibitor (SSRI) sertraline3940 were able to alleviate cholestatic pruritus, providing important clues to support key role of 5-HT system in cholestatic pruritus. Unfortunately, little is known of the modulatory effects of peripheral and central 5-HT system, especially 5-HT receptor subtypes, on cholestatic pruritus and antinociception so far7374.…”

“…The discovery of multiple 5-HT receptors subtypes may explain their complex influence on the processing of pain or itch signal2528303233. Interestingly, several clinical trials found that administration of 5-HT 3 receptor antagonist ondansetron3435363738 or selective serotonin reuptake inhibitor (SSRI) sertraline3940 were able to alleviate cholestatic pruritus, providing important clinical evidence to support critical role of 5-HT system in cholestatic pruritus. Although the importance of 5-HT system is emphasized in the modulation of pain and itch252641, the possible roles of peripheral and spinal 5-HT receptors in itch and antinociception induced by cholestasis are still unclear.…”

Pruritus in Systemic Diseases: A Review of Etiological Factors and New Treatment Modalities

“…Intravenous 5-HT3-receptor antagonist ondansetron has been shown to have antipruritic effect in cholestatic patients with conflicting results [ 57 ]. It may also have an effect on opioid pathways.…”