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World J Gastroenterol. Feb 21, 2006; 12(7): 1125-1128
Published online Feb 21, 2006. doi: 10.3748/wjg.v12.i7.1125
Effect of oral naltrexone on pruritus in cholestatic patients
Fariborz Mansour-Ghanaei, Amir Taheri, Hossein Froutan, Hadi Ghofrani, Mohsen Nasiri-Toosi, Amir-Hossein Bagherzadeh, Mohammad-Jafar Farahvash, Shahram Mirmomen, Naser Ebrahimi-Dariani, Elham Farhangi, Zahra Pourrasouli
Fariborz Mansour-Ghanaei, Amir Taheri, Hossein Froutan, Hadi Ghofrani, Mohsen Nasiri-Toosi, Amir-Hossein Bagherzadeh, Gastrointestinal and Liver Diseases Research Center , Guilan University of Medical Sciences, Rasht, Iran
Mohammad-Jafar Farahvash, Shahram Mirmomen, Naser Ebrahimi-Dariani, Elham Farhangi, Zahra Pourrasouli, Digestive Disease Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
Correspondence to: Fariborz Mansour-Ghanaei, Associate Professor, Gastrointestinal & Liver Diseases Research Center, Guilan University of Medical Sciences, Sardar-Jangle Ave, Razi Hospital, Rasht 41448 - 95655, Iran. ghanaei@gums.ac.ir
Telephone: + 98-131- 5535116 Fax: +98-131-5534951
Received: July 27, 2005
Revised: July 29, 2005
Accepted: December 26, 2005
Published online: February 21, 2006
Abstract

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 e v a l u a t e d . 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.

Keywords: Cholestasis; Pruritus; Naltrexone