Pharmacological Interventions for Cholestatic Pruritus in Adult Palliative Care Patients

Summary

A Cochrane review [Abstract] 1 included 50 studies with a total of 1 916 adult subjects with 39 different treatments for pruritus in 4 different patient groups: uraemic pruritus (n=1 574), cholestatic pruritus caused by hepatobiliary diseases (n=276), pruritus associated with malignancies (n=26), and pruritus as a symptom associated with HIV (n=40). This evidence summary concerns cholestatic pruritus (CP).

Rifampin (VAS 0 to 100: MD −24.64, 95% CI −31.08 to −18.21, statistical heterogeneity I² =95%; 2 studies, n=42) and flumecinol (RR 1.89, 95% CI 1.05 to 3.39, statistical heterogeneity I² =59%; 2 studies, n=69) were more effective for CP and showed a low incidence of adverse events compared to placebo. The opioid antagonist naltrexone reduced pruritus (VAS 0 to 10: MD −2.26, 95% CI −3.19 to −1.33, statistical heterogeneity I² =55%; 2 studies, n=52) but increased the risk of adverse events (RR 4.07, 95% CI 2.07 to 8.00; 3 studies, n=116) compared to placebo. Large doses of opioid antagonists (e.g. naltrexone) could be inappropriate in palliative care patients because of the risk of reducing analgesia.