Stopping the itch: Pruritis in palliative care

GABA analogues (e.g., gabapentin, pregabalin) showed the largest benefit compared with placebo for uremic pruritus, based on moderate-certainty evidence. Other drugs that may reduce uremic pruritus compared with placebo include kappa‐opioid receptor agonists (high-certainty evidence); fish‐oil/omega‐3 fatty acids or topical capsaicin (low-certainty evidence); and cromolyn sodium or montelukast (very low-certainty evidence). For cholestatic pruritus, several drugs may have benefits over placebo, including rifampin or flumecinol (very low-certainty evidence). Therapies for malignancy were lacking. Authors caution generalizability of results to other etiologies, given that sample sizes were mostly small.

• This review included 91 RCTs (N=4,652 adults) covering 51 different drug treatments for pruritus of various etiologies.
• Uremic/chronic kidney disease‐associated pruritus. GABA analogues likely led to a large reduction in pruritus vs. placebo, with a mean difference of −5.10 cm on a 10-cm visual analog scale (VAS), per moderate-certainty evidence. Kappa‐opioid receptor agonists (e.g., difelikefalin, nalbuphine, nalfurafine) reduced pruritus slightly vs. placebo (VAS difference, −0.96), per high-certainty evidence. Topical capsaicin or fish‐oil/omega‐3 fatty acids may lead to a large reduction in pruritus vs. placebo, but evidence is of low certainty. Montelukast or cromolyn sodium (oral) may result in reduced pruritus vs. placebo, but evidence is very uncertain.
• Cholestatic pruritus. Rifampicin or flumecinol may reduce pruritus vs. placebo, but evidence was very uncertain. Opioid antagonist naltrexone may reduce pruritus vs. placebo, but evidence was of low certainty; naltrexone was linked to the largest number of adverse events in included trials.
• Other drugs studied. Ondansetron had either a very small or no effect for treatment of either uremic or cholestatic pruritus. Small sample sizes limited conclusions about cholestyramine, thalidomide, lidocaine, or sertraline.

Source:

Boehlke C, et al. (2024, August 22). Cochrane Database Syst Rev. Pharmacological interventions for pruritus in adult palliative care patients. https://pubmed.ncbi.nlm.nih.gov/37314034/