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Naltrexone for cholestatic itch: a systematic review
  1. Fay Louise Murray-Brown
  1. Palliative Medicine, Royal Gwent Hospital, Newport, UK
  1. Correspondence to Dr Fay Louise Murray-Brown, Palliative Medicine, Royal Gwent Hospital, Newport, UK; faymurray-brown{at}nhs.net

Abstract

Background Cholestatic itch is caused by intrahepatic liver diseases, such as primary biliary cirrhosis and extrahepatic obstruction of the biliary tree, often caused by tumours. The pathophysiology of cholestatic itch is complex and no single treatment has proved definitive. Naltrexone is an opioid receptor antagonist, which reduces central opioidergic tone, believed to be raised in patients with cholestatic pruritus.

Aim To review and assess the efficacy of oral naltrexone for the treatment of cholestatic itch.

Methods Search of electronic databases, grey literature, clinical trials registries and handsearching for studies including naltrexone for cholestatic itch. Full papers were obtained if relevant and studies graded.

Results Thirteen papers were included in the analysis, including three randomised controlled trials, one controlled clinical trial, one open-label pilot study, seven case reports and one retrospective notes review. All studies found naltrexone to be effective in relieving pruritus. In all five studies performing statistical analysis, naltrexone significantly reduced pruritus compared with baseline. 37% of patients reported side effects, notably opioid withdrawal-type reactions and recurrence of previous pain, from all pathologies.

Conclusions Oral naltrexone therapy helps relieve cholestatic itch and although it should be used with caution in patients using exogenous opioids for analgesia, it should be considered when treating refractory pruritus in patients with end-stage liver disease.

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Footnotes

  • Contributors FLM-B planned and conducted and wrote the review. JK, Cicely Saunders Institute, Kings College London, proof read the article and suggested edits, changes and an updated literature review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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