Opiate receptor antagonists for treatment of severe pruritus associated with advanced cholestatic liver disease

摘要

Intractable pruritus due to advanced cholestatic liver disease can lead to intense physical suffering in terminally ill patients. We report the case of a 90-year-old man who had distressful pruritus due to irreversible drug induced cholestasis. His symptoms failed to respond to antihistamines, bile acid binding resins, and SSRIs but responded dramatically to the opiate receptor antagonists methylnaltrexone and naloxone. Improved symptom control allowed the patient to sleep after weeks along with significant reduction in daytime symptoms.A 90-year-old Caucasian man with a history of type 2 diabetes and congestive heart failure due to critical aortic stenosis (aortic valve area of 0.7 cm2) was admitted with severe itching, generalized icterus, and abdominal pain. Community acquired pneumonia was treated with a course of azithromycin two weeks prior to onset of symptoms.