Pharmacological interventions for pruritus in adult palliative care patients

Paroxetine appears to be more effective than placebo for pruritus in palliative care patients with pruritus of different origins.

The quality of evidencce is downgraded by imprecise results (few patients and wide confidencce intervals).

Summary

A Cochrane review 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). Only one study specifically researched patients treated in palliative care units or palliative care settings. Twenty-six patients were included in the study; 17 of them had solid tumors, 4 had hematological malignancies and 5 had various nonmalignant or idiopathic conditions. In this randomised, controlled, cross-over study, a selective serotonin reuptake inhibitor (SSRI) paroxetine 20 mg showed an antipruritic effect and increased patient satisfaction compared to placebo. Participants treated with paroxetine suffered slightly more from nausea and sleepiness but not from vomiting (table ).

Clinical comments

Date of latest search:

Ədəbiyyat

1. Siemens W, Xander C, Meerpohl JJ et al. Pharmacological interventions for pruritus in adult palliative care patients. Cochrane Database Syst Rev 2016;(11):CD008320.
2. Zylicz Z, Krajnik M, Sorge AA et al. Paroxetine in the treatment of severe non-dermatological pruritus: a randomized, controlled trial. J Pain Symptom Manage 2003;26(6):1105-12.