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Pathophysiology and management of opioid-induced pruritus

Arjunan Ganesh1, Lynne G Maxwell

  • 1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4399, USA.

Drugs
|November 7, 2007
PubMed

Insights

Opioid-induced pruritus, or itching, is a common side effect. Micro opioid receptor antagonists show promise for managing this discomfort, though other medications are also effective.

Area of Science:

  • Pharmacology
  • Neuroscience
  • Anesthesiology

Background:

  • Opioid use, especially neuraxial administration, frequently causes pruritus.
  • Opioid-induced pruritus, while not life-threatening, significantly impacts patient comfort and satisfaction.
  • The precise mechanisms of opioid-induced pruritus are still under investigation, but micro opioid receptors play a key role.

Purpose of the Study:

  • To review the current understanding of the mechanisms underlying opioid-induced pruritus.
  • To summarize available pharmacological therapies for preventing and managing opioid-induced pruritus.

Main Methods:

  • Literature review of studies on opioid-induced pruritus mechanisms and treatments.
  • Analysis of pharmacological agents targeting various receptors and pathways involved in pruritus.

Main Results:

  • Micro opioid receptor antagonists are consistently effective in reducing opioid-induced pruritus but have administration challenges.
  • Other agents, including mixed opioid receptor agonist-antagonists, serotonin 5-HT(3) receptor antagonists, propofol, NSAIDs, and D(2) receptor antagonists, have shown utility.
  • Serotonin, dopamine D(2) receptors, prostaglandins, and spinal pathways may also contribute to pruritus genesis.

Conclusions:

  • Opioid-induced pruritus is a multifactorial condition involving various receptors and pathways.
  • Micro opioid receptor antagonists offer a consistent therapeutic approach, despite dosing and administration issues.
  • A range of pharmacological options exist for the prevention and treatment of opioid-induced pruritus, offering alternatives for patient management.

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