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Buprenorphine and hepatic pruritus

L D Juby¹, V S Wong, M S Losowsky

¹Academic Unit of Medicine, St James's University Hospital, Leeds.

The British Journal of Clinical Practice

|November 1, 1994

Summary

Buprenorphine, a partial opiate antagonist, was tested for treating severe itching in cholestatic liver disease. While one patient showed improvement, most experienced intolerable side effects, suggesting limited use for intractable pruritus.

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Area of Science:

Hepatology
Pharmacology
Gastroenterology

Background:

Cholestatic liver disease frequently causes severe pruritus, which is often refractory to standard treatments.
The pathophysiology of pruritus in cholestatic conditions may involve the accumulation of endogenous opioid peptides due to impaired excretion.
Opioid pathways are implicated in the sensory processing of itch.

Purpose of the Study:

To evaluate the efficacy and tolerability of buprenorphine in patients with intractable pruritus associated with cholestatic liver disease.
To explore the potential role of opioid modulation in managing cholestasis-induced itch.

Main Methods:

A double-blind, placebo-controlled trial was conducted involving five patients with severe, uncontrollable pruritus.
Patients received buprenorphine, a partial opiate antagonist, and were assessed for clinical improvement and side effects.

Main Results:

One patient experienced significant clinical improvement in pruritus.
Another patient reported good relief from itching.
Three out of the five patients experienced intolerable side effects, leading to discontinuation of the treatment.

Conclusions:

Buprenorphine demonstrates a potential for limited efficacy in managing intractable pruritus in specific cholestatic liver disease patients.
The high incidence of intolerable side effects restricts its broader clinical application.
Further research is needed to identify patient subgroups who might benefit from opioid antagonist therapy for pruritus.

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