Abstract | BACKGROUND: METHODS:
Naltrexone 50 mg per day by mouth was given to 15 haemodialysis patients with severe resistant pruritus in a randomised, double-blind, placebo-controlled crossover trial. The naltrexone or placebo periods lasted 7 days each with a 7-day washout between the two periods. Pruritus was assessed by the patients on a visual analogue scale from 0 (no pruritus) to 10 (maximum), and mean daily scores were calculated. Plasma histamine and beta-endorphin levels were measured, and spontaneous and stimulated basophil histamine-release were determined. FINDINGS: The median pruritus scores at the end of the naltrexone treatment were 2.1 (interquartile range 1.5-2.15) for the naltrexone-placebo sequence and 1.0 (0.4-1.15) for the placebo- naltrexone sequence. The respective values before naltrexone was given were 9.9 (9.85-9.95) and 9.9 (9.3-10.0). Plasma beta-endorphin levels were normal and remained unchanged during the study. Plasma histamine levels were high (mean 2.32 [SD 0.11] ng/mL, normal < 1.0) and decreased after naltrexone (to 1.8 [0.09], p < 0.01). Basophils from haemodialysis patients stimulated by interleukin-3 plus IgE antibodies released high amounts of histamine. The increase was 78.3 (19.3)% compared with 26.6 (16.3)% for five normal controls (p < 0.01). Incubation of the basophils with naloxone, another opioid antagonist, prevented this effect. INTERPRETATION: Our data suggest short-term efficacy with few side-effects for the amelioration of uraemic pruritus with naltrexone.
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Authors | G Peer, S Kivity, O Agami, E Fireman, D Silverberg, M Blum, A laina |
Journal | Lancet (London, England)
(Lancet)
Vol. 348
Issue 9041
Pg. 1552-4
(Dec 07 1996)
ISSN: 0140-6736 [Print] England |
PMID | 8950882
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Narcotic Antagonists
- Naltrexone
- beta-Endorphin
- Histamine
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Topics |
- Cross-Over Studies
- Double-Blind Method
- Histamine
(blood)
- Humans
- Naltrexone
(therapeutic use)
- Narcotic Antagonists
(therapeutic use)
- Pruritus
(blood, drug therapy, etiology)
- Renal Dialysis
- Uremia
(blood, complications, therapy)
- beta-Endorphin
(blood)
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