Sertraline as a first-line treatment for cholestatic pruritus.

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Hepatology. 2007 Mar;45(3):666-74.

Sertraline as

a first-line treatment for cholestatic pruritus.

Mayo MJ, Handem I, Saldana S, e H, Getachew Y, Rush AJ.

Depart of Internal Medicine, Univ of Texas

Southwestern Medical Center

at Dallas, TX

Pruritus is frequently the most debilitating symptom of cholestatic

liver diseases. Moreover, existing therapies are often

ineffective. Recent small, retrospective case series

reports suggest that serotonin reuptake inhibitors can improve pruritus. This study was undertaken to establish the dose of sertraline and to evaluate its efficacy for cholestatic pruritus. Twenty one

subjects with chronic pruritus due to liver disease (including primary biliary

cirrhosis, primary sclerosing cholangitis,

chronic hepatitis C, and postnecrotic cirrhosis)

initially underwent an open-label, dose escalation to determine the dose with

optimal efficacy and tolerability. After a washout

period, 12 of the subjects entered a randomized, double-blind,

placebo-controlled trial. Participants quantified

their pruritus using a 0-10 visual analog scale, and pruritus was assessed for

distribution, timing, degree of disability, and physical evidence of scratching. The optimum sertraline dose

(75-100 mg/day) was well tolerated. In the controlled

portion of the study, itch scores improved in patients taking sertraline, but worsened in patients taking placebo

(P=0.009). Changes in itch distribution, duration,

direction, and physical evidence of scratching paralleled changes in the visual

analog pruritus score. CONCLUSION: Sertraline

seems to be an effective, well-tolerated treatment for pruritus due to chronic

liver disease. These results suggest that serotonergic pathways are important in the perception of

itch.

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