Codeine for pruritus in primary billiary cirrhosis? Atarax the old standby

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HREF= " http://www.findarticles.com/cf_0/m0833/9155_353/54068057/p1/article.jhtm

l " >Click here: Lancet: Codeine for pruritus in primary billiary

cirrhosis.(Research Letters)</A>

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Codeine for pruritus in primary billiary cirrhosis.(Research Letters)

Author/s: Zbigniew Zylicz

Issue: March 6, 1999

Pruritus is a frequent and troublesome symptom in primary biliary cirrhosis

(PBC). Increased plasma endogenous opioids play an important part in its

pathogenesis and antagonists such as nalmefene are used in treatment;1 their

use is, however, limited by opioid withdrawal reactions.2 We report a

44-year-old woman with severe pruritus due to PBC who responded to codeine.

Her total bilirubin was 21 mmol/L, alkaline phosphatase 516 U/L, g- glutamyl

transpeptidase 256 U/L, aspartate aminotransferase 77 U/L and alanine

aminotransferase 120 U/L. Previous treatment with ondansetron,

ursodeoxycholic acid, phenobarbital, and rifampicin was unsuccessful. After

paroxetine3 and naltrexone she experienced severe headache, nausea, vomiting,

and cold shivers. 2 years previously she had been treated for a severe

headache with a subcutaneous morphine injection. The headache did not change,

but pruritus disappeared for several hours. Accordingly, we treated her with

codeine 20 mg 4 hourly. Pruritus intensity decreased from 10/10 before

treatment (on a numeric analogue scale where 0 was no itch and 10 worst

possible itch) to 0- 1/10 2 weeks later. Pruritus was absent for 2 months

until she discontinued codeine because of constipation. Pruritus returned but

her pruritus score averaged 5/10 1 month later. Reintroduction of codeine

with laxatives had no effect at all.

Increased availability of endogenous opioids in PBC may be due to their

reduced liver clearance and/or enhanced production. High concentrations may

be responsible for increased central opioidergic neuromodulation.4 In this

situation complete inhibition by opioid antagonists may be responsible for

withdrawal symptoms. Non-antagonistic opioids like morphine and codeine bind

to the receptors but stimulate them less than do endogenous opioids. They may

work as competitive inhibitors in comparison with endogenous opioids, without

producing withdrawal symptoms. Buprenorphine, a partial m-agonist, >ETC.

>>>> <A

HREF= " http://www.ginet.com/papers/301-400/Mpape365.htm " >NALTREXONE for liver

itching /Ginet Papershttp://www.ginet.com/papers/301-400/Mpape365.htm</A>

<A

HREF= " http://onhealth.webmd.com/conditions/resource/pharmacy/multum0/item,6740

6.asp " >OnHealth: Atarax</A>

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