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Antipruritische Therapie mit dem oralen Opiatrezeptorantagonisten Naltrexon

Offene, nicht placebokontrollierte Anwendung bei 133 Patienten

Antipruritic therapy with the oral opioid receptor antagonist naltrexone

Open, non-placebo controlled administration in 133 patients

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Zusammenfassung

Hintergrund

Die Perzeption von Pruritus wird u. a. durch endogene und exogene Opiate über zentrale Opiatrezeptoren verstärkt und kann dementsprechend mit Opiatrezeptorantagonisten unterdrückt werden. Das Ziel dieser Arbeit ist es, die Effizienz von Naltrexon, einem oralen Opiatrezeptorantagonisten, bei der Therapie von schwerem Juckreiz unterschiedlicher Ursache zu beschreiben.

Patienten

Es wurden 133 Patienten mit starkem therapierefraktären Pruritus bei verschiedenen entzündlichen Dermatosen (u. a. asteatotische Dermatitis, atopische Dermatitis, Prurigo verschiedener Ursache, Psoriasis vulgaris) und bei Leber- und Nierenerkrankungen, Neoplasien sowie Pruritus unklarer Genese mit täglich 50–150 mg Naltrexon (Nemexin®) behandelt.

Ergebnisse

Ein Ansprechen auf die Therapie war bei 86 der 133 Patienten (64,6%) zu verzeichnen. Naltrexon erwies sich als sehr gut wirksam bei Prurigo nodularis, Pruritus bei kutanen Lymphomen sowie auch bei Juckreiz unklarer Genese. Eine Tachyphylaxie war bei 13% der Patienten zu beobachten, trat spät auf und konnte durch das Steigern der Dosis abgefangen werden. Nebenwirkungen der Therapie beschränkten sich zum größten Teil auf die ersten 2 Therapiewochen und umfassten vor allem neurologische (Schwindel, Kopfschmerzen, Müdigkeit) und gastrointestinale Symptome (Übelkeit, Erbrechen und Durchfall).

Schlussfolgerungen

Die vorliegenden Ergebnisse zeigen, dass der orale Opiatrezeptorantagonist Naltrexon eine effektive Therapie mit guter Verträglichkeit bei therapierefraktärem Juckreiz verschiedenster Ursache darstellt.

Abstract

Background and Objectives

The perception of pruritus is modified by endogenous and exogenous opioids via central opiate receptors and can be suppressed with opioid receptor antagonists. The aim of this investigation was to describe the efficacy and safety of naltrexone, an orally active opiate antagonist, in the treatment of severe, otherwise intractable pruritus of varying origins.

Patients

A total of 133 patients with pruritus caused by inflammatory skin diseases (asteatotic dermatitis, atopic dermatitis, prurigo, and psoriasis vulgaris), liver- and renal diseases, cutaneous lymphoma, as well as with pruritus of unknown origin were treated with naltrexone (Nemexin®) 50 to 150 mg daily.

Results

A therapeutic response was achieved in 86 of the 133 (64.6%) patients. Naltrexone was most effective in prurigo nodularis, cutaneous lymphoma and pruritus of unknown origin. Tachyphylaxis occurred in 13% of the patients, but appeared late, and could be counterbalanced by raising the dosage. Adverse drug effects were restricted to the first two weeks of treatment and included mainly neurological (dizziness, headache, fatigue) and gastrointestinal (nausea, vomiting, diarrhea) symptoms.

Conclusions

The oral opiate antagonists may well be an effective, well-tolerated therapy for intractable pruritus in many diseases.

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Authors and Affiliations

  1. Klinik und Poliklinik für Hautkrankheiten, Universitätsklinikum Münster

    A. Brune, D. Metze, T. A. Luger &  S. Ständer

  2. Klinik und Poliklinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Straße 58, 48149 , Münster

    S. Ständer

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  1. A. Brune
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  2. D. Metze
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  3. T. A. Luger
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  4. S. Ständer
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Correspondence to S. Ständer.

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Brune, A., Metze, D., Luger, T.A. et al. Antipruritische Therapie mit dem oralen Opiatrezeptorantagonisten Naltrexon. Hautarzt 55, 1130–1136 (2004). https://doi.org/10.1007/s00105-004-0802-8

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  • DOI: https://doi.org/10.1007/s00105-004-0802-8

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