Use of Butorphanol as Treatment for Cholestatic Itch.
BACKGROUND
Pruritus is a debilitating symptom of cholestatic diseases such as primary biliary cholangitis and primary sclerosing cholangitis and often results in major reduction in quality of life for afflicted patients. Classic treatment options for the treatment of cholestatic pruritus include antihistamines, bile acid resins, serotonin reuptake inhibitors, and mu-opioid antagonists. Unfortunately, these drugs are not always successful in treating pruritus of cholestasis and may be associated with adverse effects. Recent advances in our understanding of itch pathophysiology have led to the use of butorphanol, a kappa-opioid agonist and mu-opioid antagonist, for the treatment of various forms of pruritus. Reports of butorphanol to treat cholestatic itch specifically are rare.


AIMS
To better understand the role of butorphanol in the treatment of cholestatic pruritus, including characterization of its side effect profile.


METHODS
We present a case series of eight adult patients with cholestatic disease who were treated with butorphanol in hopes of alleviating intractable pruritus. Patients were identified through a clinical data request form serviced by University of Miami Information Technology.


RESULTS
Five out of eight patients (62.5%) reported successful reductions in itch severity after treatment with butorphanol, two patients reported no (or transient) change in itch severity, and one patient reported a paradoxical increase in itching. Side effects included somnolence, sedation, nausea, vomiting, and dizziness.


CONCLUSIONS
Butorphanol was safe and leads to clinically significant symptomatic improvement. Clinicians should be aware of butorphanol as an off-label treatment option for pruritus of cholestasis. Further studies are needed to better characterize the effect of butorphanol on cholestatic itch.
['Golpanian|Rachel Shireen|RS|', 'Yosipovitch|Gil|G|', 'Levy|Cynthia|C|']
D000328:Adult D000368:Aged D000982:Antipruritics D002077:Butorphanol D002779:Cholestasis D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011537:Pruritus D012074:Remission Induction D012720:Severity of Illness Index D016896:Treatment Outcome
Butorphanol Treatment Pruritus Primary biliary cholangitis Primary sclerosing cholangitis Cholestasis