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Persistent pruritus is a vexing clinical problem. Naltrexone is an orally active opiate antagonist that has been shown to relieve itch. To assess the efficacy and safety of naltrexone (50 mg daily), German investigators conducted an open-label pilot study in 50 patients with severe pruritus of various etiologies who had failed antihistamine therapy.
Thirty-five patients had a significant response within 1 week and 15 patients had no improvement. The 15 patients who had complete clearing of pruritus included 3 of 15 with no skin disease, 4 of 18 with skin disease, and 8 of 17 with prurigo nodularis. Only 1 of the 5 patients with itch of unknown origin received any benefit from naltrexone. Side effects were mild; 11 patients had nausea that wa…