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Some patients with chronic cholestatic liver disease have intractable itching that may not respond to standard antipruritic therapies. Because experimental data suggest that endogenous opioids may mediate this symptom, investigators assessed the antipruritic effect of the oral opioid receptor antagonist naltrexone.
Sixteen patients with severe cholestatic pruritus (13 with primary biliary cirrhosis and 3 with sclerosing cholangitis) were randomized to a four-week course of either naltrexone (50 mg daily) or placebo. Patients recorded the intensity of itching on a scale of 0 to 100, with 100 indicating "unbearable itching." In the naltrexone group, the mean score dropped significantly from 65 to 30 during the day, and from 59 to 33 at night. …