Preliminary observation with dronabinol in patients with intractable pruritus secondary to cholestatic liver disease

Guy W. Neff, Christopher B. O'Brien, K. Rajender Reddy, Nora V. Bergasa, Arie Regev, Enrique Molina, Rafael Amaro, Miguel J. Rodriguez, Ve Etta Chase, Lennox Jeffers, Eugene Schiff

Research output: Contribution to journalArticlepeer-review

84 Scopus citations

Abstract

Pruritus due to cholestatic liver disease can be particularly difficult to manage and frequently is intractable to a variety of medical therapies. The aim of our study is to evaluate the efficacy of Δ-9-tetrahydrocannabinol (Δ-9-THC) for intractable cholestatic related pruritus (ICRP) that has failed conventional (and unconventional) remedies. Three patients were evaluated for plasmapheresis because of ICRP. All 3 patients had previously been extensively treated with standard therapies for ICRP including: diphenhydramine, chlorpheniramine, cholestyramine, rifampicin, phenobarbital, doxepin, naltrexone, UV therapy, and topical lotions. Even multiple courses of plasmapheresis were performed without any benefit for the intractable pruritus. All patients reported significant decreases in their quality of life, including lack of sleep, depression, inability to work, and suicidal ideations. All patients were started on 5 mg of Δ-9-THC (Marinol) at bedtime. All 3 patients reported a decrease in pruritus, marked improvement in sleep, and eventually were able to return to work. Resolution of depression occurred in two of three. Side effects related to the drug include one patient experiencing a disturbance in coordination. Marinol dosage was decreased to 2.5 mg in this patient with resolution of symptoms. The duration of antipruritic effect is approximately 4-6 hrs in all three patients suggesting the need for more frequent dosing. A-9-tetrahydrocannabinol may be an effective alternative in patients with intractable cholestatic pruritus.

Original languageEnglish (US)
Pages (from-to)2117-2119
Number of pages3
JournalAmerican Journal of Gastroenterology
Volume97
Issue number8
DOIs
StatePublished - Aug 1 2002

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Fingerprint Dive into the research topics of 'Preliminary observation with dronabinol in patients with intractable pruritus secondary to cholestatic liver disease'. Together they form a unique fingerprint.

Cite this