The role of ondansetron in the management of cholestatic or uremic pruritus—A systematic review
To, T. H. M., Clark, K., Lam, L., Shelby-James,T., Currow, D. C. (2012). The role of ondansetron in the management of cholestatic or uremic pruritus—A systematic review. Journal of Pain and Symptom Management, 44(5), 725–730. doi:10.1016/j.jpainsymman.2011.11.007
Context: Pruritus associated with hepatic or renal failure can be a troublesome symptom, refractory to treatment and associated with significant physical and emotional distress and a reduction in quality of life for patients already burdened with chronic disease. Serotonin has been implicated as a possible pathological mediator, and, therefore, 5HT3 antagonists have been suggested as a possible therapeutic intervention.
Objectives: This review of the literature systematically explores the role of ondansetron in the management of cholestatic or uremic pruritus.
Methods: Electronic databases were systematically searched for randomized controlled trials examining the role of ondansetron in cholestatic or uremic pruritus between 1966 and 2008.
Results: Five randomized controlled trials were included in this systematic review: three for cholestatic pruritus and two for uremic pruritus. All trials examined ondansetron vs. placebo, with differing treatment protocols. Overall, three studies showed no benefit to ondansetron over placebo; however, two studies in cholestatic pruritus showed small reductions in pruritus with questionable clinical significance.
Conclusion: Ondansetron was demonstrated to have negligible effect on cholestatic or uremic pruritus on the basis of a limited number of studies.