Reuters Health Information (2005-11-21): Lidocaine injection effective for pruritus associated with cholestatic liver disease
Lidocaine injection effective for pruritus associated with cholestatic liver disease
Last Updated: 2005-11-21 15:01:15 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Intravenous lidocaine
alleviates pruritus that is resistant to conventional antipruritic
medications in patients with chronic cholestatic liver diseases,
according to clinicians from the liver unit at Hospital Italiano de
Buenos Aires in Argentina.
"Pruritus is a disturbing clinical problem that often complicates
chronic cholestatic liver disease (and) pathogenesis remains
undefined," Dr. Alejandra G. Villamil and colleagues note in the
October issue of the American Journal of Medicine. "Thus, it is not
surprising that treatment remains empirical and unsatisfactory in a
significant proportion of patients."
Dr. Villamil and associates randomized 18 patients with
treatment-resistant pruritus associated with cholestasis to 100 mg
lidocaine in 5 cc saline or 5 cc saline placebo administered
intravenously over 5 minutes. Each subject recorded the severity of
their pruritus on a visual analogue scale at baseline and every 12
hours (in the morning and evening) over the next 7 days.
Lidocaine was well tolerated in this patient population and led to a
significant reduction (p < 0.05) in pruritus severity relative to
placebo. "Reduction of pruritus was associated with an improvement in
fatigue, probably related to quality of sleep," the authors suggest.
The beneficial effect of lidocaine, a sodium channel blocker, in
pruritus suggests to Dr. Villamil's group that activation of sodium
channels in peripheral nerve endings may play a pathogenic role in
pruritus induced by cholestasis. Based on their findings, they say the
effects of repeated intermittent intravenous boluses of lidocaine or
oral sodium channel blocking agents in pruritus should be studied.
Am J Med 2005;118:1160-1163.