Treatment of Chronic Pruritus with the Selective Serotonin Re-uptake Inhibitors Paroxetine and Fluvoxamine: Results of an Open-labelled, Two-arm Proof-of-concept Study

Abstract

Chronic pruritus is difficult to treat and requires the evaluation of new therapeutic modalities. We initiated an open-labelled, two-arm prospective, proof-of-concept study applying two selective serotonin re-uptake inhibitors on a long-term basis. Paroxetine and fluvoxamine were tested in a total of 72 pruritic patients (27 men, 45 women, age range 28-88 years, mean age 59.2 years). The reduction in pruritus was evaluated by analysis of visual analogue scores and determination of the maximal antipruritic effect (maximal percentual reduction in pruritus). Forty-nine of 72 patients (68.0%) experienced a weak (n=9), good (n=16) or very good (n=24) antipruritic effect. Statistical analysis proved the efficacy of paroxetine and fluvoxamine with no significant difference. The best response was observed in patients with pruritus due to atopic dermatitis, systemic lymphoma and solid carcinoma. Chronic scratch lesions healed completely in 14/31 patients and partially in 17/31 patients. Adverse drug effects were observed in 70.8% of patients, resulting in discontinuation of treatment in 18 patients. These results support previous reports of high antipruritic potency of selective serotonin re-uptake inhibitors, which are a good alternative treatment modality in chronic pruritus. This should be confirmed in future double-blind studies.

Chronic Pruritus: Clinics and Treatment

“…Paroxetine (20 mg/d) was reported to have a very good antipruritic effect in patients with polycythemia vera, psychogenic and paraneoplastic pruritus as well as in pruritus of non-dermatologic origin 49 . A recent study confirms that paroxetine and fluvoxamine have beneficial effects in different types of pruritus 50 . As severe cardiac and central nervous side effects like drowsiness, vertigo and fatigue have been described especially in elderly patients this therapy should be used with caution until ongoing studies have been completed.…”

Fluoxetine (SSRI) treatment of canine atopic dermatitis: a randomized, double-blind, placebo-controlled, crossover trial

“…These studies assumed that SSRI show efficacy for pruritus associated with the central nervous system rather than the peripheral nervous system (Ständer et al 2009). In this study, fluoxetine showed no efficacy for pruritus in CAD by CA-DESI-03 and PVAS.…”

Psychopharmakatherapie bei Pruritus

“…Tab. 1, [23]). In dieser Studie hatten 70% der Patienten Nebenwirkungen wie Schläfrig-keit, Müdigkeit, sexuelle Dysfunktionen etc., die bei 18 Patienten zur Beendigung der Therapie führten.…”

“…Nur wenige dieser Studien untersuchten die Beschwerdesymptomatik gezielt mithilfe von visuellen Analogskalen oder evalulierten Fragebögen [17,21,22,23]. Ferner wurde der Großteil der Studien nicht placebokontrolliert durchgeführt.…”