Uraemic Pruritus: Relief of Itching by Gabapentin and Pregabalin

Abstract

Background: Pruritus (skin irritation or itching) is common in patients with chronic kidney disease (CKD) stages 4 and 5. It is associated with disrupted sleep, reduced quality of life, depression and increased mortality. A video of a patient describing the symptoms is at vimeo.com/49458473. Methods: We used gabapentin or pregabalin in 71 consecutive patients, 82% male. 25 had CKD stage 4 or 5, median eGFR = 17, range 9-30; 40 were on haemodialysis; 6 on peritoneal dialysis. Median itch severity score out of 10 = 8, range 6-10; median duration of itching = 6 months, range 0.5-240. Serum calcium ≤2.60 mmol/l (≤10.4 mg/dl) in 87% patients, phosphate ≤1.8 mmol/l (≤5.6 mg/dl) in 75%. 63% had used antihistamines and not gained relief. Starting dose of gabapentin 100 mg after dialysis or daily. Patients intolerant of gabapentin were offered pregabalin, starting dose 25 mg after dialysis or daily. Results: Gabapentin relieved itching in 47 patients (66%). A video of a patient describing the effect is at vimeo.com/49455976. 26 patients (37%) suffered side effects from gabapentin. Of 21 patients who stopped gabapentin due to side effects, 16 started pregabalin. Pregabalin relieved itching in 13 patients (81%). In total, gabapentin or pregabalin relieved itching in 60 patients (85%), median follow-up 2 months (range 1-8 months). Median itch severity out of 10 reduced from 8 to 1. Conclusions: Gabapentin or pregabalin relieved itching in 85% of 71 consecutively treated CKD patients. Patients should be advised about side effects and the drug initiated at a low dose. Patients intolerant of gabapentin may tolerate pregabalin.

International Comparisons of Prevalence, Awareness, and Treatment of Pruritus in People on Hemodialysis

“…Furthermore, an association between these measures and pruritus is no longer observed in the 2012-2015 data, a finding supported by other recent studies (11,20,24). There is no published interventional study showing that lowering serum phosphorus improves pruritus.…”

“…Another uncontrolled trial of ketotifen showed no effect on pruritus, and uncontrolled trials of hydroxyzine and chlorphenamine showed a partial effect or no effect (32). Plasma histamine levels are not associated with the severity of pruritus (33), and patients frequently report that antihistamines are ineffective (11,21,34). It has been suggested that antihistamines should be tried first, because they are unlikely to be harmful.…”

“…Pregabalin (n=67) reduced itch severity by 4.6 cm more than placebo (n=57) and also improved sleep quality and health-related quality of life (10). In a case series of 71 patients with severe pruritus, 85% were relieved of itching with gabapentin or pregabalin (11). Use of these agents is supported by European dermatology guidelines (7) and a Cochrane systematic review (12).…”

Role of Pregabalin in Management of Pruritus: A Literature Review

“…Pregabalin alleviated pruritus in 81% of the patients after a median time of 2.5 months (the median severity of itch reduced from 8 to 2). Over sedation was the sole reported adverse effect of pregabalin which occurred in 2 patients (30 Results of a 4 week study designed by Foroutan et al showed that pregabalin (50 mg after each dialysis session) was more effective than doxepin (10 mg/day) in reducing the severity of UP, evaluated by the VAS and 5-D itch scale, and improving quality of life, evaluated by the 5-D itch scale and dermatology life quality index, in a group of hemodialysis patients (N= 72). They also noted that the most antipruritic effects of pregabalin appeared at the end of the first week of the study, and the effects continued through the remained course of the trial.…”

Chronic kidney disease-associated pruritus: impact on quality of life and current management challenges

“…97 Pregabalin, a medication similar to gabapentin, may also improve CKD-aP 37,99 and may be particularly useful when patients are not able to tolerate gabapentin. 1,100 In a randomized, crossover trial, 50 HD patients were assigned to gabapentin 300 mg or pregabalin 75 mg daily. After a 6-week treatment period, both the medications significantly improved pruritus intensity.…”