Clinical and Administrative Sciences, Department of Pharmacy, University of Oklahoma College of Pharmacy, Oklahoma City, OK 73117, USA.
Am J Health Syst Pharm. 2011 Aug 1;68(15):1419-25. doi: 10.2146/ajhp100475.
Published reports on placebo-controlled clinical trials and other studies investigating the use of pure opioid antagonists for the prevention and treatment of opioid-induced pruritus (OIP) were evaluated.
OIP is a common adverse effect of therapeutic use of opioid medications that can have a major impact on patients' comfort, quality of life, and willingness to continue opioid therapy. A literature search identified more than a dozen published reports on the use of pure opioid antagonists (naloxone, naltrexone, methylnaltrexone) for the management of OIP in pediatric and adult patients. Of the studies included in this review, most investigated the effects of naloxone administered by various parenteral routes for the prevention of OIP. Some of those studies indicated a significant reduction in the frequency or severity of pruritus with use of naloxone (a low-dose, continuous i.v. infusion of naloxone appeared to be the most effective treatment). A significant diminution of analgesia requiring increased cumulative doses of morphine was also observed in some studies. A number of studies evaluating the use of orally administered naltrexone for the management of OIP yielded generally less favorable results. Evidence from one small study suggested a potential role for orally administered methylnaltrexone in the prevention of OIP.
Based on the existing data, a low-dose, continuous i.v. infusion of naloxone has the largest body of evidence supporting its use for prevention of OIP in adult and pediatric patients.
评估了已发表的关于安慰剂对照临床试验和其他研究的报告，这些研究调查了纯阿片类拮抗剂在预防和治疗阿片类药物引起的瘙痒（OIP）中的应用。
OIP 是治疗性使用阿片类药物的常见不良反应，会对患者的舒适度、生活质量和继续接受阿片类药物治疗的意愿产生重大影响。文献检索确定了十多篇关于纯阿片类拮抗剂（纳洛酮、纳曲酮、甲基纳曲酮）用于管理儿科和成人患者 OIP 的已发表报告。在本综述中包括的研究中，大多数研究调查了各种肠外途径给予纳洛酮预防 OIP 的效果。其中一些研究表明，使用纳洛酮可显著减少瘙痒的频率或严重程度（低剂量、持续静脉内输注纳洛酮似乎是最有效的治疗方法）。一些研究还观察到，镇痛效果明显下降，需要增加吗啡的累积剂量。评估口服纳曲酮治疗 OIP 的多项研究得出的结果通常不太理想。一项小型研究的证据表明，口服给予甲基纳曲酮可能在预防 OIP 方面具有潜在作用。
根据现有数据，低剂量、持续静脉内输注纳洛酮在预防成人和儿科患者 OIP 方面的证据最多。
