Clinical

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.