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Re: Paroxetine in the Treatment of Severe Non-Dermatological Pruritus

      To the Editor:
      In their paper,
      • Zylicz Z.
      • Krajnik M.
      • van Sorge A.A.
      • Costantini M.
      Paroxetine in the treatment of severe non-dermatological pruritus: A randomized controlled trial.
      Dr. Zylicz and colleagues draw a conclusion that “Paroxetine may be effective in the treatment of intractable severe non-dermatological pruritus associated with advanced cancer and other systemic disease.” We feel that this is not a reasonable conclusion from the study for the following reasons:
      • 1.
        As the authors themselves point out in their introduction, 5-HT3 receptor antagonism is a possible way of treating pruritus. Using cisapride, a drug “which presumably acts as a 5-HT3 receptor antagonist,” introduced a confounding factor into the study. It is possible that pruritus was controlled in some of the patients by cisapride rather than paroxetine. Use of a different antiemetic could possibly have avoided such a confounding factor.
      • 2.
        The patient group was not identical as far as the cause of pruritus was concerned. We know that a drug that confers antipruritic effect in cholestasis, for example, may not be effective in opioid-induced pruritus. As far as could be made out from the paper, the study showed that paroxetine was possibly effective in some patients with pruritus from among a divergent group. For all we know, the drug may have been extremely effective in one or two clinical situations, and not at all in some others. Hence the conclusion that paroxetine is effective in pruritus of diverse origins seems unjustifiable.
      Incidentally, we tried to look up the review by Dr. Twycross listed as Reference 1 in the Introduction. The reference section does not mention such a review.
      Despite their reservations, the authors thank Dr. Zylicz and colleagues for pursuing the vexing problem of pruritus and for bringing us closer to a solution.

      Reference

        • Zylicz Z.
        • Krajnik M.
        • van Sorge A.A.
        • Costantini M.
        Paroxetine in the treatment of severe non-dermatological pruritus: A randomized controlled trial.
        J Pain Symptom Manage. 2003; 26: 1105-1112