TRANSNASAL BUTORPHANOL FOR THE TREATMENT OF OPIOID-INDUCED PRURITUS UNRESPONSIVE TO ANTIHISTAMINES

Pruritus is a common opioid side effect and can be so severe that opio id therapy must be modified or abandoned. Antihistamines opioid antago nists, and propofol have been proposed as treatment options, but none is universally effective. The use of intranasal butorphanol an opioid agonist-antagonist, for pruritus has not been described previously. Si x patients complaining of severe opioid-induced pruritus unresponsive to diphenhydramine received 2 mg intranasal butorphanol every 4-6 hr. Scores for pruritus, pain, and sedation were recorded on separate visu al analogue scales (VAS). All patients reported significant relief fro m pruritus 60 min after butorphanol administration (P < 0. 001); five patients noted an improvement within 15 min (P < 0.08). Sedation and p ain VAS scores were not significantly different from baseline at all t ime points. These preliminary data demonstrate a substantial effect of intranasal butorphanol on opioid-induced pruritus that has not respon ded to antihistamines. Prospective controlled studies are needed to va lidate these findings.