Medical palliation of the jaundiced patient with pruritus

Cholestasis secondary to infiltration of the liver by malignant tumors or by obstruction of the biliary tree can be complicated by pruritus. The clinician and ancillary personal must recognize how debilitating pruritus is and identify the treatment of this symptom as a priority. This article reviews the pharmacologic treatment of the pruritus of cholestasis, with an emphasis on that condition secondary to malignancy. There are few data from controlled clinical trials in this group of patients; thus, much of the discussion will center on the treatments used for the pruritus of cholestasis that is not secondary to malignancy but, nevertheless, may be useful in that difficult situation.