Paroxetine for cancer related pruritus: a case report

Abstract

Purpose: Pruritus is a rare symptom among advanced cancer patients. This rarity results in limited knowledge about its mechanisms and treatments. Moreover, many previous studies have proposed pharmacological interventions to alleviate pruritus of not malignant disease but chronic liver disease (e.g. primary biliary cirrhosis). Recently, the antipruritic activity of paroxetine has been reported in various systemic disease. Case report: We report a case of 72-year-old female diagnosed hepatocellular carcinoma with liver cirrhosis. On admission, although jaundice was detected on her conjunctiva and skin with high serum total bilirubin level 3.4mg/dL (direct bilirubin 2.3mg/dL), she did not complain of pruritus. Gradually, she suffered from pruritus with no exanthema on her entire skin and perceived no beneficial effect from H1-antihistamine and topical steroid administrations (symptom score 7/10). Significant antipruritic effect was achieved immediately with oral paroxetine 10mg on day 13. On day 14, she scored pruritus on whole body at 0/10, and this antipururitic effect was observed for 2 weeks after administration until her death. No adverse effects were reported. Conclusion: Paroxetine is an antidepressant agent classified selective serotonin reuptake inhibitors. The antipruritic activity of paroxetine is possible due to the involvement of changing itch signal from peripheral serotoninergic receptor to central nervous system and inhibiting the enzyme activation (CYP2D6) of endogeneous opioids as pruritogens. We have observed the beneficial effect of paroxetine to alleviate pruritus due to malignant jaundice.