Abstract
BackgroundPruritus is a distressing symptom seen in palliative care. There is limited high-quality evidence of pharmaceutical treatments for pruritus in palliative care, including the use of paroxetine.Case presentationI present a case of a 70-year-old caucasian woman with metastatic ovarian cancer who presented with severe pruritus. She had been diagnosed with bile duct obstruction 1 month earlier. Antihistamines and over-the-counter skin creams were first trialed, to no effect. Paroxetine was started at 5 mg in the evening, with the intention of titrating up. However, 5 mg of paroxetine was effective, and the patient’s pruritus fully resolved after the second day.ConclusionsThis case supports the use of paroxetine as a therapy for pruritus in palliative care patients and suggests that paroxetine may be effective at a very low dose.
Highlights
Pruritus is a distressing symptom seen in palliative care
This case supports the use of paroxetine as a therapy for pruritus in palliative care patients and suggests that paroxetine may be effective at a very low dose
The optimal pharmaceutical therapy in palliative care for pruritus secondary to malignancy is unclear; studies and guidelines provide contrary recommendations [3,4,5]. This is reflected in the conclusion of authors of a 2016 Cochrane systematic review which indicated that there was insufficient evidence to recommend a treatment of pruritus secondary to malignancy [1]
Summary
Pruritus is a distressing symptom seen in palliative care. It can be associated with any cancer, and it is more frequently seen in patients with hematologic, solid tumors (paraneoplasia) and biliary tract malignancies [1]. A stent was attempted several days later but was not successful In collaboration with her oncologist, it was decided not to pursue further active treatment, and palliative care was initiated. Kraut Journal of Medical Case Reports (2017) 11:280 her sleep was significantly disturbed She indicated her pruritus was 8/10 on a numerical rating scale (NRS), with a score of 0 reflecting no pruritus and a score of 10 reflecting the worst pruritus. My colleagues and I decided to try paroxetine on the basis of its preferable side effect profile, in that it is less sedating She was started on 5 mg nightly, with the intention to increase the dose as tolerated. She continued on 5 mg of paroxetine nightly, with no pruritus until she died 1 week later
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