Ondansetron's Role in Managing Chronic Cholestasis-Related Pruritus

Pruritus poses a significant challenge in the context of pediatric chronic cholestasis, and its uncontrollable nature may even warrant liver transplantation. A recent study explored the effectiveness and potential side effects of orodispersible ondansetron as a supportive treatment for severe pruritus in 27 children with chronic cholestasis. Pruritus severity was assessed at baseline using various parameters, including the visual analog scale (VAS), a four-point sleep disturbance scale, itching in sensitive areas, use of sharp objects during itching, and the presence of pruritus scars.

Ondansetron (once nightly at doses ranging from 4 mg to 8 mg for an 8-week duration) was introduced as an adjunct to long-standing therapies (lasting over three months), such as ursodeoxycholic acid, cholestyramine, or a combination of both. 

The study found significant improvement in 63.6% of children. Notably, a 50% or more reduction in VAS scores was observed in 54.5%, and 63.6% of children reported improved sleep quality. Negative responses or improvements were recorded in itching in sensitive areas (68.2%), use of sharp objects during itching (77.3%), and pruritus scars (50%). There were no significant side effects, except for one patient who experienced severe diarrhea, leading to the discontinuation of ondansetron after two weeks. Laboratory investigations indicated no significant changes after eight weeks of treatment.

Thus, ondansetron emerges as a promising adjunct therapy for severe pruritus in children with chronic cholestasis, particularly in cases where compliance with cholestyramine is suboptimal.

El-koofy NM, Elmonem MA, El-Mahdy M. et al. Ondansetron as a Supportive Therapeutic Agent for Severe Pruritus in Pediatric Patients with Chronic Cholestasis. Indian J Pediatr. 2024; 91: 92. https://doi.org/10.1007/s12098-023-04755-x