The treatment of pruritus, which patients with jaundice and azotemia commonly suffer, has usually in my experience been unsuccessful. The measures commonly employed aim at general or topical sedation or improved biliary excretion.1 The prevailing conjectures as to the nature of the factors involved are that toxic substances such as intermediary carbohydrate metabolites2 or abnormal decomposition products3 affecting the cutaneous nerves are responsible for this symptom. The hypothesis has also been advanced that the mechanism responsible for pruritus is dependent primarily on an increased irritability of the sympathetic nerve endings.
If these substances, regardless of their exact nature, act by increasing the irritability of the sympathetic nervous system, a therapeutic response might be expected from the action of a pharmacologic depressant of this system, such as ergotamine tartrate. Employing this substance as well as other pharmacologically active agents, Brack4 recently tested this hypothesis.
The clinical trial
Lichtman SS. THERAPEUTIC RESPONSE TO ERGOTAMINE TARTRATE IN PRURITUS OF HEPATIC AND RENAL ORIGIN. JAMA. 1931;97(20):1463–1464. doi:10.1001/jama.1931.27310200001009
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