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Alice He [1] and Jihad M. Alhariri [1] and Ronald J. Sweren [1] and Madan M. Kwatra [2] and Shawn G. Kwatra [1]

Academic Editor: Adam Reich

1, Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA, jhu.edu

2, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA, duke.edu

Received Mar 7, 2017; Revised Apr 20, 2017; Accepted Aug 14, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Chronic itch is a distressing condition for patients with a significant effect on quality of life. If a patient is nonresponsive to topical therapy, there are limited systemic options available. Current options include corticosteroids, antihistamines, capsaicin, naltrexone, gabapentin, UV light therapy, and immunomodulatory treatments such as azathioprine, methotrexate, and cellcept. The purpose of this review is to make dermatologists aware of aprepitant as a medication that is effective for treating subsets of patients with chronic refractory pruritus.

Aprepitant was first approved in the United States in March 2003 to prevent chemotherapy-induced nausea and vomiting (CINV) [1]. The drug was originally developed to treat depression, but clinical trials failed to demonstrate an effect in a nontoxic dosage range [2]. Aprepitant is a neurokinin-1 (NK1) receptor antagonist and is the first of its class to be approved for use [3]. Aprepitant exerts its effects by blocking substance P (SP), an endogenous ligand of the NK1 receptor. Substance P mediates several physiologic processes, including pain, depression, nausea, vomiting, and pruritus [3]. As such, there is much excitement over the potential for developing NK1 receptor antagonists as a therapy for many disease states.

Recently clinicians have discovered an off-label use for aprepitant to treat chronic refractory pruritus. Concerns for aprepitant use include its high cost and potential interactions with multiple other drugs. Herein we review aprepitant’s efficacy as an antipruritic agent, mechanisms of action, and adverse effects.

2. Materials and Methods

In December 2015 through April 2017, we conducted a literature search of PubMed, Ovid MEDLINE, clinicaltrials.gov, and Google Scholar for key word combinations of “aprepitant” coupled with “pruritus,” “itch,” and “antipruritic.” All results were checked for relevance.

3. Results and Discussion
 
 

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