• Effect of mirtazapine on pruritus in patients on hemodialysis: a cross over study
  • Mahtabalsadat Mirjalili,1 Ehsan Mirzaei,2 Mahmoud Gholyaf,3 Vida Sheikh,4 Fatemeh Yasrebifar,5 Maryam Mehrpooya,6,*
    1. Shiraz University of Medical Science
    2. Shiraz University of Medical Science
    3. Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences
    4. Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences
    5. Hamadan University of Medical Sciences
    6. Hamadan University of Medical Sciences


  • Introduction: Uremic pruritus (UP) is a highly prevalent and disturbing problem in patients with advanced chronic kidney disease (CKD); however, treatment of UP is largely unsatisfactory. The present study was designed to investigate the effectiveness of mirtazapine in the treatment of pruritus in hemodialysis (HD) patients.
  • Methods: An 8-week, prospective, open-label, and cross-over randomized clinical trial study was conducted in 77 HD patients with chronic pruritus. After two-week wash out period, eligible patients were randomly assigned either to the mirtazapine (15 mg per day) or gabapentin (100 per day) for two weeks. Following two weeks washout period, subjects crossed over to the other treatment arm for two more weeks. The severity of pruritus was measured seven times during each treatment period by using the visual analog scale (VAS). Furthermore, at the end of the study, patients were also blindly asked which treatment they preferred.
  • Results: 61 patients completed the study. Although both gabapentin and mirtazapine resulted in significant decrease in VAS scores, decrease in pruritus severity was significantly greater in mirtazapine compared with gabapentin treatment period (P<0.001). Furthermore, although side effects such as drowsiness and dry mouth were more common in mirtazapine treatment period, higher percentage of the patients preferred mirtazapine for treatment of pruritus symptoms.
  • Conclusion: Although preliminary, our study provides evidence that mirtazapine can be an effective therapy for UP in patients who are on maintenance HD. Further studies would be necessary to confirm effectiveness as well as safety of mirtazapine in the long-term management of chronic pruritus.
  • Keywords: Chronic kidney disease, Uremic pruritus, Mirtazapine, Gabapentin