Clinical Efficacy and Safety of Naltrexone Combination Therapy in Older Patients with Severe Pruritus

Severe pruritus is a challenging condition, and it is more difficult to deal with in older patients due to their limitations in taking oral medication because of underlying diseases, possible interaction with concurrent medications, and poor general condition. We evaluated the efficacy and safety of...

Full description

Saved in:
Bibliographic Details
Published inAnnals of dermatology Vol. 28; no. 2; pp. 159 - 163
Main Authors Lee, Jungsoo, Shin, Jung U, Noh, Seongmin, Park, Chang Ook, Lee, Kwang Hoon
Format Journal Article
LanguageEnglish
Published Korea (South) Korean Dermatological Association; The Korean Society for Investigative Dermatology 01.04.2016
대한피부과학회
Subjects
Online AccessGet full text

Cover

Loading…
Abstract Severe pruritus is a challenging condition, and it is more difficult to deal with in older patients due to their limitations in taking oral medication because of underlying diseases, possible interaction with concurrent medications, and poor general condition. We evaluated the efficacy and safety of naltrexone (Revia®), an opioid antagonist, in elderly patients with severe pruritus that was not easily controlled with conventional antipruritics. Eighteen patients were enrolled, with a mean age of 73 years. They additionally received 50 mg of naltrexone per day for an average of 2 months. Using the visual analogue scale, 13 (72.2%) of 18 patients showed a "much improved" condition, reporting more than a 50% decrease in pruritus intensity. Sixteen (88.9%) showed symptomatic improvement, and only 2 (11.1%) had persistent pruritus. Five patients reported side effects including insomnia, fatigue, constipation, and anorexia. However, reactions were either limited to the first 2 weeks or well managed. Naltrexone could be an effective and safe alternative treatment option to control severe pruritus in older patients.
AbstractList Severe pruritus is a challenging condition, and it is more difficult to deal with in older patients due to their limitations in taking oral medication because of underlying diseases, possible interaction with concurrent medications, and poor general condition. We evaluated the efficacy and safety of naltrexone (Revia®), an opioid antagonist, in elderly patients with severe pruritus that was not easily controlled with conventional antipruritics. Eighteen patients were enrolled, with a mean age of 73 years. They additionally received 50 mg of naltrexone per day for an average of 2 months. Using the visual analogue scale, 13 (72.2%) of 18 patients showed a "much improved" condition, reporting more than a 50% decrease in pruritus intensity. Sixteen (88.9%) showed symptomatic improvement, and only 2 (11.1%) had persistent pruritus. Five patients reported side effects including insomnia, fatigue, constipation, and anorexia. However, reactions were either limited to the first 2 weeks or well managed. Naltrexone could be an effective and safe alternative treatment option to control severe pruritus in older patients.
BACKGROUNDSevere pruritus is a challenging condition, and it is more difficult to deal with in older patients due to their limitations in taking oral medication because of underlying diseases, possible interaction with concurrent medications, and poor general condition. OBJECTIVEWe evaluated the efficacy and safety of naltrexone (Revia®), an opioid antagonist, in elderly patients with severe pruritus that was not easily controlled with conventional antipruritics. METHODSEighteen patients were enrolled, with a mean age of 73 years. They additionally received 50 mg of naltrexone per day for an average of 2 months. RESULTSUsing the visual analogue scale, 13 (72.2%) of 18 patients showed a "much improved" condition, reporting more than a 50% decrease in pruritus intensity. Sixteen (88.9%) showed symptomatic improvement, and only 2 (11.1%) had persistent pruritus. Five patients reported side effects including insomnia, fatigue, constipation, and anorexia. However, reactions were either limited to the first 2 weeks or well managed. CONCLUSIONNaltrexone could be an effective and safe alternative treatment option to control severe pruritus in older patients.
Background: Severe pruritus is a challenging condition, and it is more difficult to deal with in older patients due to their limitations in taking oral medication because of underlying diseases, possible interaction with concurrent medications, and poor general condition. Objective: We evaluated the efficacy and safety of naltrexone (ReviaⓇ), an opioid antagonist, in elderly patients with severe pruritus that was not easily controlled with conventional antipruritics. Methods: Eighteen patients were enrolled, with a mean age of 73 years. They additionally received 50 mg of naltrexone per day for an average of 2 months. Results: Using the visual analogue scale, 13 (72.2%) of 18 patients showed a “much improved” condition, reporting more than a 50% decrease in pruritus intensity. Sixteen (88.9%) showed symptomatic improvement, and only 2 (11.1%) had persistent pruritus. Five patients reported side effects including insomnia, fatigue, constipation, and anorexia. However, reactions were either limited to the first 2 weeks or well managed. Conclusion: Naltrexone could be an effective and safe alternative treatment option to control severe pruritus in older patients. KCI Citation Count: 8
Author Lee, Kwang Hoon
Shin, Jung U
Park, Chang Ook
Lee, Jungsoo
Noh, Seongmin
AuthorAffiliation Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
AuthorAffiliation_xml – name: Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
Author_xml – sequence: 1
  givenname: Jungsoo
  surname: Lee
  fullname: Lee, Jungsoo
  organization: Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
– sequence: 2
  givenname: Jung U
  surname: Shin
  fullname: Shin, Jung U
  organization: Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
– sequence: 3
  givenname: Seongmin
  surname: Noh
  fullname: Noh, Seongmin
  organization: Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
– sequence: 4
  givenname: Chang Ook
  surname: Park
  fullname: Park, Chang Ook
  organization: Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
– sequence: 5
  givenname: Kwang Hoon
  surname: Lee
  fullname: Lee, Kwang Hoon
  organization: Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
BackLink https://www.ncbi.nlm.nih.gov/pubmed/27081261$$D View this record in MEDLINE/PubMed
https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002097487$$DAccess content in National Research Foundation of Korea (NRF)
BookMark eNpVUU1v1DAUtFAR3RbunJCPXBL8EcfOBalatVCpaiu6nC3HeWZNs_ZiJ4X993i7tMBppHkzb0aaE3QUYgCE3lJSC8LoBzPUjNC2ZqpmNRXdC7RghIiKq645QgtKKK86ouQxOsn5OyEtZZK-QsdMEkVZSxcIlqMP3poRnztX0O6wCQO-Mw6mHY4OX5txSvCr5OJl3PQ-mMnHgFdrSGa7wz7gm3GAhG8LD2HK-Kef1vgOHiABvk1z8tOcX6OXzowZ3vzBU_T14ny1_Fxd3Xy6XJ5dVbZh3VTZoaEtU32rpGpaR00re0ktNB3wZhgEEFDMKmIUmF51g3BMEE4k7Qrb94qfoveHvyE5fW-9jsY_4reo75M--7K61KzjgvEi_XiQbud-A4Mt3ZMZ9Tb5jUm7R-P_l-DX5c2DbhRTXMq_WdsUf8yQJ73x2cI4mgBxzppKRQVvhdpnkYPUpphzAvccQ4neD6nNoPdDaqY002XIYnn3b71nw9Ny_DfIsJw_
CitedBy_id crossref_primary_10_1186_s40001_023_01018_5
crossref_primary_10_1371_journal_pone_0188607
crossref_primary_10_1016_j_jaad_2020_07_025
crossref_primary_10_1056_NEJMc1805637
crossref_primary_10_1001_jamadermatol_2018_4093
crossref_primary_10_1007_s42399_019_00137_7
crossref_primary_10_1016_j_cger_2021_07_006
crossref_primary_10_1016_j_jdin_2022_03_007
crossref_primary_10_1016_j_jaad_2020_04_182
crossref_primary_10_1016_j_piel_2019_10_016
crossref_primary_10_3390_ijms25105164
crossref_primary_10_1007_s43440_020_00206_y
crossref_primary_10_1007_s10238_023_01141_x
crossref_primary_10_1111_bph_15672
crossref_primary_10_1016_j_jaad_2018_12_031
crossref_primary_10_3390_ph15070892
crossref_primary_10_1080_17512433_2021_1852080
crossref_primary_10_1016_j_nurpra_2020_05_002
crossref_primary_10_1200_JOP_18_00797
crossref_primary_10_1016_j_jaad_2016_11_021
crossref_primary_10_2174_1389450120666190318121122
crossref_primary_10_1016_j_ad_2021_11_002
crossref_primary_10_1016_j_ad_2022_04_007
Cites_doi 10.1016/S0190-9622(89)80353-6
10.1016/j.cell.2011.08.043
10.1159/000077841
10.1159/000082563
10.1111/j.1440-0960.1997.tb01696.x
10.1111/j.1468-3083.2009.03129.x
10.5021/ad.2011.23.1.1
10.1053/gast.1997.v113.pm9322521
10.1002/j.1552-4604.1987.tb02191.x
10.1111/j.1440-1746.2012.07109.x
10.2340/00015555-1265
10.1016/j.bbadis.2014.02.007
10.7326/0003-4819-123-3-199508010-00001
10.1038/82924
10.1016/j.jaad.2009.08.052
10.1111/j.1365-2125.1980.tb01742.x
10.1007/s002130000666
10.1001/archderm.139.11.1463
10.1034/j.1600-0625.2002.110508.x
10.1213/01.ANE.0000097168.32472.0D
ContentType Journal Article
Copyright Copyright © 2016 The Korean Dermatological Association and The Korean Society for Investigative Dermatology 2016
Copyright_xml – notice: Copyright © 2016 The Korean Dermatological Association and The Korean Society for Investigative Dermatology 2016
DBID NPM
AAYXX
CITATION
7X8
5PM
ACYCR
DOI 10.5021/ad.2016.28.2.159
DatabaseName PubMed
CrossRef
MEDLINE - Academic
PubMed Central (Full Participant titles)
Korean Citation Index
DatabaseTitle PubMed
CrossRef
MEDLINE - Academic
DatabaseTitleList PubMed
MEDLINE - Academic

Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
EISSN 2005-3894
EndPage 163
ExternalDocumentID oai_kci_go_kr_ARTI_293523
10_5021_ad_2016_28_2_159
27081261
Genre Journal Article
GroupedDBID 23M
5-W
53G
5GY
8JR
8XY
9ZL
ACYCR
ADBBV
AENEX
ALMA_UNASSIGNED_HOLDINGS
AOIJS
BAWUL
C1A
DIK
E3Z
EF.
F5P
HYE
HZB
MZR
M~E
NPM
OK1
RPM
TR2
ZZE
AAYXX
CITATION
7X8
5PM
85H
ID FETCH-LOGICAL-c429t-cd41628b687846f1a67b71ce49e34dd5e0e82c80a8eab89d5f250307192c8bb83
IEDL.DBID RPM
ISSN 1013-9087
IngestDate Tue Nov 21 21:42:26 EST 2023
Tue Apr 09 21:53:55 EDT 2024
Fri Aug 16 02:08:20 EDT 2024
Fri Aug 23 03:37:18 EDT 2024
Thu May 23 23:22:19 EDT 2024
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed false
IsScholarly true
Issue 2
Keywords Naltrexone
Elderly
Pruritus
Language English
License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c429t-cd41628b687846f1a67b71ce49e34dd5e0e82c80a8eab89d5f250307192c8bb83
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
G704-002233.2016.28.2.028
OpenAccessLink https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828377/
PMID 27081261
PQID 1781536583
PQPubID 23479
PageCount 5
ParticipantIDs nrf_kci_oai_kci_go_kr_ARTI_293523
pubmedcentral_primary_oai_pubmedcentral_nih_gov_4828377
proquest_miscellaneous_1781536583
crossref_primary_10_5021_ad_2016_28_2_159
pubmed_primary_27081261
PublicationCentury 2000
PublicationDate 2016-04-01
PublicationDateYYYYMMDD 2016-04-01
PublicationDate_xml – month: 04
  year: 2016
  text: 2016-04-01
  day: 01
PublicationDecade 2010
PublicationPlace Korea (South)
PublicationPlace_xml – name: Korea (South)
PublicationTitle Annals of dermatology
PublicationTitleAlternate Ann Dermatol
PublicationYear 2016
Publisher Korean Dermatological Association; The Korean Society for Investigative Dermatology
대한피부과학회
Publisher_xml – name: Korean Dermatological Association; The Korean Society for Investigative Dermatology
– name: 대한피부과학회
References 10495371 - J Am Acad Dermatol. 1999 Oct;41(4):533-9
7598296 - Ann Intern Med. 1995 Aug 1;123(3):161-7
7000110 - Br J Clin Pharmacol. 1980 Aug;10(2):180-3
11349393 - Psychopharmacology (Berl). 2001 Apr;154(4):397-402
14623706 - Arch Dermatol. 2003 Nov;139(11):1463-70
22413872 - J Gastroenterol Hepatol. 2012 Jul;27(7):1150-8
3680580 - J Clin Pharmacol. 1987 Mar;27(3):233-9
9431714 - Australas J Dermatol. 1997 Nov;38(4):196-8
19453814 - J Eur Acad Dermatol Venereol. 2009 Aug;23(8):948-50
20462660 - J Am Acad Dermatol. 2010 Oct;63(4):680-8
21738356 - Ann Dermatol. 2011 Feb;23(1):1-11
15178915 - Dermatology. 2004;208(4):326-30
15724090 - Dermatology. 2005;210(2):91-9
22000021 - Cell. 2011 Oct 14;147(2):447-58
9322521 - Gastroenterology. 1997 Oct;113(4):1264-9
24568861 - Biochim Biophys Acta. 2014 Jul;1842(7):869-92
14742371 - Anesth Analg. 2004 Feb;98(2):364-70, table of contents
2745760 - J Am Acad Dermatol. 1989 Jul;21(1):135-6
12366698 - Exp Dermatol. 2002 Oct;11(5):448-55
11135647 - Nat Neurosci. 2001 Jan;4(1):72-7
22102095 - Acta Derm Venereol. 2012 Sep;92(5):497-501
Phan (10.5021/ad.2016.28.2.159_ref13) 2010; 63
Liu (10.5021/ad.2016.28.2.159_ref8) 2011; 147
Heyer (10.5021/ad.2016.28.2.159_ref19) 2002; 11
Monroe (10.5021/ad.2016.28.2.159_ref16) 1989; 21
Ständer (10.5021/ad.2016.28.2.159_ref9) 2003; 139
Wolfhagen (10.5021/ad.2016.28.2.159_ref18) 1997; 113
Sullivan (10.5021/ad.2016.28.2.159_ref21) 1997; 38
Imam (10.5021/ad.2016.28.2.159_ref12) 2012; 27
Grundmann (10.5021/ad.2016.28.2.159_ref3) 2011; 23
Andrew (10.5021/ad.2016.28.2.159_ref11) 2001; 4
Dixon (10.5021/ad.2016.28.2.159_ref20) 1987; 27
Metze (10.5021/ad.2016.28.2.159_ref7) 1999; 41
Kremer (10.5021/ad.2016.28.2.159_ref1) 2014; 1842
Bergasa (10.5021/ad.2016.28.2.159_ref15) 1995; 123
Reich (10.5021/ad.2016.28.2.159_ref2) 2012; 92
Blunk (10.5021/ad.2016.28.2.159_ref10) 2004; 98
Bigliardi-Qi (10.5021/ad.2016.28.2.159_ref14) 2005; 210
Malekzad (10.5021/ad.2016.28.2.159_ref5) 2009; 23
Legroux-Crespel (10.5021/ad.2016.28.2.159_ref6) 2004; 208
Oncken (10.5021/ad.2016.28.2.159_ref4) 2001; 154
Summerfield (10.5021/ad.2016.28.2.159_ref17) 1980; 10
References_xml – volume: 21
  start-page: 135
  year: 1989
  ident: 10.5021/ad.2016.28.2.159_ref16
  publication-title: J Am Acad Dermatol
  doi: 10.1016/S0190-9622(89)80353-6
  contributor:
    fullname: Monroe
– volume: 147
  start-page: 447
  year: 2011
  ident: 10.5021/ad.2016.28.2.159_ref8
  publication-title: Cell
  doi: 10.1016/j.cell.2011.08.043
  contributor:
    fullname: Liu
– volume: 208
  start-page: 326
  year: 2004
  ident: 10.5021/ad.2016.28.2.159_ref6
  publication-title: Dermatology
  doi: 10.1159/000077841
  contributor:
    fullname: Legroux-Crespel
– volume: 210
  start-page: 91
  year: 2005
  ident: 10.5021/ad.2016.28.2.159_ref14
  publication-title: Dermatology
  doi: 10.1159/000082563
  contributor:
    fullname: Bigliardi-Qi
– volume: 38
  start-page: 196
  year: 1997
  ident: 10.5021/ad.2016.28.2.159_ref21
  publication-title: Australas J Dermatol
  doi: 10.1111/j.1440-0960.1997.tb01696.x
  contributor:
    fullname: Sullivan
– volume: 23
  start-page: 948
  year: 2009
  ident: 10.5021/ad.2016.28.2.159_ref5
  publication-title: J Eur Acad Dermatol Venereol
  doi: 10.1111/j.1468-3083.2009.03129.x
  contributor:
    fullname: Malekzad
– volume: 23
  start-page: 1
  year: 2011
  ident: 10.5021/ad.2016.28.2.159_ref3
  publication-title: Ann Dermatol
  doi: 10.5021/ad.2011.23.1.1
  contributor:
    fullname: Grundmann
– volume: 113
  start-page: 1264
  year: 1997
  ident: 10.5021/ad.2016.28.2.159_ref18
  publication-title: Gastroenterology
  doi: 10.1053/gast.1997.v113.pm9322521
  contributor:
    fullname: Wolfhagen
– volume: 27
  start-page: 233
  year: 1987
  ident: 10.5021/ad.2016.28.2.159_ref20
  publication-title: J Clin Pharmacol
  doi: 10.1002/j.1552-4604.1987.tb02191.x
  contributor:
    fullname: Dixon
– volume: 27
  start-page: 1150
  year: 2012
  ident: 10.5021/ad.2016.28.2.159_ref12
  publication-title: J Gastroenterol Hepatol
  doi: 10.1111/j.1440-1746.2012.07109.x
  contributor:
    fullname: Imam
– volume: 92
  start-page: 497
  year: 2012
  ident: 10.5021/ad.2016.28.2.159_ref2
  publication-title: Acta Derm Venereol
  doi: 10.2340/00015555-1265
  contributor:
    fullname: Reich
– volume: 1842
  start-page: 869
  year: 2014
  ident: 10.5021/ad.2016.28.2.159_ref1
  publication-title: Biochim Biophys Acta
  doi: 10.1016/j.bbadis.2014.02.007
  contributor:
    fullname: Kremer
– volume: 123
  start-page: 161
  year: 1995
  ident: 10.5021/ad.2016.28.2.159_ref15
  publication-title: Ann Intern Med
  doi: 10.7326/0003-4819-123-3-199508010-00001
  contributor:
    fullname: Bergasa
– volume: 4
  start-page: 72
  year: 2001
  ident: 10.5021/ad.2016.28.2.159_ref11
  publication-title: Nat Neurosci
  doi: 10.1038/82924
  contributor:
    fullname: Andrew
– volume: 63
  start-page: 680
  year: 2010
  ident: 10.5021/ad.2016.28.2.159_ref13
  publication-title: J Am Acad Dermatol
  doi: 10.1016/j.jaad.2009.08.052
  contributor:
    fullname: Phan
– volume: 10
  start-page: 180
  year: 1980
  ident: 10.5021/ad.2016.28.2.159_ref17
  publication-title: Br J Clin Pharmacol
  doi: 10.1111/j.1365-2125.1980.tb01742.x
  contributor:
    fullname: Summerfield
– volume: 154
  start-page: 397
  year: 2001
  ident: 10.5021/ad.2016.28.2.159_ref4
  publication-title: Psychopharmacology (Berl)
  doi: 10.1007/s002130000666
  contributor:
    fullname: Oncken
– volume: 139
  start-page: 1463
  year: 2003
  ident: 10.5021/ad.2016.28.2.159_ref9
  publication-title: Arch Dermatol
  doi: 10.1001/archderm.139.11.1463
  contributor:
    fullname: Ständer
– volume: 11
  start-page: 448
  year: 2002
  ident: 10.5021/ad.2016.28.2.159_ref19
  publication-title: Exp Dermatol
  doi: 10.1034/j.1600-0625.2002.110508.x
  contributor:
    fullname: Heyer
– volume: 41
  start-page: 533
  year: 1999
  ident: 10.5021/ad.2016.28.2.159_ref7
  publication-title: J Am Acad Dermatol
  contributor:
    fullname: Metze
– volume: 98
  start-page: 364
  year: 2004
  ident: 10.5021/ad.2016.28.2.159_ref10
  publication-title: Anesth Analg
  doi: 10.1213/01.ANE.0000097168.32472.0D
  contributor:
    fullname: Blunk
SSID ssj0061271
Score 2.1912575
Snippet Severe pruritus is a challenging condition, and it is more difficult to deal with in older patients due to their limitations in taking oral medication because...
BACKGROUNDSevere pruritus is a challenging condition, and it is more difficult to deal with in older patients due to their limitations in taking oral...
Background: Severe pruritus is a challenging condition, and it is more difficult to deal with in older patients due to their limitations in taking oral...
SourceID nrf
pubmedcentral
proquest
crossref
pubmed
SourceType Open Website
Open Access Repository
Aggregation Database
Index Database
StartPage 159
SubjectTerms Original
피부과학
Title Clinical Efficacy and Safety of Naltrexone Combination Therapy in Older Patients with Severe Pruritus
URI https://www.ncbi.nlm.nih.gov/pubmed/27081261
https://search.proquest.com/docview/1781536583
https://pubmed.ncbi.nlm.nih.gov/PMC4828377
https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002097487
Volume 28
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
ispartofPNX Annals of Dermatology, 2016, 28(2), , pp.159-163
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1La9wwEBbZHEovpe9u-kCFXnqwdy1blnwsISEtbLqQBHITeozaJRtt8Hqh-fcdWXbolp56ssEykvWNNd9Y428I-QSudJJ5nzUNE1lVGDzjjGfou6Hw2tRlXxtwcV6fXVXfrvn1AeHjvzB90r41qzysb_Ow-tnnVt7d2tmYJzZbLo4rGTVbxGxCJqIsxxA9Lb_osVOUFcsWNHMp0t4kR18201EatKhzJnOWox-PSsACfSKriz23NAmt_xfj_Dtx8g9PdPqUPBkoJP2ShvqMHEB4Th4thk3yFwQGrc81PYn6ENreUx0cvdAeunu68fRcr7sWfm0CUFwOMDTu0aGXSWCArgL9Hmt302XSXN3S-LGWXgBaPdBlG-vd7bYvydXpyeXxWTZUU8gs-pwusw65F5OmlgI5hy90LYwoLFQNlJVzHOYgmZVzLUEb2TjukR3hCoAU0EpjZPmKHAYc2RtCC2dcyQoNwBFSb4zhls2ZQ_qE778TU_J5nEx1l0QzFAYbEQOlnYoYKCYVU4jBlHzE2VY3dqWi0nU8_tiom1Yhn_-qkIxgpIxtRiwUWn_c0tABNrutKoTEJRtZFLZ5nbB56HGEdkrEHmoPDWJ_-1fQ4HqF7cHAjv77zrfkcXzKlOLzjhx27Q7eI3vpzIfeWn8DRALuNQ
link.rule.ids 230,315,733,786,790,891,27957,27958,53827,53829
linkProvider National Library of Medicine
linkToHtml http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1db9MwFLW2IQEvjK9B2QAj8cJD0saJY-dxmjZ1sJZK69DeLH8FqnbulKbStl_PdZxMdOIFnhIpjhLr2D7nxjfnIvTZmtRwUpZRURAWZYmCM0poBNxtk1KqPG1qA47G-fAi-3pJL7cQ7f6FaZL2tZrFbnEVu9mvJrfy-kr3uzyx_mR0lHHv2cL62-gRzFfCuiA9LMDA2SHO8oULigFnYXeSApv1pTcHTfKY8JjEwOTeC5gBK5I82SCmbVeVf9OcD1Mn_-Cik130o-tFSEGZx-taxfrugcHjP3fzOXrWqlN8GC6_QFvWvUSPR-3--ytkWxvRBT721hNS32LpDD6Xpa1v8bLEY7moK3uzdBbDSgNRdwM8ngbvAjxz-LsvC44nwc51hf13YHxuYUJZPKl8Kb316jW6ODmeHg2jtlBDpIHO6kgbkHWEq5wzkDNlInOmWKJtVtg0M4bageVE84HkVipeGFqC8ILFBdSl5krxdA_tOHiztwgnRpmUJNJaCqOlVEpRTQbEgDKDpcWwHvrSoSSugx-HgDjGgyukER5cQbggAsDtoU8Ao5jrmfAm2v74cynmlYBQ4VSAzoEgHNp0IAuYWH63RDq7XK9EwjiwAQg0aPMmgH7_xG7M9BDbGA73DfzzNq8AyI15dwvqu_--8yN6MpyOzsTZ6fjbPnrqexwyiQ7QTl2t7XsQSbX60EyJ3xBwEEM
linkToPdf http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1ba9swGBVrB2Uvu6_LrhrsZQ-2I_ki-XF0De22ZIG2UPYidN1CUic4DrT99ftk2aUpe-qTDZaRxZF0zmd9nA-hz9akhlPnorKkLMqIgruc5hFwtyVOqiJtawOOJ8XRWfb9PD-_VeqrTdrXahZXi4u4mv1tcytXFzrp88SS6fgg496zhSUr45Id9BDWLC37QD1swsDbIdbyxQvKIWfhhDIHRkukNwglRUx5TGNgc-8HzIAZaUG2yGmnqt3_dOfd9MlbfDR6gn73IwlpKPN406hYX98xebzXUJ-ix51KxV9Dk2foga2eo71xdw7_AtnOTnSBD70FhdRXWFYGn0hnmyu8dHgiF01tL5eVxbDjQPTdTgB8GjwM8KzCv3x5cDwNtq5r7P8H4xMLC8viae1L6m3WL9HZ6PD04CjqCjZEGmitibQBeUe5KjgDWeOILJhiRNustGlmTG6HllPNh5JbqXhpcgcCDDYZUJmaK8XTV2i3gi97jTAxyqSUSGtzmDVOKZVrOqQGFBpsMYYN0JceKbEKvhwC4hkPsJBGeIAF5YIKAHiAPgGUYq5nwptp--ufpZjXAkKGYwF6B4JxaNMDLWCB-VMTWdnlZi0I48AKINSgzX4A_qbHft4MENuaEjcNfH_bTwDo1sS7A_bNvd_8iPam30bi5_Hkx1v0yA84JBS9Q7tNvbHvQSs16kO7Kv4BmtcSww
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Clinical+Efficacy+and+Safety+of+Naltrexone+Combination+Therapy+in+Older+Patients+with+Severe+Pruritus&rft.jtitle=Annals+of+dermatology&rft.au=%EC%9D%B4%EC%A0%95%EC%88%98&rft.au=%EC%8B%A0%EC%A0%95%EC%9A%B0&rft.au=%EB%85%B8%EC%84%B1%EB%AF%BC&rft.au=%EB%B0%95%EC%B0%BD%EC%9A%B1&rft.date=2016-04-01&rft.pub=%EB%8C%80%ED%95%9C%ED%94%BC%EB%B6%80%EA%B3%BC%ED%95%99%ED%9A%8C&rft.issn=1013-9087&rft.eissn=2005-3894&rft.spage=159&rft.epage=163&rft_id=info:doi/10.5021%2Fad.2016.28.2.159&rft.externalDBID=n%2Fa&rft.externalDocID=oai_kci_go_kr_ARTI_293523
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1013-9087&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1013-9087&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1013-9087&client=summon