Purpose: To report a case of successful treatment of pruritus with mirtazapine in a patient with advanced cancer. Case summary: A male patient in his seventies with advanced malignant lymphoma had pruritus. The patient began to have pruritus within a few days after starting anti-epilepsy treatment. Oral mirtazapine was administered at a dose of 15 mg/day. Within 2 days, the patient showed partial improvement of his symptoms. After 7 days of mirtazapine therapy, the pruritus significantly improved. While the patient was taking a dose of 15 mg/day, he remained asymptomatic. Conclusion: There are only a few reports (none in Japan) showing the effectiveness of mirtazapine against pruritus in patients with advanced cancer. Although the mechanism of the pruritus-relieving effect of mirtazapine is not fully understood, this case report indicates that mirtazapine may help in the treatment of patients suffering from intractable pruritus.

Purpose: To report a case of successful treatment using gabapentin against hot flashes due to LH-RH agonist in a patient with advanced prostate cancer. Case summary: A male patient in his seventies with advanced prostate cancer had hot flashes due to LH-RH agonist therapy. The patient began to notice hot flashes within a few months after starting hormone treatment. Oral gabapentin was administered at a starting dose of 400mg/day and was gradually escalated to 1,200mg/day. Within 7 days of administration, the patient achieved a partial improvement of his symptoms. After 17 days of gabapentin therapy, the hot flashes significantly improved. While the patient was taking a maintenance dose of 1,200mg/day, he remained to be asymptomatic. Conclusion: There are only a few reports (none in Japan) that show effectiveness of gabapentin against hot flashes due to hormone treatment in male patients with prostate cancer. Although the mechanism of the hot flash-relieving effect of gabapentin is not fully understood, this case report indicates that gabapentin may help treating patients suffering from intractable hot flashes. Palliat Care Res 2009; 4(2): 334-338