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.(Ann Dermatol 28(2) 159∼163, 2016)