We read with interest the letter by Horsmans and Geubel [1] about the impressive efficacy of grapefruit juice in the treatment of cholestasis-induced severe pruritus. We report our experience with such therapy in five patients with cholestasis-induced pruritus. All of our patients had pruritus that was unresponsive to sequential treatment with bile acid-sequestering resin followed by terfenadine. The cholestasis was related to primary biliary cirrhosis in two patients who were treated continuously with ursodiol, to drug-induced hepatitis (caused by cyamamezine) in one patient, to acute viral hepatitis A in one patient (a pregnant woman), and to acute alcoholic hepatitis in one patient. Fasting bile-acid concentration in serum that was measured in patients without primary biliary cirrhosis ranged from 60 to 90 µmol/L (normal, <8 µmol/L). The intensity of pruritus was evaluated with a visual analogue scale ranging from 0 (no pruritus) to 10 (maximum intensity). These patients all received pure yellow grapefruit juice (600 mL/d) for at least 4 days. An effect was achieved only in the patient with alcoholic hepatitis. In this patient, pruritus recurred during the first week after the end of the therapy. As reported by Horsmans and Geubel, grapefruit juice did not relieve pruritus that occurred during the course of chronic hepatitis C in two additional patients who did not have cholestasis. We may have observed a lower efficacy than Horsmans and Geubel did because of the kind of grapefruit juice used, heterogeneity of patients, or different previous therapeutic schedules. These conflicting results emphasize the need for a controlled study.