Which medications in the drug class Bile Acid Lowering Agents are used in the treatment of Pruritus and Systemic Disease?

Updated: Mar 03, 2020
  • Author: David F Butler, MD; Chief Editor: William D James, MD  more...
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Answer

Bile Acid Lowering Agents

These agents are used to treat cholestatic pruritus.

Cholestyramine (Prevalite, Questran)

Cholestyramine is an anion-exchange resin that binds bile acids in the GI tract, interrupting their enterohepatic circulation; it is primarily used to lower cholesterol. Patients must have adequate bile flow for the drug to be effective. Consider this therapy early in cases of hepatic cholestasis because it is inexpensive and may provide relief (within 1-3 wk). Pruritus returns within weeks of discontinuation.

Ursodeoxycholic acid/ursodiol (Actigall, Urso 250, Urso Forte)

Ursodeoxycholic acid/ursodiol is a hydrophilic bile acid that alters the hydrophilicity and distribution of total bile acids and increases the excretion of hydrophobic bile acids. It decreases damage to the hepatocyte membrane by decreasing the uptake of hydrophobic bile acids at the terminal ileum (and likely in hepatocytes). Ursodeoxycholic acid/ursodiol is first-line treatment for patients with intrahepatic cholestasis of pregnancy; it normalizes laboratory values and decreases morbidity and mortality to the fetus by reducing exposure to bile acids.


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