How is pruritus managed in primary biliary cholangitis (PBC)?

Updated: Nov 08, 2017
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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Answer

Pruritus is often refractory to medical therapy and significantly impacts the patient's quality of life. Antipruritic treatment is as follows:

  • Antihistamines are the first-line agents for patients with mild-to-moderate pruritus, but can further depress brain function in patients with cirrhosis and signs of encephalopathy

  • Cholestyramine and colestipol sequester bile salts in the enteric lumen; a 1- to 4-day delay is expected before the itching remits

  • Rifampin can also be used for pruritus unresponsive to cholestyramine

  • Dronabinol (Marinol) use is supported by some evidence

  • Plasmapheresis may be effective in patients with severe pruritus intractable to medical treatment

In patients with cirrhosis, an elevated bilirubin level is an ominous sign of disease progression, and liver transplantation must be considered. Liver transplantation appears to be the only life-saving therapeutic option.

See Treatment and Medication for more detail.


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