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. Antihistamines are the first-line agents to relieve pruritus in early stages and are the first line medication for patients with mild-to-moderate pruritus. Use caution in patients with cirrhosis and signs of encephalopathy because antihistamines can further depress brain function.

Cholestyramine and colestipol are effective in sequestering bile salts in the enteric lumen. A 1- to 4-day delay is expected before the itching remits.

Rifampin can also be used, but the precise mechanism of action is unclear (may involve inhibition of bile acid uptake into hepatocytes and facilitation of excretion of dihydroxy and monohydroxy bile acids and toxic bile acids). Rifampin is used in patients whose pruritus is not responding to cholestyramine.

Some evidence suggests that dronabinol (Marinol) can be used to good effect.

Plasmapheresis has also been implemented for patients with severe pruritus intractable to medical treatment. Results have been good.


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