🛑 treatment Pruritus in patients with cholestasis
✅For patients who do not have primary biliary cholangitis or intrahepatic cholestasis of pregnancy we do the following:
●We initially treat with a bile acid sequestrant such as cholestyramine (total daily dose of 4 to 16 grams
✅If the bile acid sequestrant does not provide adequate, relief we switch to rifampin (150 to 300 mg twice daily)
✅
If symptoms persist, we then switch to an opioid antagonist, such as naltrexone (12.5 to 50 mg/day)
✅Switching to sertraline (75 to 100 mg daily) or phenobarbital 90 mg at bedtime can be tried if other measures fail
✅For treatment of pruritus in patients with primary biliary cholangitis, in addition to cholestyramine, we suggest treatment with ursodeoxycholic acid. We start with a low dose (eg, 200 to 300 mg daily) and then over the next few weeks gradually increase the dose to 13 to 15 mg/kg per day given in two to three divided dose
#UpTodate2024
✅For patients who do not have primary biliary cholangitis or intrahepatic cholestasis of pregnancy we do the following:
●We initially treat with a bile acid sequestrant such as cholestyramine (total daily dose of 4 to 16 grams
✅If the bile acid sequestrant does not provide adequate, relief we switch to rifampin (150 to 300 mg twice daily)
✅
If symptoms persist, we then switch to an opioid antagonist, such as naltrexone (12.5 to 50 mg/day)
✅Switching to sertraline (75 to 100 mg daily) or phenobarbital 90 mg at bedtime can be tried if other measures fail
✅For treatment of pruritus in patients with primary biliary cholangitis, in addition to cholestyramine, we suggest treatment with ursodeoxycholic acid. We start with a low dose (eg, 200 to 300 mg daily) and then over the next few weeks gradually increase the dose to 13 to 15 mg/kg per day given in two to three divided dose
#UpTodate2024