Symptomatic therapy in primary biliary cirrhosis

The most distressing symptom is usually pruritus which may respond to:

• cholestyramine:
  • can be used up to 16g four times per day orally with food
  • UDCA and cholestyramine should be spaced a minimum of 2 -4h apart
• rifampicin
• opiate antagonists – Naloxone,
• sertraline
• antihistamines - their main benefit is due to their sedative properties, although their efficacy is limited

Fatigue responds poorly to therapy. Modafinil has been reported to be effective (2)

Reference:

• (1) Lindor KD et al. Primary biliary cirrhosis. Hepatology. 2009;50(1):291-308
• (2) Hohenester et al. Primary biliary cirrhosis. Semin Immunopathol. 2009; 31(3): 283–307