Treatment of Cholestatic Pruritus in Primary Biliary Cholangitis
Pruritus is one of the characteristic cholestatic symptoms in primary biliary cholangitis (PBC) and significantly impairs health-related quality of life. Addressing it requires a structured, stepwise therapeutic strategy.
Patient with primary biliary cholangitis presenting with cholestatic pruritus. EASL recommends treating pruritus using a stepwise approach, escalating through successive lines as needed.
At the third step of the treatment ladder, oral opiate antagonists come into consideration. Specific agent selection, initiation precautions, and the full stepwise algorithm are available in the complete protocol.
References
DOI: 10.1002/hep.32117
Pruritus is one of the characteristic cholestatic symptoms in PBC and results in impaired health-related quality of life (HRQoL).
EASL recommends treating pruritus using a step wise approach.
Oral opiate antagonists (naltrexone and nalmefene) are used as third-line therapy as they can reduce the sensation of itching.
Naltrexone should be started at a low dose to avoid opiate withdrawal-like reactions in the first few days of treatment.
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