Primary sclerosing cholangitis
ICD-10 K83.0 · ICD-11 DB96.2

PSC with Moderate Pruritus — What to Do When Bile Acid Sequestrant Therapy Has Not Controlled Symptoms

Moderate pruritus is a significant symptom burden in primary sclerosing cholangitis. When first-line management does not achieve adequate reduction and control of itching, a structured next-step approach is warranted.

First-line treatment — insufficient response

Bile acid sequestrant cholestyramine (first-line) did not achieve the treatment goal of adequate reduction and control of pruritus.

Clinical goal

Reduction and control of pruritus.

Next-step approach

When cholestyramine is ineffective or poorly tolerated, second-line systemic therapy can be considered. The complete structured regimen — including which agents apply and how to sequence them — is available in the full protocol.

Instant Access to Structured Evidence-Based Regimens
References

DOI: 10.1038/ajg.2015.112

  • Bile acid sequestrants such as cholestyramine should be taken (prescribed) in patients with PSC and moderate pruritus, to reduce symptoms.
  • Second-line treatment such as rifampin and naltrexone can be considered if cholestyramine is ineffective or poorly tolerated.
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