From the Guidelines
Rifampicin is the best medicine to treat pruritus associated with hyperbilirubinemia, as it has been shown to be effective in reducing hepatic pruritus with a strength of recommendation A. The typical dosage is 150-300 mg twice daily, and patients should be monitored for hepatotoxicity. Rifampicin works by inducing hepatic enzymes to metabolize pruritogenic substances, and it has been found to be effective in reducing pruritus in patients with hepatic pruritus 1.
Other options include cholestyramine, which binds bile acids in the intestine, preventing their reabsorption and reducing serum bile acid levels that cause itching, but it is now considered as a second-line treatment due to its lower efficacy compared to rifampicin 1. Naltrexone, an opioid antagonist, can also be used, but it is considered as a fourth-line treatment due to its higher side-effect profile compared to rifampicin and cholestyramine 1.
Key points to consider when treating pruritus associated with hyperbilirubinemia include:
- Starting with rifampicin as the first-line treatment
- Monitoring patients for hepatotoxicity
- Considering cholestyramine as a second-line treatment
- Using naltrexone as a fourth-line treatment due to its higher side-effect profile
- Avoiding the use of gabapentin in patients with hepatic pruritus 1
It is essential to note that the treatment of pruritus associated with hyperbilirubinemia should be individualized, and the choice of medication should be based on the patient's specific needs and medical history. Additionally, patients should be educated on the potential side effects of the medications and the importance of adherence to the treatment regimen.
From the FDA Drug Label
Cholestyramine for Oral Suspension, USP powder, is indicated for the relief of pruritus associated with partial biliary obstruction Cholestyramine resin has been shown to have a variable effect on serum cholesterol in these patients. In patients with partial biliary obstruction, the reduction of serum bile acid levels by cholestyramine resin reduces excess bile acids deposited in the dermal tissue with resultant decrease in pruritus
The best medicine to treat pruritus associated with hyperbilirubinemia is cholestyramine. It is indicated for the relief of pruritus associated with partial biliary obstruction, which can be a cause of hyperbilirubinemia. Cholestyramine resin works by reducing serum bile acid levels, which in turn reduces excess bile acids deposited in the dermal tissue, resulting in a decrease in pruritus 2.
From the Research
Treatment Options for Pruritus Associated with Hyperbilirubinemia
- There are several treatment options available to manage pruritus associated with hyperbilirubinemia, including medications and plasma exchange.
- Rifampicin has been shown to be effective in reducing pruritus in patients with chronic cholestatic liver disease, including primary biliary cirrhosis 3, 4, 5.
- In a study published in 1999, rifampin was found to be safe and effective in reducing pruritus in children with chronic cholestasis 6.
- Plasma exchange has also been shown to be effective in reducing bilirubin levels and improving symptoms in patients with severe hyperbilirubinemia 7.
Medications Used to Treat Pruritus
- Rifampicin is a commonly used medication to treat pruritus associated with hyperbilirubinemia, and has been shown to be effective in reducing pruritus in patients with primary biliary cirrhosis and other cholestatic liver diseases 3, 4, 5.
- Ursodeoxycholic acid, diphenhydramine, and phenobarbital are also used to treat pruritus, but may not be as effective as rifampicin in some cases 6.