What is the efficacy of rifampin (Rifampicin) for treating pruritus?

From the Guidelines

Rifampin is a highly effective treatment for pruritus, particularly in patients with cholestatic liver diseases, and should be considered as a first-line treatment option. According to the most recent and highest quality study 1, rifampin is recommended as a first-line treatment for moderate to severe pruritus in sclerosing cholangitis, along with bezafibrate. The study suggests that rifampin can be used at a dose of 150-300 mg daily, and it is effective in reducing pruritus in patients with cholestatic liver diseases.

The mechanism of action of rifampin in treating pruritus is thought to be related to its ability to inhibit bile acid uptake in the intestine and induce hepatic microsomal enzymes, which helps reduce bile acid levels and subsequently decreases pruritus. However, it is essential to monitor liver function during treatment with rifampin, as it can induce hepatotoxicity in some patients. Additionally, rifampin can interact with other medications, such as oral contraceboing, warfarin, and some antiepileptics, by inducing cytochrome P450 enzymes.

Some of the key benefits of using rifampin for pruritus include:

• Rapid relief from pruritus, often within 1-2 weeks of starting treatment
• Effective in reducing bile acid levels and subsequently decreasing pruritus
• Can be used in combination with other treatments, such as bezafibrate, for enhanced efficacy

However, it is crucial to consider the potential side effects and interactions of rifampin, including:

• Gastrointestinal upset
• Headache
• Orange discoloration of bodily fluids
• Hepatotoxicity
• Drug interactions with other medications

In comparison to other treatments, such as cholestyramine and naltrexone, rifampin has been shown to be more effective in reducing pruritus in patients with cholestatic liver diseases 1. However, bezafibrate has been proposed as a first-line treatment for moderate to severe pruritus in PSC and other forms of fibrosing cholangiopathy, due to its sustained antipruritic effect and strong additive anticholestatic effects when combined with UDCA 1.

Overall, rifampin is a highly effective treatment for pruritus, particularly in patients with cholestatic liver diseases, and should be considered as a first-line treatment option, along with bezafibrate. However, it is essential to carefully monitor patients for potential side effects and interactions, and to adjust treatment accordingly.

From the Research

Efficacy of Rifampin for Pruritus

• Rifampin has been shown to be effective in treating pruritus associated with chronic cholestasis, with a meta-analysis of prospective randomized-controlled trials finding that treatment with rifampin led to complete or partial resolution of pruritus in 77% of patients 2.
• A study published in 1993 found that rifampin was effective in treating refractory pruritus in children with chronic cholestasis liver disease, with complete relief of pruritus noted in 15% of patients and a partial response in 36% 3.
• A randomized clinical trial published in 2019 found that sertraline and rifampin had similar efficacy in managing cholestatic pruritus, but sertraline had fewer adverse effects on hepatobiliary enzyme levels 4.
• A double-blind, controlled, crossover clinical trial published in 1988 found that rifampin was effective in reducing pruritus in patients with primary biliary cirrhosis, with a significant reduction in visual analogue scale pruritus scores 5.

Safety of Rifampin for Pruritus

• The meta-analysis mentioned earlier found that rifampin was safe for treatment of pruritus due to chronic cholestasis, with only 7% of patients treated with rifampin suffering side effects, which resolved after discontinuation 2.
• However, a study published in 2002 found that rifampicin caused significant hepatitis in 7.3% of patients treated for cholestatic liver disease, with two patients having significant impairment of liver synthetic function 6.
• The randomized clinical trial published in 2019 found that sertraline had fewer adverse effects on hepatobiliary enzyme levels compared to rifampin, suggesting that sertraline may be a safer alternative 4.