From the Guidelines
Pristique treatment should prioritize rifampicin as the first-line treatment for cholestatic pruritus, given its strong evidence base and efficacy in reducing pruritus symptoms, as supported by 1 and 1. The management of pruritus in cholestatic liver disease involves a step-wise approach, with rifampicin being the most effective treatment option.
- The precise mechanism of cholestatic pruritus remains unclear, but fluctuation in symptoms is characteristic, and pruritus can lessen as end-stage liver disease develops 1.
- Cholestyramine is widely used as a first-line treatment, although the evidence basis to support this is limited, and it should be spaced a minimum of four hours apart from other medications like UDCA to prevent binding and loss of efficacy 1.
- Rifampicin, a PXR agonist, has a strong evidence base and is widely used as a second-line treatment, with ongoing efficacy reported over up to 2 years of treatment 1.
- Other treatment options, such as oral opiate antagonists, sertraline, and gabapentin, can be used as third-line agents, but their efficacy is variable, and they may have significant side effects 1.
- Invasive physical approaches, such as extracorporeal albumin dialysis, plasmapheresis, and bile duct drainage, may be considered in resistant cases, but their use is limited due to their invasive nature 1.
- Transplantation is effective for the control of cholestatic itch but raises issues of organ allocation priority and patient risk in patients who would not otherwise require transplantation 1.
- Itch quantification using a visual analogue scale can help in the assessment of response to interventions, and objectification of itch through physical measurement of scratching activity has been advocated as a more accurate measure, although it is limited to use as a research tool 1.
From the Research
Pristique
- The term "Pristique" is not directly related to any of the provided studies 2, 3, 4, 5, 6.
- However, the studies provide information on treatments for depression, including fluoxetine and cognitive-behavioral therapy (CBT) 2, 3, 4, 6.
- One study discusses the combination of fluoxetine with CBT as a treatment for adolescents with major depressive disorder, showing superior results compared to fluoxetine alone or CBT alone 2.
- Another study explores the potential synergistic interactions between simvastatin and fluoxetine in models of anxiety and depression, indicating anxiolytic and antidepressant effects 3.
- A data-driven algorithm was developed to guide the selection of treatment for adolescent depression, including CBT, fluoxetine, and combination treatment, identifying subgroups of patients that respond preferentially to specific treatments 4.
- The remaining studies discuss the usage of terms ambivalence and ambiguity in psychology 5, and the potential prescriptive predictors for cognitive vs. behavioral approaches to treating depression 6.
- There is no direct evidence related to "Pristique" in the provided studies, and the term does not appear to be relevant to the topics discussed.