From the FDA Drug Label
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 Cholestyramine for Oral Suspension, USP powder, is indicated for the relief of pruritus associated with partial biliary obstruction
The first line medication for itchy skin relief due to high bilirubin is Cholestyramine. It is used to reduce serum bile acid levels, which in turn reduces excess bile acids deposited in the dermal tissue, resulting in a decrease in pruritus 1, 1.
From the Research
Cholestyramine is the first-line medication for relief of pruritus (itchy skin) caused by elevated bilirubin levels in obstructive jaundice. The typical dosage is 4-8 grams taken orally 1-2 times daily, mixed with water or juice, as recommended by international societies like the AASLD and EASL 2. This medication works by binding bile acids in the intestine, preventing their reabsorption and facilitating their elimination from the body. Bile acids are thought to contribute significantly to the itching sensation when they accumulate in the skin due to high bilirubin levels.
Key Considerations
- Patients should take cholestyramine before meals for optimal effect and should separate it from other medications by at least 2-4 hours to prevent interference with absorption.
- Alternative options if cholestyramine is ineffective include rifampicin, naltrexone, or sertraline, as supported by studies such as 3 and 4.
- Patients should also be advised to use mild soaps, apply moisturizers, avoid hot showers, and wear loose cotton clothing to minimize skin irritation while the underlying pancreatic mass and biliary obstruction are being addressed.
- Recent advances in understanding the pathophysiology of pruritus in cholestatic liver disorders, including the role of lysophosphatidic acid (LPA) and its synthetizing enzyme autotaxin (ATX), may lead to the development of new treatments, as discussed in 2 and 5.
Additional Recommendations
- It is essential to address the underlying cause of the obstructive jaundice, in this case, the pancreatic mass, to alleviate the symptoms of pruritus and prevent further complications.
- Patients should be closely monitored for any adverse effects of cholestyramine or other medications used to treat pruritus, and adjustments should be made as necessary to ensure the best possible outcome.