Which medication is used to treat pruritus in biliary cirrhosis?

Which medication is used to treat pruritus in biliary cirrhosis?

• A. Cholestyramine
• B. Ursodeoxycholic acid
• C. Hydroxyzine
• D. Loperamide

Answer: (A)

Pruritus in biliary cirrhosis comes from the buildup of bile acids in the skin due to impaired bile flow. The most effective way to relieve this itching is to interrupt the enterohepatic circulation of bile acids, lowering the amount that circulates and reaches the skin. Cholestyramine is a nonabsorbable bile acid sequestrant; it binds bile acids in the intestine so they aren’t reabsorbed, which reduces circulating bile acids and markedly eases itching. It’s often dosed as a powder mixed with food or drink. Other choices aren’t as directly targeted for this symptom. Ursodeoxycholic acid can help with cholestasis and may reduce bile acid load in some patients, but it’s not as consistently effective for pruritus as a sequestrant. An antihistamine like hydroxyzine can palliate itching in some conditions but doesn’t address the underlying bile acid accumulation in cholestasis. Loperamide is an anti-diarrheal and has no role in treating pruritus.

Pruritus in biliary cirrhosis comes from the buildup of bile acids in the skin due to impaired bile flow. The most effective way to relieve this itching is to interrupt the enterohepatic circulation of bile acids, lowering the amount that circulates and reaches the skin. Cholestyramine is a nonabsorbable bile acid sequestrant; it binds bile acids in the intestine so they aren’t reabsorbed, which reduces circulating bile acids and markedly eases itching. It’s often dosed as a powder mixed with food or drink.

Other choices aren’t as directly targeted for this symptom. Ursodeoxycholic acid can help with cholestasis and may reduce bile acid load in some patients, but it’s not as consistently effective for pruritus as a sequestrant. An antihistamine like hydroxyzine can palliate itching in some conditions but doesn’t address the underlying bile acid accumulation in cholestasis. Loperamide is an anti-diarrheal and has no role in treating pruritus.