A number of medicines are available that can be used to relieve pruritus. Some people may take more than one medicine at a time and it can take some time to find the best combination.
Sometimes medicines can work well to stop the itch; however, in other cases they may work for a short time but then stop working and need to be altered. It may be difficult to find a combination that works for a particular person.
There are operations that may be considered such as biliary diversion but success is very variable.
Sometimes itching may have more than one cause, such as liver disease and eczema, so more than one treatment approach may be needed.
Some of the most common medicines used are listed here:
Ursodeoxycholic acid (Urso)
This is a type of bile acid. It works by increasing the proportion of watery bile acids in bile. This helps bile to flow more easily. It has been shown to improve bile flow in children with liver disease and can prevent further damage to their liver cells.
Some people find their itching becomes worse in the first or second week after taking the medicine. Another potential side effect is diarrhoea.
Rifampicin is an antibiotic. Normally a low dose is given at the start of the treatment and is gradually increased to stop the itch. It can cause urine, saliva and tears to turn an orange-red colour; this is harmless.
This medicine combines with bile acids in the small intestine and reduces their reabsorption. The medicine can also bind with fat-soluble vitamins (vitamins A, D, E and K) and reduce their absorption. For this reason some vitamins (and some other medicines) shouldn’t be taken within two hours of taking cholestyramine.
This medicine has an unusual taste and texture. If a child is having difficulty taking it then ask your hospital team for advice.
For severe cases of pruritus, there may be options such as ondansetron and naltrexone that can be discussed with your medical team.
New medications have been developed called apical sodium dependent bile acid transporter (ASBT) inhibitors. They stop the uptake of bile acids in the gut and therefore reduce the amount in the body and the requirement of the liver to transport them. They are not currently licensed in the UK but hopefully will be available for treatment of PFIC and Alagille Syndrome in 2022. Trials for other conditions are ongoing. They don’t work on all patients but when they do it is likely they reduce pruritus as well as liver damage.
A sedative is a medication which can help with sleep. This may be given if pruritus is affecting sleep.