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A significant portion of patients with cholestasis (80%) will experience pruritus at some point during their disease. This is a condition that can severely decrease a patient’s quality of life as it can impact sleep, concentration, work ability, and mood. Many treatments do exist, but how effective each option is depends on the patients and its condition. Assessment using a scale, such as a visual analogue scale or a 5-D itch scale will be useful to identify an appropriate treatment.

The most common treatment option used is bile acid binding resins like cholestyramine. Its side effects are limited to the gastrointestinal region and include constipation and bloating. Here are some other commonly used treatments and its side effects


 * The antibiotic rifampin and its side effects are fever, rash, and elevated liver enzymes
 * Opioid antagonist naloxone and its side effects are that of opioid withdrawal, leading to nausea, muscle cramps, dizziness
 * The serotonin reuptake inhibitor sertraline. Side effects include diarrhea, insomnia, irritability

Given the potential for drug to drug interactions, it is thus critical that patients are fully aware of the treatment and to be mindful of any other medications they are taking.

In cholestatic liver disease, when bilirubin concentration starts to build up, a deficiency of fat soluble vitamins may also occur. The challenges of identifying and diagnosing such a condition though is that fat soluble vitamin deficiency will not manifest clinical symptoms. To manage this, doses of vitamin A, D, E, K are recommended in order to retain appropriate levels.

Cholestatic liver disease can impact lipids, and possibly lead to dyslipidemia. This condition is a result of an abnormal low density lipoprotein called lipoprotein-X, which may pose a risk for coronary artery disease. Statins and fibrates are generally used as lipid lowering therapy to treat patients with cholestatic liver disease. The side effects include headaches, muscle pain, and stomach aches.

For intrahepatic cholestasis in pregnant women, S-adenosylmethionine has proven to be an effective treatment. In a double-blind, placebo-controlled trial, S-adenosylmethionine was able to significantly improve the outcomes of common cholestasis symptoms, like pruritus and fatigue. Further, patient experiences with oral S-adenosylmethionine were similar to the placebo, meaning that there wasn’t any preference towards a specific medication. Dexamethasone is a viable treatment in regards to the symptom of intensive itching. The function of dexamethasone is that it suppresses fetoplacental oestrogen production. In a study, ten women with intrahepatic cholestasis of pregnancy were given dexamethasone over a period of 3 days. The results showed that the symptom of itching “disappeared or was markedly relieved” in all patients treated. Total bile acid levels also fell after treatment, and “all patients gave birth to a healthy child” with no other concerns. More importantly, as oestrogen levels fell, the symptoms of cholestasis did not “recur even in one of our patients who gave birth more than 2 months after stopping therapy.” As the researchers found no fetal maternal side effects compared to other drugs, they “regard it as a drug of choice in intrahepatic cholestasis of pregnancy.”

The common symptoms of intrahepatic cholestasis of pregnancy include severe pruritus and the chance of premature deliveries and stillbirths. To manage maternal pruritus and help with the outcome of pregnancy, ursodeoxycholic acid is another possible treatment. In a study of 15 patients where eight were given ursodeoxycholic acid and the remaining seven a placebo, “no adverse effects were detected in the mother or in their babies.” Of those who received a placebo, premature deliveries before week 36 had occurred in five patients with one stillbirth. In contrast, “deliveries occurred at or near term in all mothers who received ursodeoxycholic acid.” This makes ursodeoxycholic acid viable given that it improves outcomes in pregnancy and has been proven to be safe and effective.