Cholestatic pruritus is secondary to obstruction of common bile duct and can be relieved by inserting an intra-ductal stent.
Treatment should be based upon the severity of the pruritus and the following approaches can be considered:
- Warm baths and emollients
- Topical antipruritic: Levomenthol (menthol) cream BP 0.5-2% may be helpful
- Colestyramine 4-8g PO OD First line if itching is due to cholestasis (build-up of bile salts) Affects absorption of other medications: take other medications at least 1 hour before or 4-6 hours after colestyramine
- Antihistamines e.g. chlorphenamine Second line – sedative effect can be helpful if given at night as patients are woken less frequently by pruritus Sedating effect can mask or worsen encephalopathy
- Sertraline 50-100mg once daily (unlicensed)
- Other drugs include Rifampicin, Danazol and Naltrexone – please seek specialist advice (unlicensed use)
Disclaimer
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.