Pruritus in cirrhosis is commonly treated with which agent?

Pruritus in cirrhosis is commonly treated with which agent?

• A. Prednisone
• B. Cholestyramine
• C. Ursodeoxycholic acid
• D. Diphenhydramine

Answer: (B)

Pruritus in cirrhosis is driven by accumulation of bile acids that reach the skin, so the treatment goal is to reduce the bile acid load reaching the skin. Cholestyramine does exactly that: it’s a bile acid sequestrant that binds bile acids in the gut and prevents their reabsorption, lowering the enterohepatic circulation and the amount of bile acids available to irritate the skin. Since it acts locally in the gut and isn’t absorbed systemically, it can relieve itching with relatively few systemic effects. Some other options don’t target bile acid circulation effectively—antihistamines don’t address the bile acid–driven itch, and prednisone isn’t a pruritus treatment in cirrhosis. Ursodeoxycholic acid has benefits in certain cholestatic conditions but is less consistently effective for cirrhosis-associated itch.

Pruritus in cirrhosis is driven by accumulation of bile acids that reach the skin, so the treatment goal is to reduce the bile acid load reaching the skin. Cholestyramine does exactly that: it’s a bile acid sequestrant that binds bile acids in the gut and prevents their reabsorption, lowering the enterohepatic circulation and the amount of bile acids available to irritate the skin. Since it acts locally in the gut and isn’t absorbed systemically, it can relieve itching with relatively few systemic effects. Some other options don’t target bile acid circulation effectively—antihistamines don’t address the bile acid–driven itch, and prednisone isn’t a pruritus treatment in cirrhosis. Ursodeoxycholic acid has benefits in certain cholestatic conditions but is less consistently effective for cirrhosis-associated itch.