Management of hepatic pruritus

Couple of helpful pointers in this month’s BJGP:

Mild localised itch: 1% menthol in aqueous cream

Moderate/severe or generalised itch:

  1. Oral cholestyramine. Generally well tolerated, but has unpleasant taste which can be improved by mixing with fruit juice; other side-effects include anorexia, constipation or diarrhoea, abdominal discomfort and bloating.
  2. Oral colesevelam. Evidence of efficacy inconclusive, but as it’s better tolerated than cholestyramine it’s worth trying if patients find cholestyramine helpful but can’t tolerate it for whatever reason. Both this and cholestyramine are safe to use in primary care.
  3. Rifampicin or naltrexone (rifampicin is more effective). Both need regular monitoring of LFTs and the article recommends initiating them in secondary care.
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About Dr Sarah

I'm a GP with a husband and two young children.
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