Tips for Treating the "Itch" (Pruritus) With PBC

For many individuals living with primary biliary cholangitis (PBC), the itch — medically known as pruritus — is more than just a physical sensation. It is a significant burden that can impact daily activities, sleep, and overall quality of life. While fatigue and itch are the most common symptoms of the condition, their presence and intensity can vary greatly from person to person.^2,3

Understanding how to manage this symptom is a crucial component of living with PBC.

Understanding the itch with PBC

The severity of the itch is not connected to the severity of PBC or its progression. Not everyone will experience it, either. For those who do experience it, the itch can moves in cycles. There can be good and bad periods, though even within these periods, daily fluctuations can occur.²

Because the symptom burden can have such a profound mental and physical impact, it's important to talk to your doctor about what you're experiencing.²

Treating the disease versus the symptom

The first line of defense in treating PBC itself is usually Ursodeoxycholic acid (UDCA), also known as ursodiol. While UDCA can improve liver function and reduce scarring, it is unfortunately less likely to alleviate itching or fatigue.¹

However, other treatments may offer relief. For example, fibrates are sometimes prescribed in combination with UDCA. Research suggests that when taken together, these medications can reduce both liver inflammation and itching in some people; however more research is still needed.¹

Medical therapies for itch relief

Beyond treating the underlying liver condition, healthcare teams may recommend specific therapies targeted directly at controlling the itch. There are several categories of medication available, including:^1,2

• Antihistamines: while often used for allergies, antihistamines like diphenhydramine, hydroxyzine hydrochloride, and loratadine may reduce itching in PBC patients, particularly if it disrupts your sleep.
• Cholestyramine: a powder that should be mixed with food or liquids and can help reduce itching. It can sometimes cause an upset stomach.
• Antibiotics like Rifampin: while the exact mechanism is unknown, researchers believe it helps block the brain's response to itch-inducing chemicals in the blood.
• Opioid antagonists: medications containing naloxone or naltrexone may be prescribed. Similar to Rifampin, these drugs may reduce itching by acting on the brain.
• Selective Serotonin Reuptake Inhibitors (SSRIs): Sertraline, a medication typically associated with mood regulation, increases serotonin in the brain and has been shown to help reduce itching in some patients.

It's important to find what works for you

Because the experience of itch is so personal and variable, personalizing your care is essential. You should discuss your symptoms and any changes you experience with your doctor, who can be an important part of monitoring your condition.³

Although specific treatments vary by person, the goal is to find what works for you to maintain a positive quality of life. If medications no longer control the disease and liver function begins to fail, a liver transplant may be considered. It can help address the itching but is reserved for advanced stages of PBC.⁴

By staying informed and working closely with your healthcare team to explore these various treatment options, you can better manage the PBC itch and minimize its impact on your daily life.