Topic: Suggestions for relieving pruitus (itching)- a reprinted message
As always,consult doctors for advice first;this is strictly for informational purpose only.
Of course,the most important thing is to treat the underlying problem first which is the buildup of the bile acids due to bile ducts obstruction.(ie; stents)
For mild cholestatic pruritus ,nonspecific measures such as warm baths,emollients and antihistamines should be considered as the first-line therapy.
OTC emollients such as Benadryl cream,hydrocortisone 1% cream,Calamine lotion,Aveeno,lanacane and sarna cream will provide some relief.
Rx emollients such as hydrocortisone 2.5% ,fluocinolone, triamcinolone, halcinonide , betamethasone and clobetasol (from low to high potency in order) are available thru prescription for short term use.
Systemic antipruritic medications such as Benadryl 25mg-50mg can be used at night. and cyproheptadine (Periactin by Merck) three to four times daily may be useful when sedation is to be avoid.
Benadryl is over the counter and cyproheptadine may required a prescription in the States.
Cholestyramine (Questran),Colesevelam(Welchol) and colestipol(Colesid) are called bile acid sequestering agents which are prescribed for lipid lowering purpose. ( needs prescriptions in the States).
In patients with biliary obstruction, these agents reduce the serum bile acid level by binding to the bile acids in the intestine,decrease bile acids reabsorption ,reduce excess bile acids deposited in the dermal tissue with resultant decrease in pruritus (itching).The one that used more frequently is cholestyramine 4gm 1-2 times daily to a maximum of 24gm(6doses) per day.
Side effects of the bile acid sequestering agents included nausea,bloating and cramping;increase liver enzymes . Colesevelam(Welchol)-3tablet twice daily- is better tolerated and less likely to cause GI side effects.
Newer topical agent like naloxone lotion is in phase II clinical trial for treatment of pruritus accompanying cutaneous t-cell lymphoma by Elorac,Inc. It may be of value to CC patients as well.
Additional info: from uptodate.com
Better efficacy of taking bile acid sequestering agents may be increased by taking a dose before and after BREAKFAST in patient with an intact gallbladder to enhance the excretion of the agent that cause itching.
Also rifampicin 150mg-300mg twice a day or oral naltrexone,setraline 75-100mg(Zoloft) daily can be tried if other measures fail.
Other medications like phenobarbital,colchicine and methotrexate as well as paroxetine(Paxil) are also being mentioned.
IF you are using opiate narcotics to control pain such as Fentanyl,Oxycodin,codeine,Demerol,propoxyphine(Darvocet),ultram,morphine,methadone,hydromorphone(Dilaudid),hydrocodone(Norco,Vicodin and Percocet etc) ,you should not take naltrexone as well as the the lotion I mentioned above. Because it is an opiate antagonist, and it will counteract the opiates to control your pain.All of them required prescriptions in the States.
As always,this is strictly for information purposes only.so consult your doctors first.
Last edited by PCL1029 (Yesterday 20:44:42)