A 54-year-old woman with biopsy-proven primary biliary cholangitis on ursodeoxycholic acid 15 mg/kg/day reports distressing nocturnal pruritus despite adequate biochemical response. Which agent should be used first for her pruritus?
- A Naltrexone
- B Cholestyramine ✓
- C Sertraline
- D Rifampicin
Correct answer: B. Cholestyramine
Explanation
Cholestyramine is the established first-line therapy for pruritus of cholestasis, acting by binding bile acids in the gut lumen. Second-line options in stepwise fashion include rifampicin, then naltrexone (an opioid antagonist), then sertraline. Rifampicin requires monitoring for hepatotoxicity and haemolysis. Because cholestyramine binds UDCA in the intestine, the two must be separated by at least 4 hours, a practical point frequently tested alongside this question.
Reference: Sherlock's Diseases of the Liver and Biliary System, 13th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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