A 52-year-old woman with biopsy-proven primary biliary cholangitis on ursodeoxycholic acid 15 mg/kg/day has persistently severe pruritus despite adequate biochemical response. Which is the correct first-line antipruritic agent?
- A Cholestyramine 4 g up to four times daily, dosed apart from UDCA ✓
- B Rifampicin 150 mg twice daily
- C Naltrexone 50 mg daily
- D Sertraline 100 mg daily
Correct answer: A. Cholestyramine 4 g up to four times daily, dosed apart from UDCA
Explanation
Cholestyramine is the established first-line therapy for cholestatic pruritus in PBC. Because it binds UDCA in the gut and impairs its absorption, doses must be separated by at least 4 hours. Rifampicin, naltrexone, and sertraline are second-line options used only when cholestyramine fails or is intolerable.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.