PBC Information

Dr. Peters shared the following information at the Northern California PBC/PSC meeting on Saturday, May 13, 2006.

"Itching, or pruritus, in patients with liver disease can be extremely uncomfortable. It occurs when bile salts that are not being normally excreted accumulate in the skin. The bile salts irritate the skin cells resulting in pruritus. The following measures have been found successful in decreasing pruritus either by stabilizing the skin cells or by assisting in the excretion of bile."

[Measures listed below in order of the doctor’s preference. ALL measures 1-6 should be taken together:]

"Decrease water temperature of shower or bath.
Use a moisturizing soap such as Dove and avoid deodorant soaps.
Do not dry off completely after shower/bath.
After shower/bath, while skin is still damp, apply EUCERIN CREAM to all skin that is itching. EUCERIN CREAM can be bought almost anywhere (Walgreens, Wal-Mart, K-Mart, etc.)
Wear fewer/lighter clothes.
Sleep with fewer clothes and blankets."

"Cholestyramine powder (Questran, Cholestipol), a prescription medication that binds with bile salts in the intestine to decrease the absorption of bile salts, is taken one scoop/packet twice a day initially and may be increased to a total of six scoops/packets a day. Mix with water, tea, soda, or juice. Most common side effect is bulky stools and constipation.
All other medicines should be taken one hour before and four hours after taking Questran.
IF YOU ARE TAKING URSODEOXYCHOLIC ACID OR IMMUNOSUPPRESSANTS, TALK TO YOUR DOCTOR BEFORE TAKING THIS MEDICATION as taking them together will decrease both drug effects."

"Doxepin is a prescription medication. It is given at a very low dose (10-20 mg) for pruritus. Since this medication may cause drowsiness, it should be taken only at bedtime. This medication can cause side effects; however, the dose given for pruritus is extremely low and incidence of side effects is rare. Check with your physician for interactions and precautions." [Doxepin is normally used as an antidepressant.]

"Ursodeoxycholic acid is useful in patients with some cholestatic liver diseases:
PBC: 15 mg/kg/day
PSC: 20 mg/kg/day qhs."

The following are additional items Dr. Peters shared during Q&A:

All PBC/PSC patients should be tested for vitamin A and vitamin D deficiency annually. The specific vitamin D test for liver patients is a 25-hydroxy vitamin D test. Vitamin E deficiency is very rare. Vitamin K deficiency has outward signs such as bruising, bleeding from the gums and jaundice.

Atarax has not been found to be useful in combating pruritus in PBC. "I wish doctors would stop prescribing it for PBC."

PBC patients seem to be particularly sensitive to psychotropic drugs or drugs with psychotropic side effects, even when a drug may be prescribed for non-psychiatric reasons. If used, she recommended they be prescribed at about half the normal dose for a person of the same size/weight. Specific drugs with psychotropic effects named by Dr. Peters were Atarax and Morphine.

How did someone discover that black bear bile was good for the liver? Someone wondered how black bears could hibernate for six months without experiencing any liver damage.