Help, the itching is awful!

Hi,
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.
God bless.
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 daily
can be tried if other measures fail. but if you are using opiate narcotics to control pain, do not take naltrexone because it is an opiate antagonist,and all of them required prescriptions in the States.
As always,this is strictly for information purposes only.so consult your doctors first.

Ellen…..stool softeners may help or, laxatives. I am a strong believer in suppositories and found those to be the least irritating to my husband’s intestinal track; plus it appeared to be the most effective.
All my best wishes,
Marion

Ellen, I too had the 100% itching, but it went away completely about ten days after an ERCP and stents placed at that time. The gastroenterologist I saw gave me several Rx’s (can’t recall what they were , but neither was helpful).

How long ago were the stents placed?

Good luck.

Hi Ellen,
In the past, I’ve used cholestyramine for itching and it was very helpful. You’ll have to get a doctor to prescribe it. I took it in powder form and stirred it into any kind of flavored drink. That medication really helped me and I had no side effects from taking it – just relief from the constant itching.

Betsy