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. 1993 Jul;69(1):141–143. doi: 10.1136/adc.69.1.141

Effect of rifampicin in the treatment of pruritus in hepatic cholestasis.

G V Gregorio 1, C S Ball 1, A P Mowat 1, G Mieli-Vergani 1
PMCID: PMC1029430  PMID: 8024298

Abstract

Pruritus in hepatic cholestasis has been suggested to be secondary to a high concentration of serum bile acids. Rifampicin, which inhibits the uptake of bile acids by hepatocytes, has been used to treat pruritus. To determine the efficacy of rifampicin as a treatment for refractory pruritus, the medical records of 33 children (median age 25 months, range 4-135; 19 boys) with chronic cholestasis liver disease (21 with Alagille's syndrome, eight with progressive intrahepatic cholestasis, one with extrahepatic biliary atresia, one with an inborn error of bile acid metabolism, and one with cryptogenic cirrhosis) were reviewed retrospectively. The median dose of rifampicin was 5(4-10) mg/kg/day. The median duration of intake was 36(4-120) weeks. Complete relief of pruritus was noted in five (15%) patients and a partial response in 12 (36%). Overall, no significant difference was noted in the laboratory parameters before and after treatment with rifampicin. In the 21 patients with Alagille's syndrome, however, a significant decrease in alkaline phosphatase was seen before and after one and six months of starting treatment. No adverse side effects were seen. Rifampicin appears to be effective in the treatment of refractory pruritus. A prospective study is warranted to assess further the effect of rifampicin treatment in children with hepatic cholestasis.

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Selected References

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  1. Acocella G. Pharmacokinetics and metabolism of rifampin in humans. Rev Infect Dis. 1983 Jul-Aug;5 (Suppl 3):S428–S432. doi: 10.1093/clinids/5.supplement_3.s428. [DOI] [PubMed] [Google Scholar]
  2. Capelle P., Dhumeaux D., Mora M., Feldmann G., Berthelot P. Effect of rifampicin on liver function in man. Gut. 1972 May;13(5):366–371. doi: 10.1136/gut.13.5.366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cerio R., Murphy G. M., Sladen G. E., MacDonald D. M. A combination of phototherapy and cholestyramine for the relief of pruritus in primary biliary cirrhosis. Br J Dermatol. 1987 Feb;116(2):265–267. doi: 10.1111/j.1365-2133.1987.tb05825.x. [DOI] [PubMed] [Google Scholar]
  4. Cynamon H. A., Andres J. M., Iafrate R. P. Rifampin relieves pruritus in children with cholestatic liver disease. Gastroenterology. 1990 Apr;98(4):1013–1016. doi: 10.1016/0016-5085(90)90027-x. [DOI] [PubMed] [Google Scholar]
  5. Garden J. M., Ostrow J. D., Roenigk H. H., Jr Pruritus in hepatic cholestasis. Pathogenesis and therapy. Arch Dermatol. 1985 Nov;121(11):1415–1420. [PubMed] [Google Scholar]
  6. Ghent C. N., Carruthers S. G. Treatment of pruritus in primary biliary cirrhosis with rifampin. Results of a double-blind, crossover, randomized trial. Gastroenterology. 1988 Feb;94(2):488–493. doi: 10.1016/0016-5085(88)90442-8. [DOI] [PubMed] [Google Scholar]
  7. Grosset J., Leventis S. Adverse effects of rifampin. Rev Infect Dis. 1983 Jul-Aug;5 (Suppl 3):S440–S450. doi: 10.1093/clinids/5.supplement_3.s440. [DOI] [PubMed] [Google Scholar]
  8. Lal S., Singhal S. N., Burley D. M., Crossley G. Effect of rifampicin and isoniazid on liver function. Br Med J. 1972 Jan 15;1(5793):148–150. doi: 10.1136/bmj.1.5793.148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Miguet J. P., Mavier P., Soussy C. J., Dhumeaux D. Induction of hepatic microsomal enzymes after brief administration of rifampicin in man. Gastroenterology. 1977 May;72(5 Pt 1):924–926. [PubMed] [Google Scholar]
  10. Podesta A., Lopez P., Terg R., Villamil F., Flores D., Mastai R., Udaondo C. B., Companc J. P. Treatment of pruritus of primary biliary cirrhosis with rifampin. Dig Dis Sci. 1991 Feb;36(2):216–220. doi: 10.1007/BF01300759. [DOI] [PubMed] [Google Scholar]
  11. Poupon R. E., Balkau B., Eschwège E., Poupon R. A multicenter, controlled trial of ursodiol for the treatment of primary biliary cirrhosis. UDCA-PBC Study Group. N Engl J Med. 1991 May 30;324(22):1548–1554. doi: 10.1056/NEJM199105303242204. [DOI] [PubMed] [Google Scholar]
  12. Turnberg L. A., Mahoney M. P., Gleeson M. H., Freeman C. B., Gowenlock A. H. Plasmaphoresis and plasma exchange in the treatment of hyperlipaemia and xanthomatous neuropathy in patients with primary biliary cirrhosis. Gut. 1972 Dec;13(12):976–981. doi: 10.1136/gut.13.12.976. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Walt R. P., Daneshmend T. K., Fellows I. W., Toghill P. J. Effect of stanozolol on itching in primary biliary cirrhosis. Br Med J (Clin Res Ed) 1988 Feb 27;296(6622):607–607. doi: 10.1136/bmj.296.6622.607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Wehrli W. Rifampin: mechanisms of action and resistance. Rev Infect Dis. 1983 Jul-Aug;5 (Suppl 3):S407–S411. doi: 10.1093/clinids/5.supplement_3.s407. [DOI] [PubMed] [Google Scholar]
  15. Whittington R. M. Toxic epidermal necrolysis and co-trimoxazole. Lancet. 1989 Sep 2;2(8662):574–574. doi: 10.1016/s0140-6736(89)90706-x. [DOI] [PubMed] [Google Scholar]

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