Medical therapy of pruritus of cholestasis

Pruritus is one of the most frequent and distressing symptoms of chronic cholestasis. Its pathogenesis is unknown. Agents implicated include bile acids and other retained constituents of bile, as well as endogenous opioids. Therapy is empiric and not universally effective. Attempts have been made to remove pruritogens from the body with bile acid sequestrants, to increase their excretion with enzyme inducers, and to block their action with opiate antagonists. The pros and cons of individual agents and an overall approach to therapy are discussed.