, Volume 44, Issue 3, pp 602-607

Oral Nicotine in Treatment of Primary Sclerosing Cholangitis (A Pilot Study)

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Abstract

Currently, no accepted medical Therapy forpatients with primary sclerosing cholangitis (PSC) isavailable. Case-control studies have shown an inverseassociation between PSC and smoking behavior, suggesting that nicotine might have a beneficial effect inPSC. The aim of this study was to evaluate the safetyand estimate the efficacy of oral nicotine in thetreatment of PSC. Eight PSC patients who had never smoked received oral nicotine at a maximum doseof 6 mg four times a day for up to one year. Liverbiochemistries and plasma cotinine levels weredetermined at entry and at three-month intervals during the study duration. Five patients completed oneyear of treatment, but three of them had to temporarilyreduce the dose due to side effects. One patientcompleted only four months of treatment due to dizziness and heart palpitations. Two patients completedonly one month of treatment due to reactivation ofcolitis requiring corticosteroid Therapy. No significantchanges in liver biochemistries were noted during the treatment period despite a significantincrease in plasma cotinine levels. In conclusion, oralnicotine seems to have no beneficial effects in thetreatment of PSC, and it is frequently associated with side effects necessitating permanent drugcessation.