Treatment of Pruritus Secondary to Liver Disease

  • Miriam M. Düll
  • Andreas E. KremerEmail author
Liver (S Cotler and E Kallwitz, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Liver


Purpose of Review

Pruritus is a common extrahepatic symptom in various liver disorders, in particularly those with cholestatic features. This review summarizes epidemiology, pathophysiology, evidence-based therapeutic recommendations and currently investigated drugs for pruritus in hepatobiliary disorders.

Recent Findings

Recent epidemiological data suggest pruritus as a common and relevant symptom in immune-mediated liver diseases, i.e., primary biliary cholangitis (PBC) with over 70% affected patients, up to 56% suffering from chronic pruritus. The better pathophysiological understanding of hepatic pruritus has led to the identification of novel therapeutic targets, addressed in drug trials using KOR agonists, PPAR agonists, and ileal bile acid transporter inhibitors.


Hepatic itch remains among the most agonizing symptoms for affected patients and a clinical challenge for physicians. Therapeutic recommendations include a guideline-based stepwise approach starting with cholestyramine, followed by rifampicin, naltrexone, and sertraline. Bezafibrate and ileal bile acid transporter inhibitors represent promising future anti-pruritic treatment options.


Autotaxin Bile salt Cholestasis Liver Lysophosphatidic acid Pruritus 


Compliance with Ethical Standards

Conflict of Interest

Miriam M. Düll declares no conflict of interest. Andreas E. Kreme has received speaker fees from CymaBay, Falk Foundation, and Intercept and has signed advisory contracts with Beiersdorf, GSK, and Intercept. He further received unrestricted research grants from Intercept.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Department of Medicine 1, Gastroenterology, Hepatology, Pneumology and EndocrinologyFriedrich-Alexander-University Erlangen-NürnbergErlangenGermany

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