Primary biliary cirrhosis medical therapy

Primary Biliary Cirrhosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Primary Biliary Cirrhosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Primary biliary cirrhosis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Primary biliary cirrhosis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Primary biliary cirrhosis medical therapy
CDC on Primary biliary cirrhosis medical therapy
Primary biliary cirrhosis medical therapy in the news
Blogs on Primary biliary cirrhosis medical therapy
Directions to Hospitals Treating Primary biliary cirrhosis
Risk calculators and risk factors for Primary biliary cirrhosis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Pharmacologic medical therapies for Primary biliary cirrhosis include Immunomodulators,antifibrotics and anticholestatics. The anticholestatic Ursodeoxycholic acid (UDCA) is recommended as the first line medical therapy for PBC.

Medical Therapy

• Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
• Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
• Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
• Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Primary biliary cirrhosis

• 1 Anticholestatics
  • 1.1 Preferred regimen : Ursodeoxycholic acid (UDCA) 13-15 mg PO q12h for 10-21 days (Allergy to bile acids)

• 2 Immunomodulator
  • 2.1 Glucocorticoid
    • Preferred regimen :Budesonide 6 to 9 mg per day PO (contraindicated for patients who have hypersensitivity to budesonide)
    • Alternative regimen:Cyclosporine: 5-10 mg PO q24h
• 3 Farnesoid-X-receptor (FXR) agonist
  • 3.1 Obetocholic acid
• 4 Peroxisome proliferator-activated receptor agonist
  • Fibrates

Symptomatic Therapy

1.Pruritus

• 1st line
  • Cholestyramine 4 g/d (before and after breakfast)
• 2nd line
  • Rifampin 150 mg bid
• 3rd line
  • Sertraline
• 4th line
  • Naloxone
• 5th line
  • Liver transplantation

2.Supportive

• UV light,Sunlight

3.Emergency

• Plasmapheresis

4.Raynauds

• 1st line:Calcium channel blockers
• 2nd line:Alternative: prostacyclin and its derivatives, endothelin receptor antagonists and phosphodiesterase inhibitors

5.Sicca syndrome

• Dry eyes
  • Artificial tears
• Dry mouth
  • Dental hygiene
    • Dental visit every 3–6 months
• Dry vagina
  • Vaginal lubricants