Treating Primary Biliary Cholangitis

Reviewed by: HU Medical Review Board | Last reviewed: May 2024

Primary biliary cholangitis (PBC) is a long-term medical condition that impacts the liver. While PBC has no cure, treatments may help slow the disease. This may prevent complications or serious liver scarring called cirrhosis.1,2

Drugs for primary biliary cholangitis

PBC is treated with medicines that may slow disease progression and prevent complications. Ursodeoxycholic acid (UDCA) is the first drug commonly used to treat PBC. It is a bile salt that can help bile move through the liver. It works for about half of people with PBC.1-4

If UDCA does not work, your doctor may try a different drug or suggest that you take another drug with UDCA. Possible treatments include:1-5

  • Obeticholic acid (Ocaliva®) – Can be taken alone or with UDCA
  • Fibrates (TriCor®, seladelpar) – Can be taken alone or with UDCA
  • Other medicines that suppress the immune system
  • Other medicines that target specific symptoms

Surgery for primary biliary cholangitis

If medicine does not work or your liver is very damaged, your doctor may recommend a liver transplant. This surgery replaces your diseased liver with a healthy liver from a donor. In this case, you would be put on the transplant list and wait for a liver to be available.1-3

After a liver transplant, life expectancy is normal. And while PBC can come back in a healthy liver, it typically progresses more slowly.1-3

Treating primary biliary cholangitis symptoms

PCB may cause uncomfortable symptoms, and drugs that treat the disease do not always improve these symptoms. However, there are other ways to treat symptoms. For example, treatments that may help reduce itching include:1-3,6

  • Antihistamines – Certain types can also help you sleep if itching keeps you awake at night. Examples include diphenhydramine, hydroxyzine hydrochloride, and loratadine.
  • Cholestyramine – This is a type of drug called a bile acid sequestrant. It must be taken with food or drink.
  • Rifampin – This is an antibiotic drug. Experts do not know exactly how it treats itching.
  • Opioid antagonists that contain naloxone and naltrexone.
  • Sertraline – This is a selective serotonin reuptake inhibitor (SSRI), a type of antidepressant. SSRIs increase serotonin in the brain. Sertraline can help manage itching.
  • Ultraviolet (UV) light therapy – This treatment uses UV light on the skin to help reduce irritation and itching.

Other treatments for specific symptoms may include:1-3

  • Eye drops for dry eyes
  • Chewing gum or sucking on candy for dry mouth
  • Stimulants like modafinil for fatigue

Treating primary biliary cholangitis complications

As PCB progresses, it may lead to complications. The most common complications are fat malabsorption and portal hypertension. Fat malabsorption happens when the digestive system cannot process fat properly. Portal hypertension is the name for high blood pressure in the veins in and around the liver. Treatment for these complications may include:1-3

  • Vitamin and mineral supplements if your body is not digesting properly
  • Cholesterol drugs called statins if you have high cholesterol levels
  • Medicine to prevent or treat weak or thin bones if your body does not digest nutrients properly
  • Blood pressure drugs called diuretics

Before beginning treatment for PBC, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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