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- PBC facts
- What treatments are used in patients with PBC?
- Ursodeoxycholic acid (UDCA)
- Colchicine (Colcrys)
- Immunosuppressive medications
- Budesonide (Entocort)
- Azathioprine (Imuran)
- Cyclosporine (Sandimmune, Neoral, Gengraf)
- Methotrexate (Rheumatrex, Trexall)
- Obeticolic acid (Ocaliva)
- Cholestyramine (Questran) for itching
- Rifampin for itching
- Opiod antagonists for itching
- Charcoal hemoperfusion for itching
- Osteoporosis medications
- Treatment of elevated serum cholesterol and xanthomas
- Treatment of malabsorption of fat and fat-soluble vitamins (A, D, E and K)
- Treatment of edema and ascites
- Treatment of bleeding from varices
- Treatment of hepatic encephalopathy
- Treatment of enlarged spleen
- Treatment of Sicca syndrome
- Treatment of Raynaud's phenomenon
- Treatment of scleroderma
- Treatment of gallstones
- Which specialties of doctors treat PBC?
- What is the role of liver transplantation in PBC?
- What is the future for PBC?
Treatment of hepatic encephalopathy
PBC patients with an abnormal sleep cycle, impaired thinking, odd behavior, or other signs of hepatic encephalopathy usually should be treated with a low protein diet and oral lactulose. Dietary protein is restricted because it is a source of the toxic compounds present in hepatic encephalopathy. The lactulose, which is a liquid medication, traps the toxic compounds in the colon. Consequently, they cannot be absorbed into the blood stream and cause the symptoms of encephalopathy. To be sure that adequate lactulose is present in the colon at all times, the patient should adjust the dose to produce 2 to 3 semiformed bowel movements a day. If symptoms of encephalopathy persist, the oral antibiotics, neomycin or metronidazole (Flagyl), can be added to the treatment regimen.
Treatment of enlarged spleen
The blood filtration function of an enlarged spleen usually results in only mild reductions of red blood cells (anemia), white blood cells (leukopenia) and platelets (thrombocytopenia) that do not require treatment. Severe anemia, however, may require blood transfusions or treatment with erythropoietin or epoetin alfa (Epogen, Procrit), a hormone that stimulates production of red blood cells. If the numbers of white blood cells are severely reduced, another hormonal drug, called granulocyte-colony stimulating factor (G-CSF) is available to increase the white blood cells. An example of an available G-CSF drug is filgrastim (Neupogen).
No FDA-approved medication is available yet to increase the number of platelets. As a necessary precaution, patients with low platelets should not use aspirin or other non-steroidal anti-inflammatory drugs (NSAIDS) since these drugs can hinder the function of platelets. If a low number of platelets is associated with significant bleeding, transfusions of platelets usually should be given. Surgical removal of the spleen (called splenectomy) should be avoided, if possible, because of the risk of excessive bleeding during the operation and the risk of anesthesia in advanced liver disease.