Treatment of itching associated with intrahepatic cholestasis of pregnancy.
OBJECTIVE
To review the drug therapy for the treatment of itching associated with intrahepatic cholestasis of pregnancy (ICP).


METHODS
A comprehensive literature search was conducted in MEDLINE (1966-July 2002) using the following MeSH terms: pregnancy, itching, intrahepatic cholestasis, cholestyramine, ursodeoxycholic acid, and phenobarbital. Current Contents (1966-July 2002), International Pharmaceutical Abstracts (1970-June 2002), and Cochrane Database were also searched using those terms. Web of Science search was used to search references found in articles.


RESULTS
Eight clinical trials and several observational studies were identified evaluating the safety and efficacy of ursodeoxycholic acid (UDCA) in the treatment of ICP. Although these studies were small and inconsistent, improvement in maternal and fetal morbidity was demonstrated. Observational studies suggest that cholestyramine may be associated with improved maternal morbidity without a documented improvement in fetal outcome. Two observational studies evaluated the efficacy of phenobarbital for ICP treatment. Phenobarbital use was not associated with improved maternal or fetal morbidity/mortality.


CONCLUSIONS
Data from large, well-designed, randomized, controlled trials of treatment of ICP are lacking. Data that are available support the use of UDCA as a first-line agent and cholestyramine as a second-line agent for treatment of ICP. There is little evidence to recommend phenobarbital in the treatment of itching associated with that condition.
Harrison School of Pharmacy, Auburn University, Auburn, AL, USA.
J Kimble
JK
Jenkins
Lisa A
LA
Boothby
D000328:Adult; D000982:Antipruritics / Q000627:therapeutic use*; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D002780:Cholestasis, Intrahepatic / Q000150:complications* / Q000209:etiology; D005260:Female; D006801:Humans; D010634:Phenobarbital / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome; D011379:Prognosis; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
D000982:Antipruritics; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; D010634:Phenobarbital