Rifampin relieves pruritus in children with cholestatic liver disease

Ectopic liver and hepatocarcinogenesis

“…lacked a sound scientific rationale and can be classified as empiric,'' rifampin therapy was predicted to be effective based on the theory, and was then tested and found to be efficacious in double-blind, controlled trials. 3,4 Finally, the nature of pruritus is said to be ''intrinsically subjective,'' yet the authors insist that only 1 quantitative measure of scratching activity is valid. Other behavioral measures, such as quantitation by visual analogue scales, also retain validity in studies of such ''intrinsically subjective sensations.''…”

“…2,3 Concerning the source of increased levels of endogenous opioids in cholestasis, we stated 1 that ''the sites of synthesis of endogenous opioids involved in the mediation of the pruritus of cholestasis are currently unknown, but one source may be the cholestatic liver itself.'' 4 The mechanism of apparent ameliorations of the pruritus of cholestasis associated with partial or total interruption of the enterohepatic circulation is unknown. Such intervention may affect the metabolism of substances other than bile acids.…”

The pruritus of cholestasis

“…[13][14][15] The observation that rifampin induces an opiate withdrawal syndrome in patients on maintenance doses of methadone 35 raises the possibility that apparent ameliorations of the pruritus of cholestasis induced by rifampin [25][26][27] may be attributable to an effect of rifampin on the opioid neurotransmitter system, which leads to a decrease in opioidergic tone. Apparent ameliorations of the pruritus of cholestasis after the administration of propofol 36,37 may also be attributable to a modulation of opioidergic tone.…”

“…There is a consensus that an appreciable proportion of patients with chronic cholestatic liver diseases experience an amelioration of pruritus when treated with an anion exchange resin or rifampin, and this consensus is supported by subjective efficacy data from randomized, double-blind, controlled studies. [25][26][27] However, there is no standard generally-accepted regimen for treating the pruritus of cholestasis with conventional empiric therapies. 24 …”

Protective Effect of Rifampicin against Acute Liver Injury Induced by Carbon Tetrachloride in Mice

“…It was recently reported that rifampicin significantly relieved pruritus in adult patients with primary biliary cirrhosis and children with cholestatic liver disease (1,2). The potential for drug interaction often exists because rifampicin is a potent inducer of liver microsomal drug-metabolizing enzymes, as demonstrated by proliferation of smooth endoplasmic reticulum and an increase in cytochrome P-450 (P-450) in the liver (3).…”