Hepatitis and liver dysfunction with rifampicin therapy for pruritus in primary biliary cirrhosis

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http://gut.bmjjournals.com/cgi/content/abstract/50/3/436

Gut 2002;50:436-439

© 2002 by Gut

CASE REPORT

Hepatitis and liver dysfunction with rifampicin therapy for pruritus

in primary biliary cirrhosis

M I Prince, A D Burt and D E J

Centre for Liver Research, University of Newcastle, Newcastle, UK

Correspondence to:

Dr M Prince, Centre for Liver Research, 4th Floor Leech

Building, Newcastle University Medical School, Framlington Place,

Newcastle NE2 4HH, UK;

.prince@...

ABSTRACT

There is evidence to suggest that rifampicin is an effective second

line therapy for controlling pruritus in patients with chronic

cholestatic liver disease. It is most widely used as an antipruritic

agent in the autoimmune cholestatic liver disease, primary biliary

cirrhosis (PBC). Rifampicin has been reported as causing hepatitis in

patients being treated for tuberculosis. Most reports of this have

been confounded however by the concurrent use of other hepatotoxic

antitubercular therapy. Here we report a single centre experience of

the use of rifampicin in PBC, and describe three cases of significant

hepatitis associated with rifampicin therapy. Two of these patients

had significant impairment of liver synthetic function (necessitating

liver transplantation in one case). These are the first reports of

impaired hepatic synthetic function due to rifampicin monotherapy.

Rifampicin caused significant hepatitis in 7.3% (95% confidence

interval 2.5–19.4%) of patients treated for cholestatic liver disease

in our centre.

Keywords: rifampicin; pruritus; primary biliary cirrhosis; hepatitis;

liver dysfunction

Abbreviations: PBC, primary biliary cirrhosis; UDCA, ursodeoxycholic

acid; LFTs, liver function tests; ALT, alanine transaminase; ALP,

alkaline phosphatase

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