Itching, Cholestryamine and Serotonin

January 25, 2008

Cholestatic liver disease is frequently associated with generalized

pruritus. Pruritus can precede other signs and symptoms. It first

appears in hands and feet and in areas of pressure and is worse at

night. This itching can be very severe and is a serious clinical

problem. Severe unrelieved itch in these patients can be an

indication for liver transplantation.

" Although bile salts are not directly responsible for pruritus,

treatment with cholestyramine that binds bile salts is effective in

reducing itch in cholestatic disease. In addition to bile salts,

cholestyramine binds other substances in the intestine that may be

the basis for its effectiveness, since it has also been used

successfully in uremic patients and in polycythemia vera.

Cholestryamine has also been shown to improve itching of cholestasis,

suggesting that serotonin is involved in the itch (Table 89-2). It

also play a key role in intestinal secretions and bowel motility.

Serotonin is presumed to be modulated by sex drive. About 95% of

serotonin in the body is in the gut...that only leaves 5% for the

CNS. Some researchers suspect that SSRIs like paroxetine (Paxil)

might help decrease constipation because of effects on serotonin.

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s=ND & cs= & st=0 & li=0 & pm=5 & pc=05-28

>

> That website recites in interesting potential " side-effect " from

CSM of

> increased sex drive--which at first gave me a chuckle. Then, I

realized

> that mycotoxins lower androgen levels. So, I guess, take CSM, get

rid

> of mycotoxins, increase androgen levels and whallah-- " side effect. "

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