Treatment of ICP: other drugs
Because we know that UDCA doesn’t reduce bile acid levels or improve itch for all women, other medications have been tried for those women who don’t respond to it.
Rifampicin has been introduced in recent years as an additional medication to take in conjunction with UDCA for those women with severe ICP and who are not responding to UDCA alone. Because it can in rare cases worsen liver function it should be presribed in consultation with a doctor who has specialist knowledge of using it in ICP. Rifampicin is an antibiotic which is most commonly used in the treatment of tuberculosis (TB), including the treatment of TB in pregnant women. It has been used to treat several other cholestatic liver diseases, including primary biliary cirrhosis (PBC), where it has been shown to be effective at improving liver function tests and reducing bile acid levels. It also improves itch in people with PBC. A recent research paper has suggested that it can help some women with very severe ICP, but further studies are needed to establish how effective it is as a treatment for the condition. The main side-effect of rifampicin treatment is that it colours your body fluids (urine, tears etc.) orange/red.
A new trial, called TURRIFIC, is currently under way in Australia to evaluate its efficacy. ICP Support is a collaborator on this study.
Dexamethasone is a steroid that has previously been used to improve the symptoms of ICP by reducing the production of hormones. However, prolonged exposure to steroids during pregnancy is now considered to be harmful, and dexamethasone is no longer used to treat ICP. You may, however, be offered injections of dexamethasone or another steroid (betamethasone) if your doctors are considering delivering your baby early. This will help your baby’s lungs to mature and prepare them for birth. Some women report that their itching temporarily improves after having these injections.
Chlorpheniramine (also known as piriton) is an antihistamine that is sometimes prescribed because some doctors hope that it will reduce the sensation of itch, but there is no evidence that this is the case. However, it may also have the side-effect of making you feel drowsy, therefore helping you to sleep. It has no effect on liver function tests and does not reduce bile acid levels.
Vitamin K supplements may be used if you have steatorrhoea. Some women with ICP may have problems in absorbing fat. If this is happening to you, you will notice that your stools become pale. In addition to this, if you are not absorbing fat you will not be absorbing Vitamin K (because it’s a fat-soluble vitamin). Vitamin K helps your blood to clot, so if you do not absorb it properly you may have an increased risk of bleeding heavily after the birth of your baby (post-partum haemorrhage). To try to reduce this risk, some women are offered oral vitamin K (the water-soluble form). However, post-partum haemorrhage in ICP is relatively uncommon and there is no research to show that prescribing vitamin K actually does reduce the risk of bleeding. Vitamin K treatment will have no effect on your symptoms, liver function tests or bile acid levels.
Other drugs used in the past include activated charcoal, guar gum and cholestyramine. There is very little evidence that any of these drugs have beneficial effects on the itch, liver function tests or bile acid levels, and they are therefore rarely used.
Topical treatments such as calamine lotion and aqueous cream with menthol may help to relieve the itch, although the effect may be short-lived.
Some women have tried complementary medicines such as milk thistle and dandelion. None of these remedies has been formally tested in ICP pregnancies. However, because these remedies contain active ingredients it is important that you discuss this with your doctor.
Homeopathy does not contain active ingredients, despite its practitioners’ claims. There is no evidence-based research to support its use. As such, ICP Support does not support its use to treat ICP.
Geenes V, Chambers J, Khurana R, Shemer EW, Sia W, Mandair D, Elias E, Marschall HU, Hague W, Williamson C. Rifampicin in the treatment of severe intrahepatic cholestasis of pregnancy. Eur J Obstet Gynecol Reprod Biol 2015; 189: 59–63
Glantz A, Marschall HU, Lammert F, Mattsson LA. Intrahepatic cholestasis of pregnancy: a randomized controlled trial comparing dexamethasone and ursodeoxycholic acid. Hepatology 2005; 42: 1399–1405