Editing Primary biliary cholangitis (section)

===Itching===
Pruritus is a common symptom in people with PBC. First-line treatment of pruritus consists of anion-exchange resins, such as [[cholestyramine]], [[colestipol]], or [[colesevalam]].<ref name=AASLD_2018 />  These anion-exchange resins are nonabsorbed, highly positively charged substances that bind bile acids, which are negatively charged anions.<ref name=AASLD_2018 />  Anion-exchange resins relieve itching caused by excess bile acids in circulation by binding bile acids in the gut and facilitating elimination. Bloating or constipation may occur with anion-exchange resins.<ref name=AASLD_2018 /> Cholestyramine may affect absorption of [[Ursodeoxycholic acid|UDCA]]; if cholestyramine is necessary, it should be taken at least 60 minutes before or 4 hours after UDCA is taken.<ref name=AASLD_2018 />

Treatment options for pruritus that does not improve with anion-exchange resins include: [[rifampicin]], [[naltrexone]], or [[sertraline]].<ref name=AASLD_2018 /> Rifampicin may rarely cause drug induced liver injury and should be avoided if serum bilirubin is elevated (greater than 2.5&nbsp;mg/dL). Liver enzymes should be monitored after starting rifampin.<ref name=EASL_2017 /> Rifampicin induces enzymes, resulting in numerous potential drug-drug interactions.<ref name=AASLD_2018 /> Opioid antagonists may cause a self-limited opioid withdrawal like reaction, with abdominal pain, elevated blood pressure, tachycardia, goose bumps, nightmares, and depersonalization.<ref name=AASLD_2018 /> To avoid such reactions, the dose should start low and gradually be increased.<ref name=AASLD_2018 />