Hepatitis and liver dysfunction with rifampicin therapy for pruritus in primary biliary cirrhosis
Open accessAbstract
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.
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Rifampicin has potential adverse effects including hepatotoxicity and haemolysis, so patients starting it need regular blood test monitoring.
“There are concerns over potential adverse effects with rifampicin (including hepatotoxicity and haemolysis) so patients commencing treatment require regular blood test monitoring [196].”
From EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. (2017) · cites this paper as [196]
The Discussion (page not available in our copy) reports rifampicin-associated hepatotoxicity and recommends regular liver function tests during the first two months of therapy. Our copy does not mention haemolysis or recommend blood tests to monitor for it, so that adverse-effect detail is unsupported. (LLM, conf=0.87)
Experimental — accuracy not yet measuredDrug-induced liver injuries, sometimes progressing to acute liver failure, hemolysis, renal impairment, and alteration in drug metabolism, have been reported with rifampicin use, so use is avoided in patients with bilirubin levels greater than 2.5 mg/dL.
“Although uncommon, drug-induced liver injuries-sometimes progressing to acute liver failure, hemolysis, renal impairment, and alteration in drug metabolism-have all been reported with rifampicin use such that use is avoided in patients with bilirubin levels greater than 2.5 mg/dL, with close follow-up warranted.(195,199)”
From Primary Biliary Cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases (2019) · cites this paper as [199]
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Experimental — accuracy not yet measuredRifampicin has potential side effects including hepatotoxicity and haemolysis, so patients commenced on treatment need regular blood tests.
“There are concerns over potential side effects with rifampicin (including hepatotoxicity and haemolysis), so patients commenced on treatment need regular blood tests.188”
From The British Society of Gastroenterology/UK-PBC primary biliary cholangitis treatment and management guidelines (2018) · cites this paper as [188]
The Discussion reports rifampicin-associated hepatotoxicity and recommends regular liver-function tests during the first two months of treatment. The paper does not address haemolysis, so it supports the monitoring recommendation for liver injury but not that additional cited side effect. (LLM, conf=0.88)
Experimental — accuracy not yet measuredGuideline-recommended drugs for cholestatic pruritus, including cholestyramine, rifampicin, naltrexone, and sertraline, have limited efficacy and/or tolerability.
“Current guideline-recommended medical treatment options for pruritus of cholestasis include the anion exchange resin cholestyramine, the pregnane X receptor (PXR) agonist rifampicin, the opioid antagonist naltrexone, and the selective serotonin reuptake inhibitor sertraline.4,7 Efficacy or tolerability of these drugs, or both, are limited.8,9”
From Fibrates for Itch (FITCH) in Fibrosing Cholangiopathies: A Double-Blind, Randomized, Placebo-Controlled Trial (2021) · cites this paper as [8]
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- Authors
- Prince, M. I., Burt, A. D., & Jones, D. E. J.
- Affiliations
- Newcastle University (GB)
- Corresponding author
- Prince, M I
- ORCID
- Burt, A D
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2002-03
- Volume
- 50
- Issue
- 3
- Pages
- 436-439
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC1773130
- OpenAlex
- W2169053291
- Cited by
- 202
- References
- 28
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 6 · 2023: 6 · 2022: 10 · 2021: 8 · 2020: 4 · 2019: 11 · 2018: 11 · 2017: 11 · 2016: 5 · 2015: 13 · 2014: 7 · 2013: 5 · 2012: 12
- FWCI
- 7.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Ophthalmology › Drug-Induced Ocular Toxicity
- Keywords
- rifampicin, primary biliary cirrhosis, drug-induced hepatitis, pruritus, cholestatic liver disease, hepatotoxicity, liver synthetic function, liver transplantation, antipruritic therapy, adverse drug reactions
- MeSH terms
- Adult, Antipruritics, Female, Humans, Liver Cirrhosis, Biliary, Middle Aged, Pruritus, Rifampin, Chemical and Drug Induced Liver Injury
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