Maternal itch
For management of maternal itch caused by intrahepatic cholestasis of pregnancy, general skin care measures (eg loose-fitting clothing, use of emollients and soap substitutes including tar preparations) are recommended. Antihistamines can be considered (eg cyproheptadine, dexchlorpheniramine, cetirizine; see the Dermatology guidelines for doses).
If general skin care measures and antihistamines are not effective, ursodeoxycholic acid may be considered, although a randomised controlled trial1 found no meaningful reduction in itch (nor improvement in fetal outcomes). A suitable regimen is:
ursodeoxycholic acid 500 mg orally, twice daily. If needed, increase dose gradually up to a maximum of 2000 mg daily in two to four divided doses (Therapeutic Goods Administration [TGA] category B3)2. intrahepatic cholestasis of pregnancy ursodeoxycholic acid
If ursodeoxycholic acid is improving itch, continue therapy until delivery. If itch does not improve despite increased doses of ursodeoxycholic acid, it should be stopped. Other treatments (eg rifampicin) may be considered in a specialist setting—consultation with an obstetric physician is recommended.