Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy

Table 1 Pharmacologic treatment of intrahepatic cholestasis of pregnancy is summarized

Pharmacologıc agent	Mechanism of action	Dosing	Clinical effects	Pregnancy risk
Ursodeoxycholıc acid	Hydrophilic bile acid that replaces more cytotoxic bile acids	15 mg/kg per day or 500 mg twice a day	Improves pruritus, decreases elevated liver enzymes and bile acid levels, improves fetal outcome	C
	Protects bile ducts by detoxifying hydrophobic bile acids		Safe use in pregnancy, no side effects
Cholestyramıne	Binds bile salts and cuts off their enterohepatic circulation and increases their fecal excretion	8-16 g/d	Decreases pruritus with no effect on biochemical parameters and fetal outcome	C
			Non-palatable, constipation
			Fat-soluble vitamin deficiency
S-adenosyl methionine	Affects the composition and fluidity of hepatocyte membranes	1000 mg/d	Treats pruritus variably	C
	Increases methylation and biliary excretion of hormone metabolites
Dexamethasone	Suppresses fetal production of estrogen reducing bile acid levels	12 mg/d	Less effective in decreasing pruritus and bile acid levels	B
Phenobarbital	Induces hepatic enzymes to reduce the bile acids	2-5 mg/kg per day orally	Decreases pruritus 50%, no beneficial effects regarding the laboratory tests, no change in fetal outcome	C
Anti-histaminics	Manages pruritus by antihistaminic effects	25-50 mg/d	Decreases pruritus, no effect on liver enzymes and fetal outcome	C