Treating the disease

There's no cure for primary biliary cholangitis, but medications are available to help slow the progression of the disease and prevent complications. Options include:

• Ursodeoxycholic acid (UDCA). This medicine, also known as ursodiol (Actigall, Urso), is commonly used first. It helps move bile through your liver. UDCA doesn't cure primary biliary cholangitis, but it seems to improve liver function and reduce liver scarring. It's less likely to help with itching and fatigue. Side effects may include weight gain, hair loss and diarrhea.
• Obeticholic acid (Ocaliva). This is the newest medication approved by the Food and Drug Administration for primary biliary cholangitis. Studies show that when given alone or combined with ursodiol for 12 months it can help improve liver function.
• Fibrates (Tricor). Researchers aren't exactly sure how this medicine works to help ease primary biliary cholangitis symptoms. But, when taken with UDCA, it has reduced liver inflammation and itching in some people. More studies are needed to determine long-term benefits.
• Other medications. Many other drugs have been used or studied for treating primary biliary cholangitis with mixed results. They include methotrexate (Trexall) and colchicine (Colcrys).
• Liver transplant. When medications no longer control primary biliary cholangitis and the liver begins to fail, a liver transplant may help prolong life. A liver transplant replaces your diseased liver with a healthy one from a donor. Liver transplantation is associated with very good long-term outcomes for people with primary biliary cholangitis. However, sometimes the disease comes back several years later in the transplanted liver.

Treating the symptoms

Your doctor may recommend treatments to control the signs and symptoms of primary biliary cholangitis and make you more comfortable.

Treatment for fatigue

Primary biliary cholangitis causes fatigue. But, your daily habits and other health conditions can affect how tired you feel. Researchers are investigating whether a medicine called modafinil (Provigil) may help reduce fatigue in people with primary biliary cholangitis. More research is needed.

Treatment for itching

• Antihistamines such as diphenhydramine (Benadryl, others) and loratadine (Claritin, others) are commonly used to reduce itching. They may help with sleep if itching keeps you awake.
• Cholestyramine (Questran) is a powder that must be mixed with food or liquids. Though cholestyramine works for most people, the taste is unpleasant.
• Rifampin (Rifadin, others) is an antibiotic that may stop itching. Exactly how it does this is unknown. Researchers think it may block the brain's response to itch-inducing chemicals in the blood.
• Opioid antagonists such as those containing naloxone (Bunavail, Evzio) and naltrexone (Vivitrol) may help itching related to liver disease. Like rifampin, these drugs seem to reduce the itching sensation by acting on your brain.

Treatment for dry eyes and mouth

Artificial tears and saliva substitutes, available over-the-counter or by prescription, can help ease dry eyes and mouth. Chewing gum or sucking on hard candy also can help you make more saliva and relieve dry mouth.