Itching and Hep C...AGAIN

Posted by Michael S on April 22, 1999 at 23:05:41
Hi....i received a liver transplant in August of 1998.  Unfortunately the Hep C came back real quickly and i need another transplant so ive been relisted.  It seems that once again, the "Itching" associated with my Hepatitis C Is actually driving me crazy.  I spoke with the doctors at Mount Sinai and ive tried Benadryl, ActiGall and another medicine (very odd effects so i discontinued this one immediately) and NOTHING HELPS!!! Occasionally "Sarna" cream helps, but it seems to be getting worst.  I heard of a thing called "photo Sensitivity" that might help.  What do you know about this and also what do you know about Hep C and Itching and ALSO THE MEDICINES TAKEN AFTER Tx and Itching.  Im told some of This itching (this time around) can be from some of the meds.  If you know of ANYTHING at all that may alleviate this at all, im willing to try anything!!  Thanks and W/B Soon!!       Michael

Posted by HFHSM.D.-D.M. on April 29, 1999 at 12:55:41

Dear Michael S:
I am not happy to hear about your situation.  Recurrent, cholestatic hepatitis C after liver transplantation is a major problem for transplant centers and for hepatitis C patients.   I assume that you are Mt. Sinai hospital in New York.  They are one of the very experienced centers with this problem.  I can appreciate how frustrated you and they must be.  
It sounds like you did not respond to actigall and benadryl.  You may have taken a drug called naltrexone that gave you the odd sensation.  This is a very effective drug for pruritus.  You will want to ask your physicians if this is the drug you tried.  If it is, you might want to try it at a lower dose.  We also use drugs such as phenobarbital and rifampin which can be very effective for itching.  These drugs can affect the level of your other immunosuppressive medications so they have to be monitored closely.  Cholestyramine is also a drug that can be effective.
On some occasions we actually treat the hepatitis C itself with interferon or interferon and ribavirin.  On some occasions we have seen excellent responses and in a few of these patients itching improved considerably.  On a few occasions I have taken patients with severe itching and put them on narcotics with some relief.  Clearly I would not do this unless there are no non-narcotic approaches that work.  
Phototherapy and plasmapheresis are treatments that have been used for itching in general and have been used for the itching of liver disease.  The general principle is that these modalities can remove substances in the blood that cause the itching.  I have not used either of these approaches with my patients and there is not a lot of information about using them in liver disease.  However, there are reports that in some cases they have been effective and I can