Treating PBC symptoms and complications

Treating PBC

Alongside treating PBC directly and slowing the disease progression, your doctor may recommend treatments for your symptoms to improve your quality of life.

Treating itchiness

A few different treatment options are available to manage the itch associated with PBC, but a powdered drug, which is a bile acid sequestrant, is often the first treatment recommended.^1,2

Alt text: Three text boxes labelled ‘Bile Acid Sequestrant’, ‘Other drugs’, ‘Additional treatments’. Box 1, Bile Acid Sequestrant: Widely used to treat PBC-related itchiness. How it works: Helps remove bile acids that are causing the itching. Potential side effects: Constipation, bloating, headaches, reduced vitamin absorbance. (References 1,3). Box 2, Other drugs: Used if a Bile Acid Sequestrant cannot be taken or is not working. Examples: Some Antibiotics and opioid antagonists. How they work: Thought to act on the brain, such as by blocking the brain’s response to itching. (References 1-3). Box 3, Additional treatments: Can be used in addition to prescribed treatments. Antihistamines can help limit itchiness, especially during sleep. Regular use of moisturisers can help stop skin from becoming dry. Vitamin supplements may be beneficial. (References 1-3).

Dissolving your bile acid sequestrant in fruit juice rather than water can help to disguise the unpleasant taste.^1,2

If you are taking medicines as part of both general PBC treatment (e.g., the naturally occurring bile acid) and symptom management (e.g., a bile acid sequestrant) it’s important to understand whether your medicines can be taken together or not. Ask your GP if you are ever unsure, and they can provide advice.¹

Managing fatigue

Unfortunately, there are no medicines available to treat fatigue from PBC. However, your doctor can check for other conditions that you could have, as well as PBC, that could be causing your tiredness.

These conditions can include:^1,2

Anaemia, underactive thyroid, type 2 diabetes, sleep apnoea, depression.

Simple lifestyle choices can make a real difference in how you feel. Staying active, getting good quality sleep, and cutting back on caffeine, nicotine, and alcohol can all help you manage fatigue and support your overall wellbeing. We discuss this further in the Living with PBC section.

Treatment for dry eyes and mouth

If you have dry eyes, your GP may recommend eyedrops containing artificial tears.^1,3

If you have a dry mouth, your GP may recommend saliva substitutes.^1,3 Having a dry mouth can increase the risk of tooth decay, so make sure to take care of your teeth and gums and visit the dentist regularly.¹ Chewing gum or sucking hard candy can also help you make more saliva and relieve symptoms.³

Treatment for other complications

If you suffer from any other diseases or complications related to PBC, such as osteoporosis, your doctor can provide the appropriate advice or medications.

References

NHS. Primary biliary cholangitis. Available at: https://www.nhs.uk/conditions/primary-biliary-cholangitis-pbc/treatment/. Last accessed April 2025.
British Liver Trust. Treating primary biliary cholangitis. Available at: https://britishlivertrust.org.uk/information-and-support/liver-conditions/primary-biliary-cholangitis/treatment. Last accessed April 2025.
Mayo Clinic. Primary biliary cholangitis – Diagnosis & Treatment. Available at: https://www.mayoclinic.org/diseases-conditions/primary-biliary-cholangitis/diagnosis-treatment/drc-20376880. Last accessed April 2025.