Primary Biliary Cirrhosis - Management

A. Initiate therapy 

 - Initiate 1st line therapy with UDCA (13-15 mg/kg PO daily).

 - Risk stratify patients on UDCA using biochemical and/or prognostic criteria as below.

 - Consider 2nd line therapy if ALP > 1.5x ULN and/or abnormal conjugated bilirubin despite 12 months on UDCA

B. Manage symptoms

 - Pruritus: Cholestyramine, rifampicin, naltrexone, gabapentin, sertraline, bezafibrate

 - Fatigue: Non-pharmacological management

 - Sicca complex: Artificial tears and saliva, lubricants, and non-pharmacological management

 - Osteopenia/osteoporosis: Screen as per standard of care; routine calcium and vitamin D; consider therapy as indicated individually

C. Risk stratify

D. Stage & survey disease



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