PBC: What Are Your Treatment Options?

Medically Reviewed by Jennifer Robinson, MD on December 12, 2019

There's no cure yet for primary biliary cholangitis, a long-term liver disease. But there are ways to slow its progress and help ease your symptoms.


The main drug used to treat the disease is ursodeoxycholic acid, or UDCA. Your doctor might also call it ursodiol. It’s a natural bile acid that helps move bile out of your liver and into your small intestine.

UDCA will probably be the first treatment your doctor suggests. It can do a lot of good if you start it early on. If your doctor prescribes it, you may have to take it every day for the rest of your life. It slows liver damage and may make it less likely that you’ll need a transplant. You might notice side effects like weight gain, diarrhea, and hair loss.

If UDCA alone doesn’t help, or if you can't handle its side effects, your doctor may recommend obeticholic acid (Ocaliva). You might take it alone or along with UDCA. It boosts bile flow and eases how much bile acid your liver makes. Side effects might include itchy skin, belly pain, achy joints, and a sore throat.

Doctors are researching other drugs to see if they can help. Some, like colchicine and methotrexate, suppress your immune system. Other studies suggest that fenofibrate or prednisone might help. Your doctor can help you decide what’s best for you.

Treating Symptoms

There are ways to help ease the discomfort.

Itchy skin: This common symptom may also be the most annoying. It can be mild or so severe that it bothers you day and night. If it isn’t too bad, try over-the-counter antihistamines that contain diphenhydramine. They can make you sleepy, so you might try them if itching keeps you awake at night. If they don't help, your doctor can prescribe something else like cholestyramine (Locholest, Prevalite, Questran), naltrexone (Revia, Vivtrol), rifampin (Rifadin, Rimactane), and sertraline (Zoloft).

Dry eyes and mouth: Start with over-the-counter artificial tears. If they don't work, see your eye doctor for prescription drops. You can also find saliva substitutes to help with a dry mouth. Prescription options are available if they don’t do the trick. You can also suck on hard candy or chew gum to help with dry mouth.

Fatigue: PBC can make you tired all the time. But your daily habits, other medical conditions, and even drugs you take can make it worse. Work with your doctor to take care of those issues, and you might ease your fatigue. A drug called modafinil (Provigil) might help.

Liver Transplant

Treatments usually keep primary biliary cholangitis from getting worse. If they don’t, your liver could start to fail. If that happens, your doctor will discuss a liver transplant. In this surgery, your liver is removed and replaced with a healthy, donated liver. PBC can return even after a liver transplant. But it might take years.

WebMD Medical Reference



Medscape: "Primary Biliary Cholangitis (Primary Biliary Cirrhosis) Treatment & Management."

Mayo Clinic: "Primary Biliary Cirrhosis: Treatment and drugs."

American Liver Foundation: "Primary Biliary Cholangitis (PBC, previously Primary Biliary Cirrhosis)."

American College of Gastroenterology: "Primary Biliary Cirrhosis (PBC)."

National Institute of Diabetes and Digestive and Kidney Diseases: "Primary Biliary Cirrhosis."

HealthyWomen: "Primary Biliary Cholangitis (PBC) Diagnosis."

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