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Rifampicin for Cholestatic Pruritus — SCE Palliative Medicine MCQ

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HardGI SymptomsRifampicin for Cholestatic PruritusSCE Palliative Medicine

A patient with cholestatic itch takes modified-release oxycodone. After specialist review, rifampicin is considered because cholestyramine was not tolerated. Which issue most affects the plan?

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Correct answer: ERifampicin may reduce oxycodone exposure and requires liver and interaction monitoring

Rifampicin is an enzyme inducer with clinically important interactions and potential hepatotoxicity, especially relevant in liver disease. Oxycodone is mainly metabolised through CYP3A4; its SmPC reports that rifampicin 600 mg daily for seven days reduced oral oxycodone AUC by about 86%. It is not an antihistamine, opioid antagonist, renal-only drug or topical treatment. Specialist selection, analgesia review and liver monitoring are essential.

Reference: Scottish Palliative Care Guidelines: Pruritus. https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/symptom-control/pruritis/ Scottish Palliative Care Guidelines: End-stage liver disease. https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/last-days-of-life-care-around-dying/end-stage-liver-disease/ OxyContin prolonged-release tablets SmPC. https://www.medicines.org.uk/emc/product/7677/smpc