Hello and thanks for your enquiry,

I am sorry to hear about your husband's diagnosis, and how uncomfortable he is right now. It is difficult to watch a loved one deal with the severe, unrelenting itch (pruritus) that comes with jaundice. Chlorpheniramine (commonly known as Piriton) is a standard antihistamine, but it is often ineffective for jaundice-related itching because this type of itch is not caused by histamine. Instead, it is caused by a buildup of bile salts and bilirubin in the bloodstream, which occurs when a pancreatic cancer blocks the bile duct.

To treat jaundice-induced itching, doctors use medications that specifically address bile accumulation or alter how the brain perceives the itch signal.

Medications like cholestyramine come as a powder mixed with liquid. They bind to bile salts in the digestive tract so the body can excrete them, rather than absorbing them into the blood.

Rifampicin is an antibiotic that has a powerful side effect of changing how the liver processes and removes bile acids, which frequently provides significant itch relief. This drug is used by specialists and not prescribed by a GP. Naltrexone is another drug block specific receptors in the nervous system that transmit the "itch" message to the brain.

While medications do provide some relief, the best way to eliminate the jaundice and the itching entirely is to try and unblock the bile duct. A biliary stent is a tiny plastic or metal tube inserted into the bile duct during a quick, non-surgical procedure (usually an ERCP endoscopy). The stent pushes the cancer out of the way, allowing the bile to drain naturally into the bowel again. Once the stent is in place, the itching and yellowing usually begin to improve dramatically within a few days. Not everyone is suitable to have this procedure done though.

While you wait to speak with his doctor, these steps can help soothe his skin:

• Intense Moisturization: Apply a generous amount of unfragranced aqueous cream or a cooling menthol-in-aqueous-cream (0.5% or 1%). Keeping the skin cool and hydrated suppresses the urge to scratch.
• Cool Compresses: Place cool, damp cloths on the most irritated areas of his skin.
• Loose Cotton Clothing: Have him wear loose, breathable cotton garments to avoid friction and overheating, which make the itching worse.

I am not sure from your enquiry, if your husband is waiting to be seen by a hospital specialist, or is already under the care of one. Or if he is under the care of a community palliative care team. Please contact your husband’s GP, or hospital Clinical Nurse Specialist (CNS), oncologist (cancer specialist), or the local palliative/symptom team (if under the care of) today. Tell them directly that the chlorpheniramine is not working and ask if he can be prescribed cholestyramine, or other medications, and/or assessed for a biliary stent to relieve the blockage.

There is another charity called Pancreatic Cancer UK which has specialist nurses that can provide support and more information about this for you and They have a support line

I hope that this helps,

Best wishes,

Vanda

Cancer information nurse