What are your preferred treatment options for patients with cholestatic pruritus who do not respond to light therapy?  

Great question as in my experience phototherapy does not have high success rate for this. Agree that rifampicin can help quite a bit!   Here is an algorithm you might find useful: Initially treat with a bile acid sequestrant such as cholestyramine (total daily dose of 4 to 16 grams) ...

Dupilumab is in trials and for one of my patients was an absolute game changer. Worth a shot!

Treatment of cholestatic disorders is a rapidly-changing area in gastroenterology. Use of new treatments such as maralixibat and bezafibrate to modulate bile acid transport and secretion is generally beyond the scope of what we dermatologists are going to do, but GI may be able to help there. I gene...