Serotonin Antagonists

There is no specific treatment for the fatigue of cholesta-sis at present. The methodology to study fatigue is subjective; thus, there is substantial uncertainty in interpreting any data on fatigue. Some patients with PBC report that taking naps during the day facilitates the performance of their daily activities (NV Bergasa, unpublished). The examination of patients with fatigue and liver disease includes the exclusion of conditions that have a negative impact on energy level, including anemia, thyroid dysfunction, adrenal and renal insufficiencies, and depression, in order for specific treatments to be prescribed if those conditions are present.

The use of ondansetron at doses of 4 mg orally 3 times a day in patients with PBC was associated with a decrease in fatigue scores as assessed by the Fisk Fatigue Impact Score (FFIS), as published in abstract form. Headache and constipation were the most common side effects associated with ondansetron. These preliminary results may support the idea that altered serotoninergic neurotransmission contributes to the pathogenesis of fatigue in liver disease. Table 122-2 summarizes the experience with ondansetron in the treatment of fatigue to date.

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