Jaundice drug of choice
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Here is a complete, cause-based breakdown of drugs used in jaundice:
Drug of Choice in Jaundice - by Cause
There is no single drug of choice for jaundice because jaundice is a sign, not a disease. Treatment is always directed at the underlying cause. The classification below follows the standard prehepatic / intrahepatic / posthepatic framework.
1. Prehepatic Jaundice (Hemolytic)
Elevated unconjugated bilirubin due to excessive RBC breakdown.
| Cause | Drug / Treatment |
|---|---|
| Autoimmune hemolytic anemia | Corticosteroids (prednisolone) - first line |
| Malaria-induced hemolysis | Artemisinin-based combination therapy (ACTs) - e.g., artemether-lumefantrine |
| Sickle cell / thalassemia | Hydroxyurea, transfusion support |
| Gilbert's syndrome | No drug needed - self-limited, no treatment required |
| Crigler-Najjar (neonates) | Phenobarbitone (induces glucuronyl transferase, mild Type II); phototherapy for Type I |
2. Intrahepatic Jaundice (Hepatocellular)
| Cause | Drug of Choice |
|---|---|
| Viral Hepatitis B (acute/chronic) | Tenofovir or entecavir (antivirals) |
| Viral Hepatitis C | Sofosbuvir + ledipasvir or sofosbuvir + daclatasvir (DAAs) |
| Alcoholic hepatitis | Prednisolone (severe cases, Maddrey score >32) |
| Drug-induced liver injury (DILI) | Stop the offending drug - the primary intervention; N-acetylcysteine for paracetamol toxicity |
| Autoimmune hepatitis | Prednisolone + azathioprine |
| Wilson's disease | D-penicillamine (copper chelation) |
| Primary biliary cholangitis (PBC) | Ursodeoxycholic acid (UDCA) - slows progression |
| Intrahepatic cholestasis of pregnancy | Ursodeoxycholic acid (UDCA) |
| Sepsis-induced jaundice | Antibiotics targeting the source infection |
3. Posthepatic Jaundice (Obstructive / Cholestatic)
Obstruction of bile flow - primarily treated surgically/endoscopically, not by drugs alone.
| Cause | Management |
|---|---|
| Choledocholithiasis | ERCP with stone removal; antibiotics (e.g., piperacillin-tazobactam) if cholangitis present |
| Cholangiocarcinoma / pancreatic carcinoma | Biliary stenting (ERCP or PTC); surgery |
| Primary sclerosing cholangitis (PSC) | No proven drug; UDCA debated |
| Cholestatic pruritus (symptom relief) | Cholestyramine (first line) -> Rifampicin (second line) -> Naltrexone |
4. Neonatal Jaundice
| Type | Treatment |
|---|---|
| Physiologic jaundice | Phototherapy (mainstay) |
| Severe hyperbilirubinemia | Exchange transfusion |
| Breast milk jaundice | Usually resolves; temporary breastfeeding suspension if bilirubin very high |
| Rh/ABO incompatibility | Exchange transfusion + IV immunoglobulin (IVIG) |
Quick Summary - "Drug of Choice" by Scenario
| Scenario | DOC |
|---|---|
| Neonatal physiologic jaundice | Phototherapy (not a drug) |
| Obstructive jaundice - cholangitis | Antibiotics + ERCP |
| Hepatitis B jaundice | Tenofovir / Entecavir |
| Hepatitis C jaundice | Sofosbuvir-based DAA |
| Alcoholic hepatitis | Prednisolone |
| Cholestatic pruritus | Cholestyramine |
| PBC / intrahepatic cholestasis | Ursodeoxycholic acid |
| Autoimmune hepatitis | Prednisolone + Azathioprine |
| Paracetamol-induced jaundice | N-Acetylcysteine |
| Wilson's disease | D-Penicillamine |
Key Point: If asked generically in an exam context, the most commonly tested "drug for jaundice" are:
- Phenobarbitone - for neonatal/unconjugated hyperbilirubinemia (enzyme inducer)
- Ursodeoxycholic acid - for cholestatic/intrahepatic jaundice
- Cholestyramine - for cholestatic pruritus
Sources: Schwartz's Principles of Surgery 11e; Tintinalli's Emergency Medicine; Sleisenger & Fordtran's GI and Liver Disease; Yamada's Textbook of Gastroenterology
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