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Pruritus is a common complication of cholestatic disorders. The pruritus of cholestasis often has an adverse impact on daily functioning and is usually difficult to treat. Empiric medications, like antihistamines and colestyramine, often are ineffective. The pathogenesis of the pruritus of cholestasis is unknown. Increased levels of bile-acids were thought to play a role, but there is a lack of scientific evidence to support this hypothesis. Recent data, however, suggest that endogenous opioids may play a role in the pathogenesis. In addition opiate antagonists may be efficacious in ameliorating this form of pruritus.