Bile Acid Oral Dissolution Therapy

Aka: Bile Acid Oral Dissolution Therapy, Ursodeoxycholic Acid, Ursodiol, Actigal, Chenodeoxycholic Acid, Oral Dissolution Therapy, Gallstone Dissolving Agent

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II. Mechanism

  1. Bile Acid Oral Dissolution Therapy in general
    1. Decreases biliary Cholesterol hepatic secretion
    2. Forms unsaturated bile
    3. Promotes dissolution of Cholesterol crystals and Gallstones
  2. Ursodeoxycholic Acid (UDCA, Ursodiol)
    1. Naturally occurring hydrophilic bile acid
    2. Protects bile ducts by detoxifying hydrophobic bile acids
    3. Decreases cholic acid and increases Chenodeoxycholic Acid levels
      1. Reverses the effects of Intrahepatic Cholestasis of Pregnancy

III. Indications

  1. Intrahepatic Cholestasis of Pregnancy (Ursodeoxycholic Acid only)
  2. Cholelithiasis
    1. Comorbid condition that precludes safe Cholecystectomy and Symptomatic Gallstones
    2. Symptomatic patient unwilling to undergo surgery
      1. Small Gallstones (<5mm) with functioning gallbladder and no cystic duct obstruction

IV. Contraindications

  1. Excludes the 85% of patients who cannot meet the following criteria
    1. Gallstones >0.5mm (as opposed to the normal small, floating, CholesterolGallstones)
    2. Non-functional Gallbladder

V. Dosing: Ursodiol or Ursodeoxycholic Acid (UDCA, Actigal)

  1. Dose: 8-15 mg/kg/day or 500 mg orally twice daily
  2. Course: 6-12 months (in Symptomatic Gallstones) or until delivery in Intrahepatic Cholestasis of Pregnancy

VI. Dosing: Chenodeoxycholic Acid

  1. Do NOT use in pregnancy (Pregnancy Category X)
  2. Start: 250 mg twice daily for 2 weeks
  3. Titrate
    1. Increase by 250 mg/day each week
    2. Maximum: 13-16 mg/kg/day divided bid (or until sub-maximal dose that is tolerated)

VII. Efficacy: Cholelithiasis

  1. Stones dissolving over 6-12 months: 60-90%
  2. Stones reoccuring within 5 years: 25-50%
  3. Better prognosis associated factors
    1. Single Gallstone AND
    2. Non-obese AND
    3. Young patient

VIII. References

  1. Abraham (2014) Am Fam Physician 89(10): 795-802 [PubMed]
  2. Ozkan (2015) World J Gastroenterol 21(23): 7134-41 [PubMed]

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Related Studies

Cost: Medications

ursodiol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
URSODIOL 250 MG TABLET Generic $0.48 each
URSODIOL 300 MG CAPSULE Generic $0.67 each
URSODIOL 500 MG TABLET Generic $0.75 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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