Pharm

Bile Acid Oral Dissolution Therapy

search

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

  • Mechanism
  1. Decreases biliary Cholesterol hepatic secretion
  2. Forms unsaturated bile
  3. Promotes dissolution of Cholesterol crystals and Gallstones
  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
  • 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
  • Dosing
  • Ursodiol (Actigal)
  1. Dose: 8-10 mg/kg/day PO divided bid to tid
  2. Course: 6-12 months
  • 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)
  • Efficacy
  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