Ursodeoxycholic Acid

Ursodeoxycholic Acid (often shortened to UDCA) is a bile acid found in small amounts in human bile. Taken by mouth, it lowers the proportion of cholesterol in bile and makes bile less likely to form stones. The UK SmPC lists two main uses in adults: primary biliary cholangitis (formerly called primary biliary cirrhosis), a long-term autoimmune condition of the small bile ducts, and the dissolution of small to medium-sized radiolucent gallstones rich in cholesterol in people whose gallbladder still works. It can suit people for whom surgery is unsuitable or who would rather avoid an operation. Certain products are also licensed for liver and bile problems linked to cystic fibrosis in children from 6 years.

This listing covers a single strength, 300mg film-coated tablets, available in packs of 30, 60, 90, 120 or 180 tablets. Larger packs are simply more tablets of the same strength; they do not change the daily amount, which is set by your prescriber.

Dosing is based on body weight. For primary biliary cholangitis, the SmPC for 300mg tablets gives 10–15 mg per kg per day, split into two to four doses. For gallstone dissolution the usual figure is 6–12 mg per kg per day, taken as one dose at night or in divided doses, rising to 15 mg/kg/day in people with obesity if needed. Gallstone treatment may run for up to two years and is continued for three months after the stones appear to have gone. Tablets are swallowed with a drink of water. Liver function tests (AST, ALT and gamma-GT) are checked every four weeks for the first three months and then every three months; with gallstones, imaging of the gallbladder is usually repeated after 6–10 months.

Ursodeoxycholic acid is licensed in the UK and is a prescription-only medicine (POM). It is supplied as 150mg, 300mg and 450mg tablets, 250mg and 500mg tablets under some brands, 250mg capsules and an oral suspension. Brand names you may see include Ursofalk, Urdox and Cholurso, alongside generic packs that carry only the chemical name.

According to the SmPC, this medicine is not used with calcified (radio-opaque) gallstones, acute inflammation of the gallbladder or bile ducts, a blocked bile duct, frequent attacks of biliary colic or a gallbladder that does not contract properly. Hypersensitivity to bile acids is another reason to avoid it. Some UK product information also lists pregnancy, breastfeeding and women who could become pregnant, as well as chronic liver disease, peptic ulcers and inflammatory bowel conditions; your prescriber will go through the leaflet that applies to your pack.

Colestyramine, colestipol and antacids containing aluminium bind bile acids in the gut, so they are taken at least two hours apart from Ursodeoxycholic Acid. The tablets can raise ciclosporin absorption and lower the effect of ciprofloxacin in some people. Oestrogen-containing medicines, including combined contraceptives, and cholesterol-lowering clofibrate can increase cholesterol in bile and work against stone dissolution. The most common side effect is soft or loose stools or diarrhoea. Severe upper right abdominal pain and, in advanced primary biliary cholangitis, worsening of liver cirrhosis have been reported very rarely. Hives (urticaria) is also very rare. Tell your GP about pain in the right side of the abdomen, persistent diarrhoea or yellowing of the skin or eyes.

Ursodeoxycholic Acid works slowly, and blood tests or scans are part of treatment rather than an extra. Whether this medicine is right for you, and at what dose, is a decision for your doctor or prescriber, based on your liver results and medical history.