Bile acid replacement
Cholic acid
Brand names: Orphacol, Kolbam
Adult dose
Dose: 10–15mg/kg/day in 1–2 divided doses
Route: PO
Frequency: OD-BD
Paediatric dose
Dose: 12.5 mg/kg
Route: PO
Frequency: OD or in divided doses
Range 5–15 mg/kg/day; titrate to suppress urinary atypical bile acids
Paediatric weight-based calculator
Range 5–15 mg/kg/day; titrate to suppress urinary atypical bile acids
Clinical pearls
- Inborn errors of primary bile acid synthesis
Contraindications
- Sensitivity to bile acids
Side effects
- Diarrhoea
- Hepatotoxicity
Interactions
- Bile acid sequestrants (give 5h apart)
- Aluminium antacids (give 5h apart)
- Ciclosporin increases cholic acid concentrations
Monitoring
- LFTs
- Plasma & urine bile acid profile
Reference: BNFc; BNF; https://bnf.nice.org.uk/drugs/cholic-acid/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Weight-Based Levothyroxine Dose Calculator · Thyroid
- Tumor Lysis Syndrome Risk (Cairo-Bishop) · Oncological Emergency
- Cryoprecipitate Dose Calculator for Fibrinogen Replacement · Transfusion Medicine
- Free Water Deficit in Hypernatraemia · Fluid / Electrolytes
- Urine Anion Gap · Acid-Base
- Bicarbonate Deficit Calculator · Acid-Base
Pathways
- Lower Gastrointestinal Bleed · BSG 2019; NICE NG141
- Variceal Upper GI Bleed · BSG 2015; Baveno VII (2022)
- Spontaneous Bacterial Peritonitis (SBP) · BSG / EASL 2018
- Hepatorenal Syndrome · EASL 2018; ICA 2015
- Hepatic Encephalopathy · EASL 2014; West Haven criteria
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021