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Gastroprotective Pregnancy: B — UDCA is the treatment of choice for intrahepatic cholestasis of pregnancy

Ursodeoxycholic Acid (UDCA)

Brand names: Ursofalk, Destolit

Adult dose

Dose: PBC: 13–15mg/kg/day. Gallstones: 8–12mg/kg/day. Cholestasis of pregnancy: 10–15mg/kg/day
Route: Oral
Frequency: Once daily (at night) or in divided doses
Max: 1g/day (standard). Up to 15mg/kg in PBC
PBC (primary biliary cholangitis): 13–15mg/kg/day in 2–3 divided doses. Take with food. Gallstone dissolution: 8–12mg/kg OD at night × 12–24 months (radiolucent stones <20mm only). Intrahepatic cholestasis of pregnancy: improves pruritis and maternal outcomes.

Dose adjustments

Renal

No adjustment required.

Hepatic

Use is primary indication in hepatic disease. Caution in decompensated cirrhosis.

Clinical pearls

  • PBC: normalises LFTs in ~80% of patients in early-stage disease. Delays progression. Add obeticholic acid (Ocaliva) or fenofibrate in inadequate responders.
  • Intrahepatic cholestasis of pregnancy: UDCA 500mg BD improving pruritis and reducing fetal distress — consider early delivery at 37 weeks.
  • For gallstone dissolution: only small, radiolucent cholesterol stones in functioning gallbladder without ductal dilatation. Recurrence common after stopping — surgery preferred in fit patients.
  • Take at night: bile secretion higher nocturnally, maximising biliary UDCA concentration.

Contraindications

  • Acute cholecystitis or cholangitis
  • Calcified or pigmented gallstones
  • Bile duct obstruction or occlusion
  • Inflammatory bowel disease (may worsen colitis — relative)

Side effects

  • GI disturbance (nausea, diarrhoea — usually mild)
  • Calcification of gallstones (if treatment stopped before complete dissolution)
  • Pruritus (initially may worsen before improving in cholestatic conditions)

Interactions

  • Antacids / colestyramine: reduce absorption — take UDCA 2h apart
  • Oral contraceptives: may impair UDCA effect (increase biliary cholesterol)

Monitoring

  • LFTs every 3–6 months (PBC)
  • symptom response (pruritus)
  • biliary imaging

Reference: BSG PBC Guidelines 2018; NICE BNF 84. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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