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Bile Acid Pregnancy: Caution — used in intrahepatic cholestasis of pregnancy (specialist supervised); limited data in paediatric context

Ursodeoxycholic Acid (Paediatric)

Brand names: Ursofalk, Destolit

Adult dose

Dose: Primary biliary cholangitis: 13–15 mg/kg/day in 2–4 divided doses
Route: Oral
Frequency: BD–QDS
Max: 15 mg/kg/day
Adult use in GI hepatology section

Paediatric dose

Route: Oral
Frequency: BD–TDS
Max: 20 mg/kg/day
Concentration: 250 mg/5 mL suspension; 150 mg, 250 mg, 500 mg capsules/tablets mg/day/ml
BNF for Children / ESPGHAN: dosing is indication-specific daily total. TPN cholestasis: 10 mg/kg BD. Biliary atresia post-Kasai: 15–20 mg/kg/day. CF liver disease: 20 mg/kg/day. PFIC: 15–20 mg/kg/day. Pruritus: 10–15 mg/kg/day. Use daily dose ÷ frequency for per-dose calculation. Source: BNF for Children 2024; ESPGHAN Liver Guidelines; Cystic Fibrosis Trust

Dose adjustments

Renal

No dose adjustment required

Hepatic

Monitor LFTs — treatment is for hepatic conditions

Clinical pearls

  • TPN-associated cholestasis: UDCA started early reduces bilirubin and improves cholestasis — widely used in NICUs
  • Cystic fibrosis: UDCA 20 mg/kg/day significantly improves liver function tests and may reduce progression to cirrhosis
  • Kasai procedure: UDCA post-Kasai improves bile flow and reduces progression to liver failure
  • Suspension available for young infants — check local pharmacy stock

Contraindications

  • Acute cholangitis
  • Non-functioning gallbladder

Side effects

  • Diarrhoea
  • Nausea
  • Gallstone calcification (if used for dissolution)

Interactions

  • Antacids (aluminium) — reduce UDCA absorption (separate by 2h)
  • Colestyramine — binds and reduces UDCA absorption

Monitoring

  • LFTs (bilirubin, ALT, GGT, ALP)
  • Symptom response (pruritus, jaundice)
  • Abdominal USS if gallstones suspected

Reference: BNF for Children; ESPGHAN Guidelines; Cystic Fibrosis Trust. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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