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==Overview==
==Overview==
Patients with [[asymptomatic]] gallstones are usually not treated since the chances of [[Complication (medicine)|complications]] developing in the future are low, however, patients with symptomatic gallstones can be treated medically, for example, with [[Ursodiol|ursodeoxycholic acid]]. However, the mainstay of treatment for gallstone disease is surgically, especially since the introduction of [[Laparoscopic surgery|laparoscopic]] [[cholecystectomy]]. [[Fibrates]], including [[gemfibrozil]] and [[fenofibrates]] are an absolute contraindication in gallstone disease.


Patients with asymptomatic gallstones are usually not treated since the chances of complications developing in the future are low, however, patients with symptomatic gallstones can be treated medically, for example, with ursodeoxycholic acid or lithotripsy. However, the mainstay of treatment for gallstone disease is surgical cholecystectomy.
==Medical therapy==


*[[Pharmacological|Pharmacologic]] medical therapies for gallstone disease include either medical dissolution therapy or contact dissolution therapy.<ref name="pmid8054014">{{cite journal |vauthors=Darzi A, Geraghty JG, Williams NN, Sheehan SS, Tanner AN, Keane FB |title=The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease |journal=Ann R Coll Surg Engl |volume=76 |issue=1 |pages=42–6 |year=1994 |pmid=8054014 |pmc=2502162 |doi= |url=}}</ref><ref name="pmid9200309">{{cite journal |vauthors=Portincasa P, van de Meeberg P, van Erpecum KJ, Palasciano G, VanBerge-Henegouwen GP |title=An update on the pathogenesis and treatment of cholesterol gallstones |journal=Scand. J. Gastroenterol. Suppl. |volume=223 |issue= |pages=60–9 |year=1997 |pmid=9200309 |doi= |url=}}</ref>
*[[Cholesterol]] gallstones can sometimes be dissolved by oral [[ursodeoxycholic acid]].
*Nonsurgical approaches are used only in special situations such as when a patient has a serious medical condition preventing surgery and only then for [[cholesterol]] stones.
*Stones commonly recur within 5 years in patients treated non-surgically.
**'''Oral dissolution therapy''':
***Drugs made from [[bile acid]] are used to dissolve gallstones.<ref name="pmid8017748">{{cite journal |vauthors=Rubin RA, Kowalski TE, Khandelwal M, Malet PF |title=Ursodiol for hepatobiliary disorders |journal=Ann. Intern. Med. |volume=121 |issue=3 |pages=207–18 |year=1994 |pmid=8017748 |doi= |url=}}</ref><ref name="pmid17185355">{{cite journal |vauthors=Guarino MP, Cong P, Cicala M, Alloni R, Carotti S, Behar J |title=Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones |journal=Gut |volume=56 |issue=6 |pages=815–20 |year=2007 |pmid=17185355 |pmc=1954869 |doi=10.1136/gut.2006.109934 |url=}}</ref><ref name="pmid6724255">{{cite journal |vauthors=Hardison WG, Grundy SM |title=Effect of ursodeoxycholate and its taurine conjugate on bile acid synthesis and cholesterol absorption |journal=Gastroenterology |volume=87 |issue=1 |pages=130–5 |year=1984 |pmid=6724255 |doi= |url=}}</ref><ref name="pmid1943496">{{cite journal |vauthors=Uchida K, Akiyoshi T, Igimi H, Takase H, Nomura Y, Ishihara S |title=Differential effects of ursodeoxycholic acid and ursocholic acid on the formation of biliary cholesterol crystals in mice |journal=Lipids |volume=26 |issue=7 |pages=526–30 |year=1991 |pmid=1943496 |doi= |url=}}</ref><ref name="pmid9952243">{{cite journal |vauthors=van de Heijning BJ, van de Meeberg PC, Portincasa P, Doornewaard H, Hoebers FJ, van Erpecum KJ, Vanberge-Henegouwen GP |title=Effects of ursodeoxycholic acid therapy on in vitro gallbladder contractility in patients with cholesterol gallstones |journal=Dig. Dis. Sci. |volume=44 |issue=1 |pages=190–6 |year=1999 |pmid=9952243 |doi= |url=}}</ref>
***The drugs [[Ursodiol|ursodeoxycholic acid]] (Actigall) and  [[chenodeoxycholic acid]] (Chenix) are taken orally and work best for small [[cholesterol]] stones.
***[[Bile acid|Bile acids]] work by reducing [[biliary]] [[cholesterol]] secretion, increasing [[bile acid]] concentration, and therefore, reducing the cholesterol [[saturation]] in [[bile]].
***Months or years of treatment may be necessary before all the stones dissolve.
***Both drugs may cause mild [[diarrhea]], and [[chenodeoxycholic acid]] may temporarily raise levels of [[blood]] [[cholesterol]] and the [[liver enzyme]] [[transaminase]].
**'''Contact dissolution therapy''':
***This experimental procedure involves injecting a [[drug]] directly into the gallbladder to dissolve [[cholesterol]] stones.<ref name="pmid6365507">{{cite journal |vauthors=Ward A, Brogden RN, Heel RC, Speight TM, Avery GS |title=Ursodeoxycholic acid: a review of its pharmacological properties and therapeutic efficacy |journal=Drugs |volume=27 |issue=2 |pages=95–131 |year=1984 |pmid=6365507 |doi= |url=}}</ref><ref name="pmid7094795">{{cite journal |vauthors=Bachrach WH, Hofmann AF |title=Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis. part I |journal=Dig. Dis. Sci. |volume=27 |issue=8 |pages=737–61 |year=1982 |pmid=7094795 |doi= |url=}}</ref><ref name="pmid7049627">{{cite journal |vauthors=Bachrach WH, Hofmann AF |title=Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis. Part II |journal=Dig. Dis. Sci. |volume=27 |issue=9 |pages=833–56 |year=1982 |pmid=7049627 |doi= |url=}}</ref>
***The drug, methylterbutyl ether, can dissolve some stones in 1 to 3 days, but it causes irritation and some complications have been reported.
***The procedure is being tested in symptomatic patients with small stones.


===Dosing===


==Medical Therapy==
*'''1 Gallstone disease'''
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
**1.1 '''Biliary tract'''
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
***'''1.1.1 Adult'''
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
****'''1.1.1.1 Gall stone dissolution'''
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
*****Preferred regimen (1): [[Ursodiol]] PO 8-10 mg/kg q24h in 2-3 divided doses (Max up to 24 months)
===Disease Name===
****'''1.1.1.2 Gall stone prevention'''
 
*****Preferred regimen (1): [[Ursodiol]] PO 300 mg q12h
* '''1 Stage 1 - Name of stage'''
****'''Primary biliary cirrhosis'''
** 1.1 '''Specific Organ system involved 1'''
*****Preferred regimen (3): ([[Urso]], [[Urso forte]]): Oral: 13-15 mg/kg/day in 2-4 divided doses (with food)
*** 1.1.1 '''Adult'''
***'''1.1.2 Pediatric'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
****'''1.1.2.1 Children < 8 years of age'''
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
*****Preferred regimen (1):In parenteral nutrition-induced cholestasis in neonates, some experts recommend: Oral: 30 mg/kg/day in 2- 3 divided doses
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
****'''1.1.2.2 Children > 8 years of age'''
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
****'''1.1.2.2.1 Gall stone dissolution'''
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*****Preferred regimen (1): [[Ursodiol]] PO 25 mg/kg q24h (Max up to 13 months)
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*'''2 Other medical therapies'''<ref name="pmid8417484">{{cite journal |vauthors=Saunders KD, Cates JA, Abedin MZ, Roslyn JJ |title=Lovastatin and gallstone dissolution: a preliminary study |journal=Surgery |volume=113 |issue=1 |pages=28–35 |year=1993 |pmid=8417484 |doi= |url=}}</ref><ref name="pmid9512129">{{cite journal |vauthors=Chapman BA, Burt MJ, Chisholm RJ, Allan RB, Yeo KH, Ross AG |title=Dissolution of gallstones with simvastatin, an HMG CoA reductase inhibitor |journal=Dig. Dis. Sci. |volume=43 |issue=2 |pages=349–53 |year=1998 |pmid=9512129 |doi= |url=}}</ref><ref name="pmid25303682">{{cite journal |vauthors=de Bari O, Wang HH, Portincasa P, Paik CN, Liu M, Wang DQ |title=Ezetimibe prevents the formation of oestrogen-induced cholesterol gallstones in mice |journal=Eur. J. Clin. Invest. |volume=44 |issue=12 |pages=1159–68 |year=2014 |pmid=25303682 |pmc=4659711 |doi=10.1111/eci.12350 |url=}}</ref><ref name="pmid447112">{{cite journal |vauthors=Doran J, Keighley MR, Bell GD |title=Rowachol--a possible treatment for cholesterol gallstones |journal=Gut |volume=20 |issue=4 |pages=312–7 |year=1979 |pmid=447112 |pmc=1412390 |doi= |url=}}</ref><ref name="pmid6430390">{{cite journal |vauthors=Ellis WR, Somerville KW, Whitten BH, Bell GD |title=Pilot study of combination treatment for gall stones with medium dose chenodeoxycholic acid and a terpene preparation |journal=Br Med J (Clin Res Ed) |volume=289 |issue=6438 |pages=153–6 |year=1984 |pmid=6430390 |pmc=1442019 |doi= |url=}}</ref>
*** 1.1.2 '''Pediatric'''
**'''2.1 Lipid lowering agents'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***'''2.1.1 [[HMG-CoA reductase|HMG CoA reductase]] inhibitors'''
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
****Preferred regimen (1): [[Statins]]
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***:'''NOTE (1):''' [[Statins]]will reduce cholesterol secretion hence the rationale for their use.
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***2.1.2 '''Cholesterol absorption inhibitor'''
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
****Preferred regimen (1): '''[[Ezetimibe]]'''
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
***:'''NOTE (1):''' [[Ezetimibe]] is a hypocholesterolemic drug that acts by inhibiting [[intestinal]] [[cholesterol]] [[absorption]].
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
**'''2.2 Dissolution agents'''
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***2.2.1 [[Monoterpenes]]
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
****Preferred regimen (1): Rowachol
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***:'''NOTE (1):''' Rowachol, an orally administered mixture of cyclic [[monoterpenes]] is capable of dissolving radiolucent and some radio-opaque gallstones.
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
***:'''NOTE (2):''' It also enhances the efficacy of [[Ursodiol|ursodeoxycholic acid]] or [[Lithotriptor|lithotripsy]] when used in combination.
** 1.2 '''Specific Organ system involved 2'''
*'''3 Biliary colic treatment'''<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=882 |title=BestBets: Buscopan (hyoscine butylbromide) in biliary colic. |format= |work= |accessdate=}}</ref><ref name="pmid22540869">{{cite journal |vauthors=Colli A, Conte D, Valle SD, Sciola V, Fraquelli M |title=Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic |journal=Aliment. Pharmacol. Ther. |volume=35 |issue=12 |pages=1370–8 |year=2012 |pmid=22540869 |doi=10.1111/j.1365-2036.2012.05115.x |url=}}</ref><ref name="pmid12426013">{{cite journal |vauthors=Henderson SO, Swadron S, Newton E |title=Comparison of intravenous ketorolac and meperidine in the treatment of biliary colic |journal=J Emerg Med |volume=23 |issue=3 |pages=237–41 |year=2002 |pmid=12426013 |doi= |url=}}</ref><ref name="pmid9207282">{{cite journal |vauthors=Akriviadis EA, Hatzigavriel M, Kapnias D, Kirimlidis J, Markantas A, Garyfallos A |title=Treatment of biliary colic with diclofenac: a randomized, double-blind, placebo-controlled study |journal=Gastroenterology |volume=113 |issue=1 |pages=225–31 |year=1997 |pmid=9207282 |doi= |url=}}</ref> 
*** 1.2.1 '''Adult'''
**'''3.1 Analgesics'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
***'''3.1.1 Non-steroidal anti-inflammatory drugs'''
*** 1.2.2  '''Pediatric'''
****Preferred regimen (1): [[Ketorolac]] and [[Diclofenac]]
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
***:'''NOTE (1):''' During [[pregnancy]], [[Non-steroidal anti-inflammatory drug|NSAIDs]] are best to be avoided, especially beyond 32 weeks.
 
***'''3.1.2 Biliary colic in pregnancy'''
* 2 '''Stage 2 - Name of stage'''
****Preferred regimen (1): [[Scopolamine|Hyoscine butylbromide]]
** 2.1 '''Specific Organ system involved 1 '''
****Preferred regimen (2): [[Opioid]] analgesics
**: '''Note (1):'''
****Preferred regimen (3): [[Acetaminophen]]
**: '''Note (2)''':
**: '''Note (3):'''  
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 
 
 
==Overview==
 
== Medical therapy ==
Cholesterol gallstones can sometimes be dissolved by oral [[ursodeoxycholic acid]]. Gallstones may recur however, once the drug is stopped.
 
Nonsurgical approaches are used only in special situations such as when a patient has a serious medical condition preventing surgery and only for cholesterol stones. Stones commonly recur within 5 years in patients treated nonsurgically.
 
*'''Oral dissolution therapy.''' Drugs made from bile acid are used to dissolve gallstones. The drugs ursodiol (Actigall) and chenodiol (Chenix) work best for small cholesterol stones. Months or years of treatment may be necessary before all the stones dissolve. Both drugs may cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase.
*'''Contact dissolution therapy.''' This experimental procedure involves injecting a drug directly into the gallbladder to dissolve cholesterol stones. The drug—methyl tert-butyl ether—can dissolve some stones in 1 to 3 days, but it causes irritation and some complications have been reported. The procedure is being tested in symptomatic patients with small stones.
 
===Treatment of biliary colic===
These attacks are intensely painful, similar to that of a [[kidney stone]] attack. One way to alleviate the abdominal pain is to drink a full glass of water at the start of an attack to regulate the bile in the [[gallbladder]], but this does not work in all cases. Another way is to take magnesium followed by a bitter liquid such as [[coffee]] or [[swedish bitters]] an hour later. Bitter flavors stimulate bile flow. A study has found lower rates of gallstones in coffee drinkers.<ref>{{cite web|url=http://jama.ama-assn.org/cgi/content/abstract/281/22/2106t |title=A Prospective Study of Coffee Consumption and the Risk of Symptomatic Gallstone Disease in Men |accessdate=2007-08-25 |work=The Journal of the American Medical Association}}</ref>
 
Pain management is an important part of treating biliary colic.  Treatment is often with [[NSAIDs]] such as [[ketorolac]] (Toradol) and [[diclofenac]] (Voltaren).  [[Hyoscine butylbromide]] (Buscopan) is occasionally used but is less effective than analgesics.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=882 |title=BestBets: Buscopan (hyoscine butylbromide) in biliary colic. |format= |work= |accessdate=}}</ref>


===Contraindicated medications===
===Contraindicated medications===


{{MedCondContrAbs
*Gallstones are considered an absolute contraindication to the use of the following medications:
 
**These drugs increase the [[cholesterol]] secretion in the bile.
|MedCond =Gallstone|Fenofibrate|Gemfibrozil}}
***[[Fenofibrate]]
***[[Gemfibrozil]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
<references />


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[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Primary care]]
{{WH}}
{{WS}}

Latest revision as of 22:02, 22 December 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Patients with asymptomatic gallstones are usually not treated since the chances of complications developing in the future are low, however, patients with symptomatic gallstones can be treated medically, for example, with ursodeoxycholic acid. However, the mainstay of treatment for gallstone disease is surgically, especially since the introduction of laparoscopic cholecystectomy. Fibrates, including gemfibrozil and fenofibrates are an absolute contraindication in gallstone disease.

Medical therapy

  • Pharmacologic medical therapies for gallstone disease include either medical dissolution therapy or contact dissolution therapy.[1][2]
  • Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid.
  • Nonsurgical approaches are used only in special situations such as when a patient has a serious medical condition preventing surgery and only then for cholesterol stones.
  • Stones commonly recur within 5 years in patients treated non-surgically.

Dosing

  • 1 Gallstone disease
    • 1.1 Biliary tract
      • 1.1.1 Adult
        • 1.1.1.1 Gall stone dissolution
          • Preferred regimen (1): Ursodiol PO 8-10 mg/kg q24h in 2-3 divided doses (Max up to 24 months)
        • 1.1.1.2 Gall stone prevention
          • Preferred regimen (1): Ursodiol PO 300 mg q12h
        • Primary biliary cirrhosis
          • Preferred regimen (3): (Urso, Urso forte): Oral: 13-15 mg/kg/day in 2-4 divided doses (with food)
      • 1.1.2 Pediatric
        • 1.1.2.1 Children < 8 years of age
          • Preferred regimen (1):In parenteral nutrition-induced cholestasis in neonates, some experts recommend: Oral: 30 mg/kg/day in 2- 3 divided doses
        • 1.1.2.2 Children > 8 years of age
        • 1.1.2.2.1 Gall stone dissolution
          • Preferred regimen (1): Ursodiol PO 25 mg/kg q24h (Max up to 13 months)
  • 2 Other medical therapies[11][12][13][14][15]
  • 3 Biliary colic treatment[16][17][18][19]

Contraindicated medications

  • Gallstones are considered an absolute contraindication to the use of the following medications:

References

  1. ↑ Darzi A, Geraghty JG, Williams NN, Sheehan SS, Tanner AN, Keane FB (1994). "The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease". Ann R Coll Surg Engl. 76 (1): 42–6. PMC 2502162. PMID 8054014.
  2. ↑ Portincasa P, van de Meeberg P, van Erpecum KJ, Palasciano G, VanBerge-Henegouwen GP (1997). "An update on the pathogenesis and treatment of cholesterol gallstones". Scand. J. Gastroenterol. Suppl. 223: 60–9. PMID 9200309.
  3. ↑ Rubin RA, Kowalski TE, Khandelwal M, Malet PF (1994). "Ursodiol for hepatobiliary disorders". Ann. Intern. Med. 121 (3): 207–18. PMID 8017748.
  4. ↑ Guarino MP, Cong P, Cicala M, Alloni R, Carotti S, Behar J (2007). "Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones". Gut. 56 (6): 815–20. doi:10.1136/gut.2006.109934. PMC 1954869. PMID 17185355.
  5. ↑ Hardison WG, Grundy SM (1984). "Effect of ursodeoxycholate and its taurine conjugate on bile acid synthesis and cholesterol absorption". Gastroenterology. 87 (1): 130–5. PMID 6724255.
  6. ↑ Uchida K, Akiyoshi T, Igimi H, Takase H, Nomura Y, Ishihara S (1991). "Differential effects of ursodeoxycholic acid and ursocholic acid on the formation of biliary cholesterol crystals in mice". Lipids. 26 (7): 526–30. PMID 1943496.
  7. ↑ van de Heijning BJ, van de Meeberg PC, Portincasa P, Doornewaard H, Hoebers FJ, van Erpecum KJ, Vanberge-Henegouwen GP (1999). "Effects of ursodeoxycholic acid therapy on in vitro gallbladder contractility in patients with cholesterol gallstones". Dig. Dis. Sci. 44 (1): 190–6. PMID 9952243.
  8. ↑ Ward A, Brogden RN, Heel RC, Speight TM, Avery GS (1984). "Ursodeoxycholic acid: a review of its pharmacological properties and therapeutic efficacy". Drugs. 27 (2): 95–131. PMID 6365507.
  9. ↑ Bachrach WH, Hofmann AF (1982). "Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis. part I". Dig. Dis. Sci. 27 (8): 737–61. PMID 7094795.
  10. ↑ Bachrach WH, Hofmann AF (1982). "Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis. Part II". Dig. Dis. Sci. 27 (9): 833–56. PMID 7049627.
  11. ↑ Saunders KD, Cates JA, Abedin MZ, Roslyn JJ (1993). "Lovastatin and gallstone dissolution: a preliminary study". Surgery. 113 (1): 28–35. PMID 8417484.
  12. ↑ Chapman BA, Burt MJ, Chisholm RJ, Allan RB, Yeo KH, Ross AG (1998). "Dissolution of gallstones with simvastatin, an HMG CoA reductase inhibitor". Dig. Dis. Sci. 43 (2): 349–53. PMID 9512129.
  13. ↑ de Bari O, Wang HH, Portincasa P, Paik CN, Liu M, Wang DQ (2014). "Ezetimibe prevents the formation of oestrogen-induced cholesterol gallstones in mice". Eur. J. Clin. Invest. 44 (12): 1159–68. doi:10.1111/eci.12350. PMC 4659711. PMID 25303682.
  14. ↑ Doran J, Keighley MR, Bell GD (1979). "Rowachol--a possible treatment for cholesterol gallstones". Gut. 20 (4): 312–7. PMC 1412390. PMID 447112.
  15. ↑ Ellis WR, Somerville KW, Whitten BH, Bell GD (1984). "Pilot study of combination treatment for gall stones with medium dose chenodeoxycholic acid and a terpene preparation". Br Med J (Clin Res Ed). 289 (6438): 153–6. PMC 1442019. PMID 6430390.
  16. ↑ "BestBets: Buscopan (hyoscine butylbromide) in biliary colic".
  17. ↑ Colli A, Conte D, Valle SD, Sciola V, Fraquelli M (2012). "Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic". Aliment. Pharmacol. Ther. 35 (12): 1370–8. doi:10.1111/j.1365-2036.2012.05115.x. PMID 22540869.
  18. ↑ Henderson SO, Swadron S, Newton E (2002). "Comparison of intravenous ketorolac and meperidine in the treatment of biliary colic". J Emerg Med. 23 (3): 237–41. PMID 12426013.
  19. ↑ Akriviadis EA, Hatzigavriel M, Kapnias D, Kirimlidis J, Markantas A, Garyfallos A (1997). "Treatment of biliary colic with diclofenac: a randomized, double-blind, placebo-controlled study". Gastroenterology. 113 (1): 225–31. PMID 9207282.

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