Gallstones (Cholelithiasis) Medication_ Gallstone Dissolution Agents

10/13/2015 Gallstones (Cholelithiasis) Medication: Gallstone Dissolution Agents

http://emedicine.medscape.com/article/175667medication 1/3

Gallstones (Cholelithiasis) MedicationAuthor: Douglas M Heuman, MD, FACP, FACG, AGAF; Chief Editor: Julian Katz, MD more...

Updated: Jan 20, 2015

Medication SummaryMedical dissolution of gallstones may be attempted with administration of ursodiol.

Gallstone Dissolution Agents

Class Summary

These agents suppress hepatic cholesterol secretion and inhibit intestinal absorptionof cholesterol. Ursodiol is the most common drug used. It solubilizes cholesterol inmicelles and acts by dispersing cholesterol in aqueous media.

View full drug information

Ursodiol (Actigall, Urso 250, Urso Forte)

Ursodiol (ursodeoxycholic acid) is indicated for radiolucent noncalcified gallbladderstones smaller than 20 mm in diameter when conditions preclude cholecystectomy.Ursodiol suppresses hepatic secretion and inhibits intestinal absorption. It appearsto have little inhibitory effect on the synthesis and secretion into bile of endogenousbile acids and does not appear to affect secretion of phospholipids into bile. Afterrepeated doses, the drug reaches steadystate bile concentrations in about 3 weeks.Cholesterol is insoluble in aqueous media, but it can be solubilized in at least 2different ways in the presence of dihydroxy bile acids. In addition to solubilizingcholesterol in micelles, ursodiol acts by dispersing cholesterol as liquid crystals inaqueous media. The overall effect of ursodiol is to increase the concentration levelat which saturation of cholesterol occurs.

The various actions of ursodiol combine to change the bile of patients withgallstones from cholesterolprecipitating to cholesterolsolubilizing bile, thusresulting in bile conducive to cholesterol stones dissolution.

Contributor Information and DisclosuresAuthorDouglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department ofVeterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology,Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: AmericanAssociation for the Study of Liver Diseases, American College of Physicians, American GastroenterologicalAssociation

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer forother; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol MyersSquibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other;Received grant/research funds from MannKind for other.

Coauthor(s)Jeff Allen, MD Assistant Professor, Department of Surgery, University of Louisville

Disclosure: Nothing to disclose.

Anastasios A Mihas, MD, DMSc, FACP, FACG Professor, Department of Medicine, Division ofGastroenterology, Virginia Commonwealth University School of Medicine; Consulting Staff, VirginiaCommonwealth University Hospitals and Clinics; Chief of GI Clinical Research, Director of GI Outpatient Service,Associate Director of Hepatology, Hunter Holmes McGuire Veterans Affairs Medical Center

Anastasios A Mihas, MD, DMSc, FACP, FACG is a member of the following medical societies: AmericanAssociation for the Study of Liver Diseases, American College of Gastroenterology, American College ofPhysicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, SigmaXi, Southern Society for Clinical Investigation, American Federation for Clinical Research, GastroenterologyResearch Group


Chief EditorJulian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology,American College of Physicians, American Gastroenterological Association, American Geriatrics Society,American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law,Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for SocialResponsibility


AcknowledgementsFirass Abiad, MD Head of Division, General and Laparoscopic Surgery, Specialized Medical Center Hospital,Saudi Arabia


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BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College ofMedicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of LiverDiseases, American College of Gastroenterology, American Gastroenterological Association, and AmericanSociety for Gastrointestinal Endoscopy


David Eric Bernstein, MD Director of Hepatology, North Shore University Hospital; Professor of ClinicalMedicine, Albert Einstein College of Medicine

David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study ofLiver Diseases, American College of Gastroenterology, American College of Physicians, AmericanGastroenterological Association, and American Society for Gastrointestinal Endoscopy


Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine,Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western ReserveUniversity School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha,American Academy of Emergency Medicine, American College of Chest Physicians, American College ofEmergency Physicians, American College of Physicians, American Heart Association, American ThoracicSociety, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, andSociety for Academic Emergency Medicine


David FM Brown, MD Associate Professor, Division of Emergency Medicine, Harvard Medical School; ViceChair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of EmergencyPhysicians and Society for Academic Emergency Medicine


William K Chiang, MD Associate Professor, Department of Emergency Medicine, New York University Schoolof Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology,American College of Medical Toxicology, and Society for Academic Emergency Medicine


Alfred Cuschieri, MD, ChM, FRSE, FRCS, Head, Professor, Department of Surgery and Molecular Oncology,University of Dundee, UK


Imad S Dandan, MD Consulting Surgeon, Department of Surgery, Trauma Section, Scripps Memorial Hospital

Imad S Dandan, MD is a member of the following medical societies: American Association for the Surgery ofTrauma, American College of Surgeons, American Medical Association, American Trauma Society, CaliforniaMedical Association, and Society of Critical Care Medicine


David Greenwald, MD Associate Professor of Clinical Medicine, Fellowship Program Director, Department ofMedicine, Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine

David Greenwald, MD is a member of the following medical societies: Alpha Omega Alpha, American College ofGastroenterology, American College of Physicians, American Gastroenterological Association, American Societyfor Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy


Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of EmergencyMedicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine,Martin Luther King Jr/Drew Medical Center


Faye Maryann Lee, MD Staff Physician, Department of Emergency Medicine, New York University/BellevueHospital Center

Faye Maryann Lee, MD is a member of the following medical societies: Phi Beta Kappa


Sally Santen, MD Program Director, Assistant Professor, Department of Emergency Medicine, VanderbiltUniversity

Sally Santen, MD is a member of the following medical societies: American College of Emergency Physiciansand Society for Academic Emergency Medicine


Assaad M Soweid, MD, FASGE, FACG Associate Professor of Clinical Medicine, Endosonography andAdvanced Therapeutic Endoscopy, Director, EndoscopyBronchoscopy Unit, Division of Gastroenterology,Department of Internal Medicine, American University of Beirut Medical Center, Lebanon

Assaad M Soweid, MD, FASGE, FACG is a member of the following medical societies: American College ofGastroenterology, American College of Physicians, American College of PhysiciansAmerican Society of InternalMedicine, American Gynecological and Obstetrical Society, and American Medical Association


Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center Collegeof Pharmacy; EditorinChief, Medscape Drug Reference

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