Indicated for patients with radiolucent, noncalcified gallbladder stones <20mm in diameter in whom elective cholecystectomy would be undertaken if not for the presence of increased surgical risk or for patients who refuse surgery. Prevention of gallstone formation in obese patients experiencing rapid weight loss.
Use in patients with radiolucent, noncalcified gallbladder stones <20mm in diameter in whom elective cholecystectomy would be undertaken if not for the presence of increased surgical risk or for patients who refuse surgery
8-10mg/kg/day given bid-tid. Obtain ultrasound at 6-month intervals for 1 yr. Continue therapy after stones have dissolved and confirm with repeat ultrasound within 1-3 months
Prevention of Gallstone Formation in Obese Patients Experiencing Rapid Weight Loss:
600mg/day (300mg bid)
Calcified cholesterol stones, radiopaque stones, compelling reasons for cholecystectomy (radiolucent bile pigment stones, unremitting acute cholecystitis, cholangitis, biliary obstruction, gallstone pancreatitis, biliary-gastrointestinal fistula).
Monitor SGOT (AST) and SGPT (ALT) at the initiation of therapy and periodically thereafter. Caution in elderly.
Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, N/V, arthralgia, coughing, viral infection, bronchitis, pharyngitis, back pain, myalgia, headache, sinusitis.
Decreased absorption with bile acid sequestrants and aluminum-based antacids. Estrogens, oral contraceptives, and clofibrate (and perhaps other lipid-lowering drugs) may increase hepatic cholesterol secretion and encourage cholesterol gallstone formation.
PREGNANCY AND LACTATION
Category B, caution in nursing.
MECHANISM OF ACTION
Bile acid; suppresses hepatic synthesis, cholesterol secretion, and inhibits intestinal cholesterol absorption; actions combine to change bile from cholesterol-precipitating to cholesterol-solubilizing, resulting in bile conducive to cholesterol stone dissolution.
Absorption: Small bowel (90%). Metabolism: Liver (1st pass, conjugation). Elimination: Feces.
Assess for type of bile pigment stones (calcified cholesterol, radiopaque, radiolucent), unremitting acute cholecystitis, cholangitis, biliary obstruction, gallstone pancreatitis, biliary GI fistula, nursing status, and possible drug interactions. Obtain baseline AST and ALT.
Ultrasound should be taken in 6-month intervals for first year. If appear dissolved, continue therapy and confirm on repeat ultrasound within 1-3 months. If partial dissolution not seen by 12 months, success is greatly reduced. Monitor AST and ALT periodically. Signs/symptoms of hypersensitivity reactions.
Seek medical attention if symptoms of hypersensitivity or allergic reactions occur. Advise patient that gallbladder stone dissolution requires months of therapy.
25°C (77°F); excursions permitted to 15-30°C (59-86°F). Dispense in tight container.
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