page98
1.9
Drugs affecting intestinal
secretions
1.9.1 Drugs affecting biliary composition
and flow
1.9.2 Bile acid sequestrants
1.9.3 Aprotinin
1.9.4 Pancreatin
1.9.1
Drugs affecting biliary
composition and flow
The use of laparoscopic cholecystectomy and of endo-
scopic biliary techniques has limited the place of the bile
acid ursodeoxycholic acid in gallstone disease.
Urso-
deoxycholic acid is suitable for patients with unimpaired
gall
bladder
function,
small
or
medium-sized radiolu-
cent stones,
and whose mild symptoms are not amen-
able to other treatment;
it should be used cautiously in
those with liver disease (but see below). Patients should
be given dietary advice (including avoidance of exces-
sive cholesterol
and calories) and they require radiolo-
gical monitoring. Long-term prophylaxis may be needed
after
complete dissolution of
the gallstones has been
confirmed because they may recur
in up to 25% of
patients within one year of stopping treatment.
Ursodeoxycholic acid is also used in primary biliary
cirrhosis;
liver tests improve in most
patients but
the
effect on overall survival is uncertain.
URSODEOXYCHOLIC ACID
Indications
see under Dose and under preparations
Cautions
see notes above; interactions: Appendix 1
(ursodeoxycholic acid)
Contra-indications
radio-opaque stones,
non-func-
tioning gall bladder, inflammatory diseases and other
conditions of the small intestine, colon and liver which
interfere with entero-hepatic circulation of bile salts
Hepatic impairment
avoid in chronic liver disease
(but used in primary biliary cirrhosis)
Pregnancy
no evidence of harm but manufacturer
advises avoid
Breast-feeding
not known to be harmful but manu-
facturer advises avoid
Side-effects
nausea,
vomiting,
diarrhoea;
gallstone
calcification;
pruritus
Dose
. Dissolution of gallstones, 8–12 mg/kg daily as a single
dose at bedtime
or
in two divided doses,
for up to 2
years;
treatment is continued for 3–4 months after
stones dissolve
. Primary biliary cirrhosis,
see under
Ursofalk
c
Ursodeoxycholic Acid
(Non-proprietary) A
Tablets
,
ursodeoxycholic acid 150 mg,
net price 60-
tab pack = £20.48.
Label:
21
Capsules
, ursodeoxycholic acid 250 mg, net price 60-
cap pack = £38.86.
Label:
21
Destolit
c
(Norgine) A
Tablets
,
scored,
ursodeoxycholic acid 150 mg,
net
price 60-tab pack = £17.67.
Label:
21
Urdox
c
(Wockhardt) A
Tablets
,
f/c,
ursodeoxycholic acid 300 mg,
net price
60-tab pack = £26.50.
Label:
21
Ursofalk
c
(Dr Falk) A
Capsules
, ursodeoxycholic acid 250 mg, net price 60-
cap pack = £30.17,
100-cap pack = £31.88.
Label:
21
Suspension
,
sugar-free,
ursodeoxycholic acid
250 mg/5 mL,
net price 250 mL = £26.98.
Label:
21
Dose
primary biliary cirrhosis,
10–15 mg/kg daily as a single
daily dose or in 2–4 divided doses
Dissolution of gallstones, see Dose, above
Ursogal
c
(Galen) A
Tablets
,
scored,
ursodeoxycholic acid 150 mg,
net
price 60-tab pack = £17.05.
Label:
21
Capsules
, ursodeoxycholic acid 250 mg, net price 60-
cap pack = £30.50.
Label:
21
Other preparations for biliary disorders
A terpene mixture (
Rowachol
c
)
raises biliary choles-
terol
solubility.
It
is
not
considered to be a useful
adjunct.
Rowachol
c
(Rowa) A U
Capsules
, green, e/c, borneol 5 mg, camphene 5 mg,
cineole 2 mg, menthol 32 mg, menthone 6 mg, pinene
17 mg in olive oil. Net price 50-cap pack = £7.35.
Label:
22
Dose
1–2 capsules 3 times daily before food (but see notes
above)
Interactions: Appendix 1 (
Rowachol
c
)
1.9.2
Bile acid sequestrants
Colestyramine is an anion-exchange resin that
is not
absorbed from the gastro-intestinal
tract.
It
relieves
diarrhoea and pruritus by forming an insoluble complex
with bile acids in the intestine. Colestyramine can inter-
fere with the absorption of a number of drugs. Colestyr-
amine is also used in hypercholesterolaemia (section
2.12).
COLESTYRAMINE
(Cholestyramine)
Indications
pruritus associated with partial biliary
obstruction and primary biliary cirrhosis;
diarrhoea
associated with Crohn’s disease,
ileal resection,
vagotomy,
diabetic vagal neuropathy,
and radiation;
hypercholesterolaemia (section 2.12)
Cautions
section 2.12
Contra-indications
section 2.12
Pregnancy
section 2.12
Breast-feeding
section 2.12
Side-effects
section 2.12
Dose
. Pruritus,
4–8 g daily in a suitable liquid;
CHILD
1–18
years see
BNF for Children
. Diarrhoea, initially 4 g daily increased by 4 g at weekly
intervals to 12–24 g daily in a suitable liquid in 1–4
78
1.9 Drugs affecting intestinal secretions
BNF 61
1
Gastro-intestinal system