UrsodiolUrsodeoxycholic Acid

About Ursodiol

Ursodiol is a naturally occurring bile acid. It lowers the cholesterol the liver secretes into bile, so small cholesterol stones can slowly dissolve, and in primary biliary cholangitis it changes the mix of bile acids and improves liver blood tests. The 300 mg capsules are labeled for dissolving radiolucent, non-calcified gallstones smaller than 20 mm in people not having surgery, and for preventing gallstones in obese people losing weight quickly; the 250 and 500 mg tablets are labeled for primary biliary cholangitis.

Stomach pain, diarrhea, indigestion, nausea and headache are common; itching, rash and hair thinning are also listed. There is no boxed warning. The capsules are not used for calcified or pigment stones, or with acute cholecystitis, cholangitis, a blocked bile duct, gallstone pancreatitis or a fistula; the tablets are not used when the bile duct is completely obstructed. On the tablets, liver tests are checked monthly for three months and then every six months; gallstone treatment is followed with ultrasound every six months and continued for one to three months after the stones have gone, and stones often return.

Doses are set by body weight: for gallstones 8 to 10 mg per kilogram a day in two or three doses, 600 mg a day for prevention during weight loss, and for primary biliary cholangitis 13 to 15 mg per kilogram a day in two to four doses with food. A pharmacy fills the form written; the other form needs a new prescription.

Taking Ursodiol

How to take it

Capsules for gallstones two or three times a day, with or without food; tablets for primary biliary cholangitis two to four times a day with food. Swallow capsules whole. The scored 500 mg tablet can be broken on the line; keep half tablets apart and use them within 28 days. It works slowly, over months.

If you miss a dose

Take it as soon as you remember, unless it is nearly time for the next dose; in that case skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in a tightly closed container, away from heat and moisture, out of reach of children.

Interactions to know about

Cholestyramine, colestipol and antacids containing aluminum bind ursodiol in the gut and reduce how much is absorbed, so ask the pharmacist how to space them. Estrogens, birth control pills and clofibrate increase the cholesterol in bile and can work against it. Tell the prescriber about liver disease or a blocked bile duct.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Ursodiol differs from pharmacy to pharmacy

Ursodiol is dosed by weight and taken two to four times a day for months or years, so a month’s supply is a lot of capsules or tablets, and a pharmacy that prices each unit from a published list can quote far more than one that starts from what it paid. The 300 mg capsules have many makers; the tablets and the 200 and 400 mg capsules have fewer, so those are quoted more variably.

Ways to pay less for Ursodiol without insurance

• Ask the pharmacy to quote the strengths that make up your daily dose in the fewest units, if the prescriber agrees.
• Ask for a ninety-day prescription, since treatment runs for months or years.
• Make sure the prescription allows generic substitution, especially if it names Actigall.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Ursodiol

1. 1.Is this the capsule or the tablet, and is it right for my condition?
2. 2.Should I take it with food, and can I split the tablet?
3. 3.How should I space it from cholestyramine, colestipol or antacids?
4. 4.When are my liver tests or ultrasound due?

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