Issues for surgery
For dissolution of gallstones – risk of recurrence of gallstones if omitted during treatment period.
For cholestatic pruritis and bile reflux gastritis – risk of loss of symptomatic control if omitted.
For intrahepatic cholestasis of pregnancy – risk of loss of symptomatic control, worsening of liver function tests and potential increased risk of perinatal complications if omitted.
For primary biliary cholangitis (primary biliary cirrhosis, PBC) – risk of liver damage if omitted.
Advice in the perioperative period
Elective surgery
Omit dose(s) whilst fasting.
Check liver function tests (LFTs) pre-operatively if not checked within the last 3 months.
Emergency surgery
Omit dose(s) whilst fasting.
Check liver function tests (LFTs) pre-operatively if not checked within the last 3 months.
If patient admitted with acute cholecystitis, acute cholangitis, or occlusion of biliary tract – hold until acute flare has resolved. If patient not for surgical intervention, review risk versus benefit of continuing treatment.
Post-operative advice
Resume post-operatively once enteral intake resumed if still required.
Monitor LFTs post-operatively.
For patients undergoing hepatobiliary surgery
Review continued need post-operatively.
Interactions with common anaesthetic agents
None.
Interactions with other common medicines used in the perioperative period
Antacids
Absorption of ursodeoxycholic acid is reduced by oral antacids; manufacturer advises separate administration by 2 hours.
Ciprofloxacin
There have been rare cases where ciprofloxacin serum concentrations have been reduced in patients taking ursodeoxycholic acid. The clinical significance of this interaction is unknown, but bear in mind in case of unexpected response to treatment.
Further information
None relevant.
References
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 16th April 2023]
Summary of Product Characteristics – Ursodeoxycholic acid 250mg capsules. ADVANZ Pharma. Accessed via www.medicines.org.uk 15/04/2023 [date of revision of the text January 2016]
Ursodeoxycholic Acid. In: Brayfield (ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://medicinescomplete.com [Accessed 16th April 2023]
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinecomplete.com [Accessed on 16th April 2023]