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Actigall (ursodeoxycholic acid) is used to:

• Prevent cholesterol gallstones from forming during rapid weight loss;
• Dissolve existing cholesterol gallstones as an alternative to surgery;
• Manage symptoms from primary biliary cirrhosis.

The active ingredient, ursodeoxycholic acid, is produced naturally by the liver and excreted into bile, which is then stored in the gallbladder until it is needed to aid in digestion. As a medication, Actigall does two things:

• Inhibits cholesterol absorption during digestion
• Inhibits cholesterol production by the liver, which in turn reduces cholesterol content in bile.

With less cholesterol in the bile (which is stored in the gallbladder) it is more difficult for gallstones to develop or grow, and allows existing gallstones to break down.

It is unclear how exactly Actigall helps reduce the severity of symptoms in primary biliary cirrhosis.

Preventing Gallstones

In the majority of cases, Actigall is prescribed for gallstone prevention in individuals who are obese and likely to undergo rapid weight loss, be it from diet, surgical procedures, fasting, taking medications, or any other method. Treatment is typically as follows:

• Take 300 milligrams (mg) of Actigall twice daily, for a total of 600 mg per day.
• Spread each dose as evenly apart as possible.
• Take with food and a full drink.

Treatment typically continues for at least 6 months, and in some cases may last longer if weight loss is still occurring or there is reason to believe gallstone development is still an issue. Once weight normalizes, there is no need to continue treatment.

Dissolving Gallstones

When effective, dissolving gallstones with Actigall is an alternative to surgery. Note that it is effective only on stones consisting of cholesterol, and will have no effect on other types.

Treatment is somewhat variable:

• Daily doses usually consist of 8 to 10 milligrams (mg) of Actigall per kilogram (kg) of body weight.
• Total daily doses should be split into two or more smaller doses so that no single dose exceeds 300 mg.
• Spread doses as evenly apart as possible.
• Take with food and a full drink.

Treatment will usually last for a minimum of one year. Progress should be checked at least every six months. If significant reduction of stones is observed at the first six-month checkup, complete resolution is likely. If there is little evidence of stones being dissolved after 12 months, treatment is unlikely to work and should be stopped. When the medication appears to be working, it may be taken until stones are completely gone. About 50 percent of patients find stones return several years after stopping treatment if appropriate lifestyle changes are not made. Treatment may be repeated if needed.

Primary Biliary Cirrhosis

Primary biliary cirrhosis is a relatively complicated liver disease and the exact mechanism by which Actigall works is unclear. Treatment is usually very similar in all cases:

• Daily dose is typically 13 to 15 milligrams (mg) of Actigall per kilogram (kg) of body weight.
• Total daily doses should be split into two or more smaller doses so that no single dose exceeds 300 mg.
• Spread doses as evenly apart as possible.
• Take with food and a full drink.

In primary biliary cirrhosis the medication is typically taken for life, or until a liver transplant. When the medication is effective, it will improve liver function and reduce the severity of symptoms, which can extend life and delay the need for a transplant.

Adverse Effects

Actigall is a remarkably safe medication, unlikely to produce serious side effects even when taken in doses much larger than those recommended. Most common side effects are mild and transient, disappearing entirely as the body adjusts to treatment:

• Itching
• Rash
• Nausea
• Vomiting
• Stomach cramps
• Constipation
• Diarrhea

Actigall may interact with a variety of other medications; check with a doctor or pharmacist if unsure about mixing treatments.