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BiliaryObstructionMedication
Updated:Nov27,2016
Author:JenniferLynnBonheur,MDChiefEditor:VinayKumarKapoor,MBBS,MS,FRCS,FAMS
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MEDICATION
MedicationSummary
Bileacidbindingresinsandursodeoxycholicacidareusedtotreatcholelithiasiswhensurgeryis
refusedorisinappropriate.Normalgallbladderfunctionmustbeestablishedbyoralcholecystography
findingspriortotheinitiationofdrugtherapy.
Gallstonesolubilizingagents
ClassSummary
Ursodeoxycholicacid(ursodiol)isanaturallyoccurringbileacidpresentinsmallquantitiesinhuman
bile.Suppressesliversynthesisandsecretionofcholesterol.Inhibitsintestinalcholesterolabsorption.
Ursodiol(Actigall)
Viewfulldruginformation
Usedtotreatbiliarystasisanddissolvegallstones.
Narcoticantagonists
ClassSummary
Endogenousopioidsmayeffectpruriticdevelopmentassociatedwithcholestasis.Treatmentwith
narcoticantagonistsmayattenuatepruritus.
Naloxone(Narcan)
Viewfulldruginformation
Preventsorreversesopioideffects(eg,hypotension,respiratorydepression,sedation,pruritus),
possiblybydisplacingopiatesfromtheirreceptors.
Antibiotics
ClassSummary
Rifampin,inparticular,hasbeensuggestedasatreatmentforcholestasisincertainpatients.By
reducingintestinalflora,itslowsconversionofprimarytomoretoxicsecondarybilesalts.Hasalso
beenshowntodecreaseserumlevelsofbilirubinandALP,perhapsinpartcontributingtoits
effectivenessinminimizingassociatedpruritus.
Rifampin(Rifadin,RifadinIV,Rimactane)
Viewfulldruginformation
InhibitsDNAdependentbacterialbybindingtothebetasubunitofDNAdependentRNApolymerase,
blockingRNAtranscription.
Bileacidbindingresins
ClassSummary
Inhibitenterohepaticreuptakeofintestinalbilesalts.
Cholestyramine(Questran)
Viewfulldruginformation
Actsasacholesterolloweringagent.Formsanonabsorbablecomplexwithbileacidsintheintestine,
whichinhibitsenterohepaticreuptakeofintestinalbilesalts.
Colestipol(Colestid)
Viewfulldruginformation
Bindsbileacidsintheintestine,facilitatespartialremovalofbileacidsfromenterohepaticcirculation,
andpreventstheirreabsorption.
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