Brand Name: Actigall

Available in 300 mg capsules, and 250 mg, 500 mg tablets

Background

Most people have heard that one's liver produces a greenish fluid called bile and that this mysterious substance is stored in the gall bladder but beyond this, knowledge of the composition and function of bile simply is not mainstream. Bile is indeed the greenish under-appreciated fluid, produced in the liver and stored in the gall bladder. At the appropriate time in digestion, the gallbladder contracts and bile squirts down the bile duct and into the small intestine. Bile carries with it an assortment of the body's toxins that are dumped safely into the gastrointestinal tract and ultimately eliminated in the stool. Bile also assists in the absorption of dietary fats, fat-soluble vitamins, and other desirable substances.

Bile consists mostly of cholesterol derivatives called bile acids. There are many types of bile acids, each with different functions. Some are simply lost in the intestine and eliminated in stool and some are reabsorbed (i.e., recycled) for reuse by the liver. If more bile acids are required than were reabsorbed, then the liver must make more. If the liver is in failure, reabsorbed bile acids are not captured by the liver for reuse but instead pass through the liver and into the body's circulation (hence the basis for the bile acids test that has become a popular diagnostic in evaluating veterinary liver patients.)

Ursodeoxycholic acid, called ursodiol, is one of the bile acids produced by the Chinese black bear and it has been used in the treatment of liver disease for centuries. Nowadays, however, it is produced in the laboratory and not extracted from bear gallbladders.

How this Medication is Used

There are many benefits to the use of ursodeoxycholic acid in the treatment of liver disease.

Removal of Toxic Bile Acids
Heretofore, the bile acids mentioned are "good." They carry away toxins and assist digestion. This is all fine and dandy inside the confines of the GI tract, but some bile acids are damaging to the liver if they are reabsorbed. In dogs and cats, toxic bile acids are produced when intestinal bacteria consume "good" bile acids and convert them into "bad" ones. The intestine must avoid reabsorbing toxic bile acids and try to only reabsorb the safe kind for recycling. Ursodeoxycholic acid is a non-toxic bile acid. The intestine will preferentially reabsorb ursodeoxycholic acid over more toxic bile acids when the two types are together in the intestine.

Increased bile flow
When the liver is healthy, small amounts of toxic bile acids get reabsorbed into the liver and are dealt with promptly. When the liver is not healthy, these bile acids build up and damage the liver further. Ursodeoxycholic acid is what is called a choleretic, which means it improves the flow of bile through the tiny ducts into the gall bladder and improves the flow of bile from the gall bladder into the intestine. In other words, it helps the flow of bile, which in turn facilitates the removal of toxic bile acids as well as other toxins excreted in bile from the body.

Ursodeoxycholic acid also appears to have beneficial effects in normalizing immune reactions in the liver and may be useful in the treatment of cirrhosis and chronic active hepatitis.

Side Effects

No serious side effects have turned up in any of the testing of this medication on dogs and cats. The occasional patient experiences some nausea. (Ursodeoxycholic acid is toxic to rabbits, baboons, and rhesus monkeys.)

The use of ursodeoxycholic acid can lower blood cholesterol levels.

There is a possibility that chronic use of ursodeoxycholic acid in cats may deplete the body of the essential amino acid taurine, thus necessitating dietary supplementation with this amino acid. Dogs are able to manufacture their own taurine internally so this issue is not problematic for them.

Interactions With Other Drugs

Ursodeoxycholic acid should not be given at the same time as aluminum-containing antacids (such as Amphojel) as these compounds may bind together and impede the action of the ursodeoxycholic acid.

Concurrent use with Aluminum containing antacids may bind ursodiol thus interfering with the effectiveness of ursodiol.

Concerns and Cautions

The capsule size is inconveniently large for dosing small animals. Capsules can be split and the inner powder sprinkled in food, or a compounding pharmacy can create a flavored oral suspension or smaller strength capsule.

If the common bile duct is obstructed with a gallstone, it's not appropriate to increase bile flow. In such a situation, the use of ursodeoxycholic acid would be contraindicated.

The bile acids test is a common blood test in monitoring liver function. Lately, concern has been raised that the use of ursodiol will falsely elevate this test. While it is not known for sure whether this is actually a problem, it has been suggested to discontinue this medication for a couple of days prior to a bile acids test.

Ursodiol is best given with food.