Colesevelam
Severe
Database
Decreased efficacy of ursodeoxycholic acid.
Administer ursodeoxycholic acid at least 2 hours before or 4-6 hours after colesevelam. Monitor for therapeutic effect.
Drug reference
Ursodeoxycholic Acid
Bile acid / gallstone dissolution agent / hepatoprotective · Hepatoprotective
Also known as UDCA, Ursodiol, Ursodeoxycholate
START
8-10 mg/kg/day divided for gallstones; 13-15 mg/kg/day for PBC; take with meals
TYPICAL MAX
15 mg/kg/day (20 mg/kg in CF)
STOP IF
No response after 6-12 months (gallstones), worsening liver function, severe diarrhea
WATCH
LFTs monthly for first 3 months then 6-monthly (PBC), ultrasound at 6-12 months (gallstones), check gallbladder function
CDSCO approvedSchedule HJan AushadhiATC A05AA02
KDIGO 2024 + manufacturer label
- ONSET
- 30min · absorption onset
- PEAK
- 2h · Peak plasma concentration
- t½
- 4d · Very long half-life (enterohepatic circulation)
- DURATION
- 1d · 24-hour coverage with divided doses
EXCRETION
Fecal (major); renal (<1%)
route + CYP
INTERACTIONS
2 major
SEVERE in our sources
PREGNANCY
Not recommended in pregnancy; limited data - weigh benefits vs risks
FDA category + note
Top interactionssee all 12 →
- ColesevelamSevereDatabase
- ColestipolSevereDatabase
Available in India
748 branded formulations and 29 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Reduces cholesterol absorption in intestine and secretion into bile; displaces cholesterol from bile acid micelles, promoting cholesterol solubilization; cytoprotective effect on hepatocytes via anti-apoptotic and membrane-stabilizing actions
Indications
Dissolution of cholesterol gallstonesPrimary biliary cholangitis (PBC)Primary sclerosing cholangitis (off-label)Drug-induced cholestasisNon-alcoholic fatty liver disease (off-label)
Dosing
- Adult
- Gallstones: 8-10 mg/kg/day in 2-3 divided doses (typically 300 mg BD-TDS); PBC: 13-15 mg/kg/day in 2-4 divided doses
- Pediatric
- PBC in children: 10-15 mg/kg/day in 2-3 divided doses; CF-related liver disease: 20-30 mg/kg/day
- Renal adjustment
- No specific adjustment needed; minimal renal excretion
- Hepatic adjustment
- No dose reduction needed in liver disease; primary indication is liver disease
- Geriatric
- No specific adjustment; standard weight-based dosing
- Max dose
- 15 mg/kg/day (usual); up to 20 mg/kg/day in CF-related liver disease
Pharmacokinetics
Onset
Weeks to months (for gallstone dissolution)
Peak effect
1-3 hours (Tmax)
Duration
24 hours
Half-life
3.5-5.8 days (long half-life due to enterohepatic circulation)
Bioavailability
~90%
Protein binding
96-99%
Metabolism
Hepatic conjugation to taurine and glycine; extensive enterohepatic recirculation
Excretion
Fecal (major); renal (<1%)
Contraindications
- Radiopaque (calcified) gallstones
- Non-functioning gallbladder
- Acute cholecystitis
- Biliary-gastrointestinal fistula
- Hypersensitivity to UDCA
Side effects
Common
Diarrhea (dose-related)NauseaPruritusConstipationAbdominal painHeadache
Serious
- Severe right upper quadrant pain (biliary colic during stone dissolution)
- Hepatic decompensation in late-stage PBC (rare)
- Urticaria
- Worsening of liver function in advanced cirrhosis
Pregnancy & lactation
Pregnancy
Not recommended in pregnancy; limited data - weigh benefits vs risks
Lactation
Excreted in breast milk in small amounts; compatible with breastfeeding per WHO
Drug interactions
Colestipol
Severe
Database
Decreased efficacy of ursodeoxycholic acid.
Administer ursodeoxycholic acid at least 2 hours before or 4-6 hours after colestipol. Monitor for therapeutic effect.
Aluminum Hydroxide
Moderate
Database
Decreased therapeutic effect of ursodeoxycholic acid.
Administer ursodeoxycholic acid at least 2 hours before or after aluminum hydroxide (or other aluminum-containing antacids).
Source: DDInter
Aluminum Containing Antacids
Moderate
Database
Decreased efficacy of ursodeoxycholic acid.
Administer ursodeoxycholic acid at least 2 hours before or after aluminum-containing antacids. Monitor for therapeutic effect.
Cholestyramine
Moderate
Database
Bile acid sequestrants bind UDCA in gut, reducing absorption by ~50%
Take UDCA at least 2 hours before or 4 hours after cholestyramine
Source: Kimi deep-research + Cla
Clofibrate
Moderate
Database
Reduced efficacy of ursodeoxycholic acid in dissolving gallstones.
Avoid concomitant use if ursodeoxycholic acid is used for gallstone dissolution. If used for other indications, monitor for reduced efficacy.
Estrogens
Moderate
Database
Reduced efficacy of ursodeoxycholic acid in dissolving gallstones.
Avoid concomitant use if ursodeoxycholic acid is used for gallstone dissolution. If used for other indications, monitor for reduced efficacy.
Ethinyl Estradiol
Moderate
Database
Reduced efficacy of ursodeoxycholic acid, especially for gallstone dissolution.
Avoid concomitant use if possible, particularly when ursodeoxycholic acid is used for gallstone dissolution. Consider alternative contraception.
Oral Contraceptives
Moderate
Database
Reduced efficacy of ursodeoxycholic acid in dissolving gallstones.
Avoid concomitant use if ursodeoxycholic acid is used for gallstone dissolution. If used for other indications, monitor for reduced efficacy.
Rifampicin
Moderate
Database
Decreased plasma concentrations and reduced therapeutic efficacy of ursodeoxycholic acid.
Avoid concomitant use if possible. If unavoidable, monitor UDCA efficacy and consider dose adjustment.
Ciclosporin
Moderate
Database
UDCA may increase ciclosporin absorption
Monitor ciclosporin levels when co-prescribing
Source: Kimi deep-research + Cla
Ciprofloxacin
Moderate
Database
Reduced absorption of fluoroquinolones due to chelation
Take fluoroquinolones 2 hours before or 6 hours after UDCA
Source: Kimi deep-research + Cla
Related guidelines
MASLD / non-alcoholic fatty liver disease
INASL · Hepatology · 2023
MASLD / non-alcoholic fatty liver disease
AASLD · Gastroenterology · 2023
Acute liver failure
ICMR · Gastroenterology · 2022
Primary prevention of cardiovascular disease
AHA · Cardiology · 2019
Primary PCI for acute coronary syndrome
ESC · Cardiology · 2026
Ask House about Ursodeoxycholic Acid
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Katzung, BNF, Nelson·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19