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
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
—
none in our sources
PREGNANCY
Not recommended in pregnancy; limited data - weigh benefits vs risks
FDA category + note
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
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
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
8 additional unreviewed or low-confidence interactions hidden because their provenance or source detail is insufficient.
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
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Textbook-sourced·Sources: Goodman & Gilman 14e, Katzung, BNF, Nelson·Updated: 2026-05-19·Cockpit curated: 2026-05-19