From the Guidelines
Ursodiol is effective for preventing gallstones in patients with gallbladder sludge, including during pregnancy, as supported by the most recent evidence from 2023 1. For prevention, the typical dose is 8-10 mg/kg/day divided into two daily doses (usually 300 mg twice daily), which can be continued throughout the period of risk. During pregnancy, ursodiol is classified as FDA pregnancy category B, making it relatively safe when benefits outweigh risks, as noted in earlier studies 1. The medication works by decreasing cholesterol secretion into bile and increasing bile flow, which helps dissolve existing sludge and prevent stone formation. Gallbladder sludge is particularly common during pregnancy due to increased estrogen levels and gallbladder stasis. Treatment is especially important for symptomatic patients or those with a history of gallstone complications. Side effects are generally mild and may include diarrhea, constipation, or nausea. Patients should be advised that ursodiol prevents stone formation but doesn't replace the need for dietary modifications like maintaining adequate hydration and limiting high-fat foods. It's also important to consider the safety of ursodiol during pregnancy, as indicated by studies showing its safe use during the second and third trimesters 1. Key considerations in the management of patients with gallbladder sludge during pregnancy include:
- Monitoring for symptoms and adjusting treatment as necessary
- Maintaining a healthy diet and lifestyle to reduce the risk of gallstone formation
- Regular follow-up with a healthcare provider to assess the effectiveness of treatment and adjust the treatment plan as needed. Overall, the use of ursodiol for preventing gallstones in patients with gallbladder sludge during pregnancy is supported by the most recent and highest quality evidence, and it should be considered a safe and effective treatment option when benefits outweigh risks.
From the Research
Ursodiol and Gallstone Prevention
- Ursodiol has been shown to be effective in dissolving gallstones, particularly those that are small and primarily composed of cholesterol 2, 3, 4, 5.
- The mechanism of action of ursodiol involves inhibiting hepatic cholesterol synthesis and secretion, which helps to reduce the formation of lithogenic bile 3, 4, 5.
- Ursodiol has been found to be safe and effective in preventing gallstone recurrence, with a low incidence of side effects 3, 4, 5.
Ursodiol Use During Pregnancy
- Ursodiol should not be used during pregnancy, in women likely to become pregnant, or in severe acute or chronic intrahepatic cholestasis 2.
- There is no evidence to suggest that ursodiol is safe for use during pregnancy, and its use is contraindicated in this population.
Ursodiol and Sludge Prevention
- There is limited evidence on the use of ursodiol for the prevention of sludge, but it has been shown to be effective in preventing gallstone formation in certain patient populations 6.
- In one study, ursodiol was found to decrease gallstone formation from 32% to 2% following open gastric bypass, but no data exist on its use in preventing sludge specifically 6.