From the Guidelines
To lower bilirubin levels, phototherapy is the most effective treatment, especially in neonates, as it converts unconjugated bilirubin into a water-soluble form that can be easily excreted, thereby reducing the risk of bilirubin neurotoxicity 1. When it comes to lowering bilirubin levels, several approaches can be considered, but the most critical factor is the underlying cause of the elevation.
- For neonates, phototherapy is the primary treatment for hyperbilirubinemia, as it has been shown to reduce the risk of bilirubin neurotoxicity and the need for exchange transfusions 1.
- The procedure involves exposing the newborn to light in the blue-green wavelength range, which peaks at 478 nm and has an irradiance of 25 to 35 mW/cm2/nm, to at least one surface of the body.
- This treatment is guided by serial measurements of total serum/plasma bilirubin concentrations and screening for intrinsic risk factors for bilirubin neurotoxicity.
- While other methods, such as increasing fluid intake, consuming a balanced diet, and regular exercise, may help support liver function and reduce bilirubin levels, phototherapy remains the most effective treatment for severe hyperbilirubinemia, particularly in high-risk neonates 1.
- It is essential to note that failure to respond to phototherapy is unusual, unless complicated by an increased rate of bilirubin production due to hemolysis or issues with the phototherapy device.
- In cases where bilirubin elevation is caused by an underlying condition, treating the primary condition is crucial to reducing bilirubin levels.
- Consultation with a healthcare provider is necessary for proper diagnosis and treatment, especially if bilirubin levels are significantly elevated.
From the FDA Drug Label
The sites of the drug’s therapeutic actions are in the liver, bile, and gut lumen. Ursodiol suppresses hepatic synthesis and secretion of cholesterol, and also inhibits intestinal absorption of cholesterol The answer to how to lower bilirubin is not directly addressed in the provided drug label for ursodeoxycholic acid (PO) 2. Key points:
- The label discusses the drug's therapeutic actions in the liver, bile, and gut lumen.
- It mentions the suppression of hepatic synthesis and secretion of cholesterol and inhibition of intestinal absorption of cholesterol. However, there is no direct information on lowering bilirubin levels. The FDA drug label does not answer the question.
From the Research
Methods to Lower Bilirubin
- Ursodeoxycholic acid (UDCA) can be used in conjunction with phototherapy to reduce bilirubin levels in neonates with glucose-6-phosphate dehydrogenase (G6PD) deficiency and hyperbilirubinemia, as shown in a study published in 2021 3.
- A systematic review and meta-analysis of randomized controlled trials found that UDCA can shorten the duration of phototherapy and lower mean total serum bilirubin in neonates with indirect hyperbilirubinemia 4.
- UDCA has been shown to have a reductive effect on bilirubin levels in neonates on phototherapy, reducing the duration of treatment and in-patient care 5.
Diagnostic Evaluation
- The diagnostic evaluation of hyperbilirubinemia should start with a careful history and physical examination, followed by imaging assessment of the biliary tree and liver 6.
- Algorithm models that incorporate bilirubin levels can be used to predict outcomes in patients with chronic liver disease 6.
Physiological Relevance of Bilirubin
- Recent research suggests that bilirubin may have a role as a metabolic hormone, and low levels of bilirubin (hypobilirubinemia) may be associated with metabolic dysfunction and cardiovascular complications 7.
- Further research is needed to understand the clinical significance of low bilirubin levels and to explore potential treatment options for patients with hypobilirubinemia 7.