From the Guidelines
Rowatinex is not recommended as a primary treatment for cholelithiasis (gallstones). While Rowatinex is a terpene mixture that has been used in some European countries for urinary tract stones, there is insufficient evidence supporting its effectiveness for gallstones 1. The standard treatment for symptomatic gallstones is surgical removal of the gallbladder (cholecystectomy), which is considered the definitive treatment. For patients who cannot undergo surgery, alternative options include oral dissolution therapy with ursodeoxycholic acid (typically 8-10 mg/kg/day divided into two doses for 6-24 months) or extracorporeal shock wave lithotripsy in select cases.
Key Considerations
- The mechanism of gallstone formation involves cholesterol supersaturation in bile, and effective treatments must address this underlying process through either physical removal of the gallbladder or chemical dissolution of cholesterol stones, which Rowatinex has not been proven to accomplish.
- Nonsurgical therapy dissolves gallstones by solubilizing their cholesterol through various methods, but this therapy is generally limited to gallstones with a diameter less than 1.5 cm and whose content is primarily cholesterol 1.
- Rowatinex lacks robust clinical evidence for gallstone dissolution and is not included in major treatment guidelines for cholelithiasis.
Treatment Options
- Surgical removal of the gallbladder (cholecystectomy)
- Oral dissolution therapy with ursodeoxycholic acid
- Extracorporeal shock wave lithotripsy in select cases
Important Notes
- Expectant management delays treatment and poses a dilemma, as watchful waiting may avoid an unnecessary intervention, but delaying an intervention can result in adverse consequences 1.
- The choice of treatment requires information about the efficacy, safety, and benefits of each option, and clinicians and patients must recognize three categories of disease: silent gallstones, symptomatic disease, and complications of gallstone disease.
From the Research
Role of Rowatinex (Rowachol) in Cholelithiasis Treatment
There is no direct mention of Rowatinex (Rowachol) in the provided studies.
Available Treatment Options
- The current treatment options for cholelithiasis include:
- Laparoscopic cholecystectomy, which is the treatment of choice for symptomatic cholelithiasis 2
- Medical treatment, which is indicated for patients who are not fit or are afraid of surgery 2
- Oral bile acids, such as chenodeoxycholic acid and ursodeoxycholic acid, which can dissolve cholesterol-rich gallstones 2, 3, 4
- Lithotripsy combined with oral bile acid for dissolution of fragments 2
- Contact dissolution using methyltertbutylether 2
- FABACs (Fatty Acid Bile Acid Conjugates), which are novel synthetic lipid molecules that can prevent the formation of cholesterol crystals and dissolve existing ones 5
- Statins and ezetimibe, which are currently available drug therapies used for cholesterol gallstones 6, 3
- Herbal plants, which are being researched for their potential therapeutic effects in the treatment of cholelithiasis 6
Key Considerations
- The choice of treatment depends mainly on gallstone size and the patient's overall health 2
- Careful patient selection and bedtime administration of the whole daily bile acid dose can enhance treatment and achieve up to 75% complete dissolution annually 2
- Following dissolution using any form of treatment, gallstones recur in about 50% of patients, and cannot be reliably prevented by low dose bile acid or dietary manipulations 2