Recommended Dosage of Ursodeoxycholic Acid for Intrahepatic Cholestasis of Pregnancy
The recommended dose of ursodeoxycholic acid (UDCA) for intrahepatic cholestasis of pregnancy (ICP) is 10-15 mg/kg/day divided into 2-3 daily doses. 1, 2
Dosing Guidelines
- Initial dosing: 10-15 mg/kg/day divided into 2-3 daily doses 1, 2
- Dose titration: If symptoms persist, the dose can be increased up to 21-25 mg/kg/day 2
- Practical dosing: Typically administered as 500 mg twice daily (equivalent to approximately 14-17 mg/kg/day for a 70 kg woman) 3
- Lower dose option: Some studies have shown effectiveness with doses as low as 300-450 mg/day (4-6 mg/kg/day) 4
Treatment Efficacy
UDCA is the first-line agent for treating ICP and has been shown to:
- Reduce maternal pruritus 2, 5, 6
- Improve liver function tests and decrease serum bile acid levels 4, 6
- Potentially improve perinatal outcomes 5
Treatment Duration
- Treatment should be continued from diagnosis until delivery 1, 2
- UDCA can be stopped at delivery, but if symptoms persist postpartum, it should be tapered over 2-4 weeks 2
Monitoring During Treatment
- Weekly monitoring of total serum bile acids and liver function tests 2
- Assessment of pruritus severity
- Monitoring for vitamin K deficiency, especially if using cholestyramine as an adjunct therapy 1, 2
Common Pitfalls to Avoid
- Inadequate dosing: Starting with too low a dose or failing to titrate up when symptoms persist 2
- Delayed treatment: Promptly initiating UDCA therapy upon diagnosis is important for symptom relief 2
- Insufficient monitoring: Regular assessment of bile acid levels and liver function tests is essential 2
- Overlooking vitamin K deficiency: Particularly important if cholestyramine is used as adjunctive therapy 1, 2
Alternative and Adjunctive Treatments
If UDCA alone is insufficient for symptom control:
- Rifampicin: 300-600 mg daily can be added, but monitor for hepatotoxicity (occurs in ~5% of patients) 1, 2
- Anion exchange resins: Cholestyramine (4-8 g/day) or colestipol (5-10 g/day), administered at least 4 hours apart from UDCA 1, 2
- S-adenosyl-L-methionine: May have additive effects with UDCA 2, 7
Delivery Timing Based on Bile Acid Levels
The timing of delivery should be determined by bile acid levels:
- Bile acids ≥100 μmol/L: Delivery at 36 weeks 1, 2
- Bile acids 40-99 μmol/L: Delivery between 37-38 weeks 1, 2
- Bile acids <40 μmol/L: Delivery between 38-39 weeks 1, 2
UDCA is considered safe during pregnancy and breastfeeding, with no reported adverse effects on the fetus or neonate 1, 2.