Ursodeoxycholic Acid Dosing Frequency in Pregnancy
Ursodeoxycholic acid (UDCA) tablets should be taken 2-3 times daily during pregnancy, with a total daily dose of 10-15 mg/kg divided into these multiple doses. 1
Specific Dosing Regimens
The most commonly prescribed regimens include:
- 300 mg twice daily or three times daily 1
- 500 mg twice daily 1
- Total daily dose: 10-15 mg/kg/day, divided into 2-3 doses 1, 2
The divided dosing (2-3 times per day rather than once daily) is the standard approach recommended by major guidelines. 1
Dose Titration Strategy
Starting approach:
- Begin with 10 mg/kg/day divided into 2-3 doses 1
- If pruritus persists after 1-2 weeks, the dose can be increased 1
- Maximum dose: up to 21 mg/kg/day 1
Important consideration: Recent evidence suggests that gradual dose escalation (starting low and slowly increasing) may be associated with better neonatal outcomes compared to starting with full doses immediately. 3 This represents an emerging approach that challenges traditional full-dose initiation.
Clinical Response Timeline
- Pruritus improvement: typically within 1-2 weeks 1
- Biochemical improvement: usually within 3-4 weeks 1
- If no symptom relief occurs within this timeframe, consider dose escalation 1
Safety and Tolerability
UDCA is considered safe during pregnancy and breastfeeding. 1 Mild side effects (nausea, dizziness) occur in up to 25% of patients but are generally well-tolerated. 1
Critical Timing Consideration
If using cholestyramine concurrently (for refractory pruritus), separate UDCA administration by at least 4 hours to prevent binding and reduced absorption. 1
Context-Specific Dosing
For intrahepatic cholestasis of pregnancy (ICP): 10-15 mg/kg/day divided 2-3 times daily 1
For primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC) in pregnancy: 15-20 mg/kg/day 1, 2