Medications

What are Gallbladder Medications? 

Gallbladder medications are typically used to manage gallbladder diseases, particularly gallstones. Gallstones are hardened deposits in the gallbladder, a small organ under the liver. They can cause pain and other symptoms, which is why medication is sometimes prescribed. 

Who is Suitable for Gallbladder Medications?

The use of gallbladder medications is limited. They are suitable for people who:

• Have cholesterol gallstones that are small in size (less than 15 mm in diameter).
• Have a functional gallbladder (gallbladder needs to be working for the medicines to have an effect).
• Are unwilling or unable to undergo surgery (e.g., cholecystectomy - gallbladder removal surgery) due to various reasons, such as other health conditions that make surgery risky.
• Are not in urgent need of treatment, as these medications can take a long time to work.

Gallbladder medications may not be suitable for everyone, and they don't always prevent gallstones from recurring once treatment is stopped. Moreover, they're generally not used in acute cholecystitis (inflammation of the gallbladder) or choledocholithiasis (stones in the common bile duct). It's always best to discuss with your doctor to understand the potential risks and benefits before starting any new medication.

Benefits of Gallbladder Medications

• Non-Surgical Approach: Medications such as ursodeoxycholic acid (ursodiol) or chenodeoxycholic acid can be a good option for those not good candidates for surgery or those who wish to avoid it.
• Symptom Relief: These medications can help alleviate symptoms like abdominal pain, nausea, and fever associated with gallstones.
• Dissolving Gallstones: Ursodeoxycholic acid and chenodeoxycholic acid work to dissolve cholesterol gallstones, thereby eliminating the cause of discomfort.

Medications for Gallbladder Conditions

The two most commonly used medications for gallbladder conditions are:

• Ursodeoxycholic Acid (UDCA) or Ursodiol: This naturally occurring bile acid can help dissolve cholesterol gallstones. It works by reducing the production of cholesterol and promoting its dissolution in the bile.
• Chenodeoxycholic Acid (Chenodiol): This medication also helps dissolve cholesterol gallstones. It functions similarly to UDCA but is less commonly used due to a higher risk of side effects.

These medications can take months or even years to dissolve gallstones fully and are most effective on small stones formed by cholesterol.

Alternative Options to Gallbladder Medications

• Surgery: Cholecystectomy, or gallbladder removal, is the most common treatment for gallstones that cause symptoms. This can be done laparoscopically (minimally invasive) or as an open surgery.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure is used when gallstones are located in the bile ducts. It involves inserting a flexible tube down the throat, through the stomach, and into the small intestine to reach the bile ducts, where tools can be used to remove the stones or insert stents to keep the ducts open.
• Extracorporeal Shock Wave Lithotripsy (ESWL): This procedure uses sound waves to break up gallstones into smaller pieces that can then be dissolved with medication.
• Diet Changes: Dietary changes may be recommended for individuals with mild symptoms or at risk for gallstones. This could include a diet low in fat, cholesterol, and fibre.
• Lifestyle Changes: Regular exercise and maintaining a healthy weight can help prevent gallstones.

Gallbladder Medications Prognosis 

When used as prescribed, gallbladder medications like ursodeoxycholic acid (ursodiol) and chenodeoxycholic acid can effectively dissolve small cholesterol gallstones. However, these drugs take time and may require several months to years of therapy to dissolve gallstones completely.

The success rate varies, but it is estimated that around 50% of patients have a positive response. This is more likely in individuals with small, floating gallstones made purely of cholesterol, as these drugs do not work on pigment stones or stones with a calcium component.

Unfortunately, recurrence rates are high once the medication is stopped. Studies suggest that gallstones may recur in nearly 50% of patients within five years of successful dissolution therapy.

Risks of Gallbladder Medications

While gallbladder medications can be beneficial, they also carry potential risks:

• Side Effects: Ursodiol and chenodiol can cause side effects, including diarrhoea, upset stomach, and skin rash. Chenodiol may also lead to liver damage, so it is less commonly used.
• Prolonged Treatment Duration: The treatment can take considerable time (months to years) to dissolve gallstones completely. This requires patient compliance and regular follow-ups with the doctor.
• Incomplete Dissolution: Medications may not completely dissolve gallstones, especially if they are large or not purely made of cholesterol.
• Recurrence of Gallstones: Even after the successful dissolution of gallstones, there's a significant risk of recurrence when the medication is stopped.
• Not Suitable for All: People with a non-functioning gallbladder, severe liver disease, bile duct obstruction, or acute gallbladder inflammation should not use these medications.

Before starting any medication, it's crucial to understand the potential benefits and risks. Always discuss these factors with your doctor to make an informed decision.