Biliary cirrhosis

Treatment of biliary cirrhosis
Ursodeoxycholic acid
Ursodeoxycholic acid 150mg tablets

12–16 mg/kg daily in 3 divided doses for 3 months, then 12–16 mg/kg once daily, dose to be taken at bedtime.

Ursodeoxycholic acid 250mg tablets

12–16 mg/kg daily in 3 divided doses for 3 months, then 12–16 mg/kg once daily, dose to be taken at bedtime.

In combination with ursodeoxycholic acid in adults with an inadequate response to ursodeoxycholic acid, or as monotherapy in adults unable to tolerate ursodeoxycholic acid.

Obeticholic acid
Obeticholic acid 5mg tablets

Initially 5mg once daily for 6 months, then increased to 10mg once daily if necessary and if tolerated.

Obeticholic acid 10mg tablets

Initially 5mg once daily for 6 months, then increased to 10mg once daily if necessary and if tolerated.

History Notes

25/10/2022

Ursodeoxycholic acid formulations and flag updated, ERWG Sept 22.

15/12/2021

East Region Formulary content agreed.

Treatment of bile acid malabsorption

Colestyramine can also be used for pruritus associated with biliary obstruction and cirrhosis.

Colestyramine
Colestyramine 4g oral powder sachets sugar free

4-8g once daily.

For patients experiencing diarrhoea caused by bile acid malabsorption who are unable to tolerate colestyramine due to adverse drug reactions or formulation issues.

Colesevelam
Colesevelam 625mg tablets

1.25-3.75g daily in 2-3 divided doses.

Prescribing Notes:

  • Colestyramine and colesevelam should be initiated by consultant gastroenterologists only.
  • Colestyramine may affect absorption of other drugs, so other drugs should be taken at different times of day – at least one hour before or 4-6 hours after.

History Notes

25/10/2022

Colesevelam formulations updated, ERWG Sept 22.

15/12/2021

East Region Formulary content agreed.

Treatment of bile acid malabsorption

Colestyramine can also be used for pruritus associated with biliary obstruction and cirrhosis.

Colestyramine
Colestyramine 4g oral powder sachets sugar free

For dose, refer to BNF for Children.

For patients experiencing diarrhoea caused by bile acid malabsorption who are unable to tolerate colestyramine due to adverse drug reactions or formulation issues.

Colesevelam
Colesevelam 625mg tablets

As per specialist.

Prescribing Notes:

  • Colestyramine should be initiated by consultant gastroenterologists only.
  • Colestyramine may affect absorption of other drugs, so other drugs should be taken at different times of day – at least one hour before or 4-6 hours after.
  • Additional information on paediatric GI conditions and initial management are available on the NHS Lothian RefHelp website. These are developed by the RHCYP Paediatric Gastroenterology, Hepatology and Nutrition (PGHAN) service, providing specialist services for Lothian, Fife and the Borders as part of the South-East Scotland Regional PGHAN Network (SESPGHAN).

History Notes

30/08/2023

East Region Formulary content agreed - ERFC 09/08/2023.