Ursodeoxycholic acid

Overview

Used for the itch of intrahepatic cholestasis of pregnancy — but RCOG 2022 no longer recommends it routinely to improve fetal outcomes (PITCHES trial was negative).

Mechanism

A hydrophilic bile acid that displaces toxic hydrophobic bile acids from the bile-acid pool, protects hepatocytes and improves bile flow — modestly reducing pruritus.

Indications

• Symptomatic relief of pruritus in intrahepatic cholestasis of pregnancy (limited benefit)
• Primary biliary cholangitis, gallstone dissolution (cross-reference GI)

Adverse effects

Cautions & contraindications

Interactions

• Bile-acid sequestrants (colestyramine) reduce absorption — separate dosing

Monitoring & kinetics

Bile acids + LFTs (cholestasis severity guides timing of birth — serum bile acids ≥100 µmol/L = high stillbirth risk)

Oral.