Formulary
Cholic acid: Indications, Dosing, Side Effects and Interactions
Cholic acid is the predominant primary bile acid in humans, which can be used to provide a source of bile acid in patients with inborn deficiencies in bile...
MedNext Academy | 3 min read
Cholic acid: Indications, Dosing, Side Effects and Interactions
Cholic acid is the predominant primary bile acid in humans, which can be used to provide a source of bile acid in patients with inborn deficiencies in bile...
Drug action
Cholic acid is the predominant primary bile acid in humans, which can be used to provide a source of bile acid in patients with inborn deficiencies in bile acid synthesis.
Indications and dose
**Inborn errors of primary bile acid synthesis (initiated by a specialist)**
- **Adult** (By Mouth): Usual dose 5-15 mg/kg daily; increased in steps of 50 mg daily in divided doses if required, dose to be given with food at the same time each day; Usual maximum 500 mg/24 hours.
**Inborn errors of primary bile acid synthesis (initiated by a specialist) for cholic acid**
- **Child (body-weight up to 10 kg)** (By mouth): 50 mg daily, then increased in steps of 50 mg daily in divided doses; usual dose 5-15 mg/kg daily in divided doses, dose to be given with food at the same time each day.
- **Child (body-weight 10 kg and above)** (By mouth): Usual dose 5-15 mg/kg daily; increased in steps of 50 mg daily in divided doses if required, dose to be given with food at the same time each day; Usual maximum 500 mg/24 hours.
Side effects
Frequency not known Cholelithiasis (long term use); diarrhoea; pruritus Side-effects, further information Patients presenting with pruritus and/or persistent diarrhoea should be investigated for potential overdose by a serum and/or urine bile acid assay.
Interactions
**Other interactions (3):**
- Phenobarbital and primidone, which is partially metabolized in phenobarbital, antagonise the effect of cholic acid.
- Ciclosporin alters the pharmacokinetics of cholic acid by inhibition of the hepatic uptake and hepatobiliary secretion of bile acids, as well as its pharmacodynamics by inhibition of cholesterol...
- If administration of ciclosporin is considered necessary, serum and urine bile acid levels should be closely monitored and the cholic acid dose adjusted accordingly.
Pregnancy
Limited data available-not known to be harmful, manufacturer advises continue treatment. Monitoring in pregnancy Manufacturer advises monitor patient parameters more frequently in pregnancy.
Breast feeding
Present in milk but not known to be harmful.
Hepatic impairment
Manufacturer advises caution and stop treatment if there are signs of severe hepatic failure-limited information available (no experience with impairment from causes not related to inborn errors of primary bile acid synthesis). Dose adjustments Manufacturer advises adjust dose as the degree of impairment improves during treatment.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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