BRAND NAME: ACTIGALL
AVAILABLE IN
300 mg
CAPSULES
BACKGROUND
Most people have heard that one’s liver produces a greenish fluid
called “bile” and that this mysterious substance is stored in the
gall bladder but beyond this, knowledge of the composition and function
of bile simply is not “mainstream.” Bile is indeed the greenish under-appreciated
fluid, produced in the liver and stored in the gall bladder. At the
appropriate time in digestion, the gallbladder contracts and bile
squirts along the bile duct and into the small intestine. Bile carries
with it an assortment of the body’s toxins which are thus dumped
safely into the gastrointestinal tract and ultimately eliminated
in stool. Bile also assists in the absorption of dietary fats, fat-soluble
vitamins, and other desirable substances.
Bile consists mostly of cholesterol derivatives called “bile acids.”
There are many types of bile acids, each with different functions.
Some are simply lost in the intestine and eliminated as mentioned
in stool and some are reabsorbed (i.e. recycled) for reuse by the
liver. If more bile acids are required than were reabsorbed, then
the body must make more. If the liver is in failure, reabsorbed bile
acids are not captured by the liver but are instead released into
the body’s circulation (hence the basis for the “bile acids” test
that has become a popular diagnostic in the evaluation of veterinary
liver patients.)
Ursodeoxycholic acid, also called “ursodiol,” is one of the bile
acids produced by the Chinese black bear and it has been used in
the treatment of liver disease for centuries. Nowadays, it is produced
in the laboratory and not extracted from bear gall bladders. The
therapeutic properties are reviewed below.
HOW THIS MEDICATION IS USED
There are many benefits to the use of ursodeoxycholic acid in the
treatment of liver disease:
Removal of Toxic Bile Acids
Not all bile acids were created equal, meaning that some are more
toxic to the liver than others. The bile acids produced by dogs
and cats are not as toxic as some of their human counterparts but,
in the intestine, even the relatively benign dog and cat bile acids
are modified by intestinal bacteria into toxic bile acids. These
toxic bile acids are reabsorbed back into the body where they damage
the liver if they are allowed to build up. Ursodeoxycholic acid
is a non-toxic bile acid. The intestine will preferentially reabsorb
ursodeoxycholic acid over more toxic bile acids when the two types
are together in the intestine. Unabsorbed toxic bile acids are
eliminated in stool.
Increased bile flow
Small amounts of toxic bile acids get reabsorbed into the liver and
are dealt with promptly when the liver is healthy. When the liver
is not healthy, though, these bile acids build up and damage the
liver further. Ursodeoxycholic acid is what is called a “choleretic”
which means it improves the flow of bile through the tiny ducts
into the gall bladder and improves the flow of bile from the gall
bladder into the intestine. In other words, it helps the flow of
bile, which in turn facilitates the removal of toxic bile acids
(as well as other toxins excreted in bile) from the body.
Ursodeoxycholic acid also appears to have beneficial effects in
normalizing immune reactions in the liver and may be useful in the
treatment of cirrhosis and chronic active hepatitis.
SIDE EFFECTS
No serious side effects have turned up in any of the testing of
this medication on dogs and cats. The occasional patient has experienced
some nausea. (Ursodeoxycholic acid is toxic to the rabbit, baboon,
and rhesus monkey.)
The use of ursodeoxycholic acid can lower blood cholesterol levels.
There is a possibility that chronic use of ursodeoxycholic acid
in cats may deplete the body of the essential amino acid taurine,
thus necessitating dietary supplementation with this amino acid.
Dogs are able to manufacture their own taurine internally so this
issue is not problematic for them.
INTERACTIONS WITH OTHER DRUGS
Ursodeoxycholic acid should not be given at the same time as aluminum
containing antacids (such as Amphogel) as these compounds may bind
together and impede the action of the ursodeoxycholic acid.
CONCERNS AND CAUTIONS
The capsule size is inconveniently large for dosing small animals.
A compounding pharmacy is generally needed to produce an appropriately
sized medication.
If the common bile duct is obstructed with a gallstone, it is not
appropriate to increase bile flow. In such a situation, the use of
ursodeoxycholic acid would be contraindicated.
Actigall Medical Center Actigall
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