Ursodeoxycholic acid (UDCA) (Ursofalk ®) is used to treat forms of cholestatic liver disease (CLD). Example: primary biliary cirrhosis, primary sclerosing cholangitis and cholestasis related to cystic fibrosis.
Hypercholesterolemia is a common feature of CLD. So a patient that needs to take UDCA may already be on a cholesterol lowering medicine.
Are there any potential issues starting UDCA, if the patient is already on a cholesterol lowering medicine? Have you checked your AMH? What about MIMS interaction checker? Wait a minute… Nothing’s there?
The CMI of Ursofalk® writes: “If you or your child needs to take a cholesterol lowering medicine or an antacid, take it at least 2hrs before or 2hrs after the dose of Ursofalk.”
Awesome! You can just tell all the patients that are on both these medicines this. Or can you?
The PI writes that the cholesterol medicine cholestyramines (Questran Lite ®) “binds to UDCA in the intestine and thereby inhibit its absorption and efficacy.” That is why we separate its dose by 2hrs from UDCA.
It does not mention to separate the dosage of other cholesterol medicines. But what does it say?
In short, concomitant use of UDCA and rosuvastatin resulted in a significant increase in the plasma levels of rosuvastatin. So “a DOSE REDUCTION in rosuvastatin should be considered in any individuals exposed to both rosuvastatin and UDCA.” It also writes that it’s “possible that this interaction may also occur between UDCA and other statins.”
Now, imagine a patient already on rosuvastatin starting UDCA. If you just looked at the AMH and MIMS, you most likely would have told them nothing. If you read the CMI, you would have told them to separate both medicines by 2hrs hours. This is the same as telling them nothing. But luckily, you read this post. You’re not going to do any of that 😋.
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