Gallstone disease medical therapy: Difference between revisions

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Revision as of 14:00, 4 December 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Patients with asymptomatic gallstones are usually not treated since the chances of complications developing in the future are low, however, patients with symptomatic gallstones can be treated medically, for example, with ursodeoxycholic acid or lithotripsy. However, the mainstay of treatment for gallstone disease is surgical cholecystectomy.

Medical therapy

Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid. Gallstones may recur however, once the drug is stopped.

Nonsurgical approaches are used only in special situations such as when a patient has a serious medical condition preventing surgery and only for cholesterol stones. Stones commonly recur within 5 years in patients treated nonsurgically.

Oral dissolution therapy. Drugs made from bile acid are used to dissolve gallstones. The drugs ursodiol (Actigall) and chenodiol (Chenix) work best for small cholesterol stones. Months or years of treatment may be necessary before all the stones dissolve. Both drugs may cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase.
Contact dissolution therapy. This experimental procedure involves injecting a drug directly into the gallbladder to dissolve cholesterol stones. The drug—methyl tert-butyl ether—can dissolve some stones in 1 to 3 days, but it causes irritation and some complications have been reported. The procedure is being tested in symptomatic patients with small stones.

Treatment of biliary colic

These attacks are intensely painful, similar to that of a kidney stone attack. One way to alleviate the abdominal pain is to drink a full glass of water at the start of an attack to regulate the bile in the gallbladder, but this does not work in all cases. Another way is to take magnesium followed by a bitter liquid such as coffee or swedish bitters an hour later. Bitter flavors stimulate bile flow. A study has found lower rates of gallstones in coffee drinkers.^[1]

Pain management is an important part of treating biliary colic. Treatment is often with NSAIDs such as ketorolac (Toradol) and diclofenac (Voltaren). Hyoscine butylbromide (Buscopan) is occasionally used but is less effective than analgesics.^[2]

Contraindicated medications

Gallstone is considered an absolute contraindication to the use of the following medications:

References

↑ "A Prospective Study of Coffee Consumption and the Risk of Symptomatic Gallstone Disease in Men". The Journal of the American Medical Association. Retrieved 2007-08-25.
↑ "BestBets: Buscopan (hyoscine butylbromide) in biliary colic".

Template:WH Template:WS

[1] "A Prospective Study of Coffee Consumption and the Risk of Symptomatic Gallstone Disease in Men". The Journal of the American Medical Association. Retrieved 2007-08-25.

[2] "BestBets: Buscopan (hyoscine butylbromide) in biliary colic".

[1]

[2]

@@ Line 6: / Line 6: @@
 Patients with asymptomatic gallstones are usually not treated since the chances of complications developing in the future are low, however, patients with symptomatic gallstones can be treated medically, for example, with ursodeoxycholic acid or lithotripsy. However, the mainstay of treatment for gallstone disease is surgical cholecystectomy.
-==Medical Therapy==
-*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
-*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
-*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
-*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
-===Disease Name===
-* '''1 Stage 1 - Name of stage'''
-** 1.1 '''Specific Organ system involved 1'''
-*** 1.1.1 '''Adult'''
-**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''
-**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
-**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
-**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
-**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
-**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
-*** 1.1.2 '''Pediatric'''
-**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
-***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
-***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
-****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
-***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
-***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
-** 1.2 '''Specific Organ system involved 2'''
-*** 1.2.1 '''Adult'''
-**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
-*** 1.2.2  '''Pediatric'''
-**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
-* 2 '''Stage 2 - Name of stage'''
-** 2.1 '''Specific Organ system involved 1 '''
-**: '''Note (1):'''
-**: '''Note (2)''':
-**: '''Note (3):'''
-*** 2.1.1 '''Adult'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
-***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
-**** Oral regimen
-***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
-***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
-***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
-***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
-***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
-*** 2.1.2 '''Pediatric'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
-***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
-***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
-**** Oral regimen
-***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
-***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
-** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
-**: '''Note (1):'''
-**: '''Note (2)''':
-**: '''Note (3):'''
-*** 2.2.1 '''Adult'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
-***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
-**** Oral regimen
-***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
-***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
-***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
-***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
-***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
-*** 2.2.2 '''Pediatric'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
-***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
-***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
-**** Oral regimen
-***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
-***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
-==Overview==
 == Medical therapy ==
@@ Line 120: / Line 22: @@
 ===Contraindicated medications===
-{{MedCondContrAbs
+{{MedCondContrAbs|MedCond =Gallstone|Fenofibrate|Gemfibrozil}}
-|MedCond =Gallstone|Fenofibrate|Gemfibrozil}}
 ==References==