[Cholestasis: drug therapy]

For the medical treatment of cholestasis plant alkaloids, phenobarbital and S-adenosyl-L-methionine (SAMe) have been used. Although the mode of action of these substances is understood in part, the treatment of patients was unsuccessful. In contrast, ursodeoxycholic acid, a physiologically occurring bile acid in man, was successful. The daily dosage of ursodeoxycholic acid is 10-15 mg/kg bodyweight. Best results have been obtained in primary biliary cirrhosis where symptoms improved markedly, the cholestasis-indicating enzymes and immunoglobulin M decreased significantly. After long-term therapy even liver histology improved. Recently it has been shown that ursodeoxycholic acid prolongs the interval to liver transplantation. Ursodeoxycholic acid has to be taken lifelong, because interruption of therapy, even after long periods of continued treatment will induce a rebound of cholestasis. Ursodeoxycholic acid therapy is without side effects. In patients with primary sclerosing cholangitis ursodeoxycholic acid prolongs life expectancy only in combination with endoscopic bile duct dilatation.