Do not take Ursodeoxycholic Acid Tablets if:

• You have an acute inflammation of the gallbladder or the bile ducts.
• You have a narrowing or blockage of the bile ducts.
• You suffer from often occurring cramp-like pain in the upper abdomen (biliary colic).
• You have calcified gallstones that do not transmit X-rays.
• You have a gall bladder that cannot properly constrict any more.
• You are allergic to bile acids or any of the other ingredients of this medicine (listed in section 6).
• You have an active gastric or duodenal ulcer.

Children

In children with disrupted biliary drainage due to production of connective tissue in the bile duct (biliary atresia) in whom the bile flow is not restored by healing or by an artificial bile duct (portoenterostomy).

Warnings and precautions

This medicine must be used under medical supervision.

Your doctor should examine your liver every 4 weeks during the first three months of treatment. Then this should be done every 3 months. Apart from allowing for identification of responders and non-responders in patients being treated for primary biliary cholangitis, this monitoring would also enable an early detection of potential hepatic deterioration, particularly in patients with advanced primary biliary cholangitis.

When used for dissolving gallstones:

In order to be able to assess the therapeutic progression of the dissolution of gallstones and to timely identify a possible calcification of the stones, the gall bladder, depending on the size of the stones, should be visualized 6 to 10 months after the start of the treatment (oral cholecystography) with total image and occlusions and in the standing and lying position (ultrasound control).

If the gallbladder cannot be visualized on X-rays, or in cases of calcified gallstones, impaired contractility of the gall bladder or frequent episodes of biliary colic, the treatment with Ursodeoxycholic Acid Tablets should be discontinued.

When used for the treatment of advanced primary biliary cholangitis:

In very rare cases decompensation of liver cirrhosis is observed which partially decreased after treatment discontinuation.

Women who use Ursodeoxycholic Acid for dissolving gallstones should stop using the birth control pill and other methods used to prevent pregnancy, because the hormones in the birth control pill can promote the production of gallstones.

When you are in the final stage of primary biliary cholangitis it can in very rare cases occur that your liver function is strongly reduced. The liver function will partly recover after stopping the treatment.

If you experience problems with diarrhoea, your doctor will reduce the dose. If the diarrhoea persists, your doctor may decide to stop the treatment.

Contact your doctor or pharmacist before you start to use this medicine.

Other medicines and Ursodeoxycholic Acid Tablets

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This also applies for medicines obtained without a prescription.

The effect of the following drugs can be influenced (interactions):

A reduced effect of the following medicines is possible when using this medicine:

• Medicines binding stomach acid based on aluminium hydroxide and bile acid binding substances (colestyramine, colestipol) can bind the ursodeoxycholic acid and thereby prevent its absorption. Therefore, these medicines may not be taken simultaneously with Ursodeoxycholic Acid, but always 2 hours before or after.
• Ursodeoxycholic acid can reduce the absorption of ciprofloxacin, dapsone (antibiotics) and nitrendipine (antihypertensive agent) from the intestine. When one of these resources has been used simultaneously with Ursodeoxycholic Acid Tablets, your doctor will carefully supervise you.

An intensified effect of the following medicines is possible when using this medicine:

• Ursodeoxycholic acid may increase the absorption of cyclosporine from the intestine: if necessary, the dosing guided by the cyclosporine concentration should be adjusted in the blood.

Oestrogens, oral contraceptives (“the pill”) and cholesterol-lowering agents (such as clofibrate) may promote the forming of gallstones, and can thus counteract the effect of the treatment of gallstones with Ursodeoxycholic Acid Tablets

Inform your doctor or pharmacist, if you are taking or have recently taken other medicines. This also applies for medicines obtained without a prescription.

Pregnancy and breast-feeding

If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Pregnancy

You should not use this medicine during pregnancy unless your doctor considers it absolutely necessary.

Women of child-bearing potential

Even if you are not pregnant, you should discuss this possibility with your doctor, because women of childbearing age may only be treated, if they use a reliable method of contraception. Non-hormonal contraception or contraception with low dose oestrogens is recommended. However, if you use this medicine for solving gallstones, you may only use non-hormonal contraception, because hormonal contraception promotes the formation of gallstones.

Breast-feeding

Tell your doctor if you are breastfeeding or about to start breastfeeding. According to few documented cases of breastfeeding women milk levels of ursodeoxycholic acid in milk are very low and probably no adverse reactions are to be expected in breastfed infants.

Driving and using machines

Ursodeoxycholic Acid has no or negligible influence on driving ability or the ability to operate machines.