Ursodiol use while Breastfeeding
Drugs containing Ursodiol: Urso, Actigall, Urso DS, Urso Forte
Medically reviewed by Drugs.com. Last updated on Dec 31, 2019.
Ursodiol Levels and Effects while Breastfeeding
Summary of Use during Lactation
Because of the low levels of ursodiol (ursodeoxycholic acid) in breastmilk, amounts ingested by the infant are small and are not expected to cause any adverse effects in breastfed infants. No special precautions are required.
Maternal Levels. A woman received oral ursodiol 750 mg daily throughout pregnancy for primary biliary cirrhosis. She continued ursodiol postpartum and ursodiol was undetectable in her breastmilk by HPLC assay. Details of milk collection and assay limits were not reported.
Seven mothers with intrahepatic cholestasis of pregnancy were given oral ursodiol 14 mg/kg daily beginning an average of 14 days prior to delivery and continuing postpartum. Colostrum samples taken in the first 72 hours postpartum contained an average of 118 mcg/L. The mothers treated with ursodiol had levels of bile acids in colostrum that were much less elevated than 9 untreated control women with cholestasis of pregnancy.
A woman with primary biliary cirrhosis developed severe pruritus and elevated serum bile acids 3 weeks postpartum. Ursodiol was started at a dose of 500 mg (7.5 mg/kg) daily increased to 1500 mg (25 mg/kg) daily over the next 8 weeks. Total bile acids in breastmilk increased from 0.5 micromol/L to 1 micromol/L after 8 weeks of therapy; after 16 weeks, total bile acids in milk were 0.6 micromol/L. Urodiol milk levels were undetectable before drug initiation, 63 mcg/L at an ursodiol dose of 500 mg daily after 2 weeks, 118 mcg/L with a dose of 1 gram daily after 4 weeks, 79 mcg/L with a dose of 1.5 grams daily after 11 weeks, and 196 mcg/L with a dose of 1.5 grams daily after 19 weeks.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
One breastfed (extent not stated) infant developed normally over the first 6 months of life during maternal ursodiol therapy of 750 to 1000 mg daily.
Seven women who were taking ursodiol 14 mg/kg daily near term and postpartum. They reported no adverse reactions in their breastfed infants during the early postpartum period.
A mother receiving oral ursodiol 250 mg 3 times daily for primary biliary cirrhosis reportedly breastfed her infant normally, although the extent and duration of breastfeeding was not stated.
A woman with primary biliary cirrhosis developed severe pruritus and elevated serum bile acids 3 weeks postpartum. Ursodiol was started at a dose of 500 mg (7.5 mg/kg) daily, increasing to 1500 mg (25 mg/kg) daily over the next 8 weeks. Psychomotor development of her breastfed (extent not stated) infant was normal, and no apparent side effects were observed in the infant.
A retrospective review of the medical records of pregnant patients at a hospital in Ankara, Turkey who had a diagnosis of primary biliary cirrhosis found 8 patients who took ursodiol postpartum in doses of 13–15 mg/kg daily. “Most” of the patients breastfed their infants (extent not stated). No infant side effects were reported.
A woman was breastfeeding her 8-day-old preterm infant 10 times daily for about 15 minutes each time. The infant was born by cesarean section at 34 weeks of gestation with a weight of 3600 grams,. She was diagnosed with cholestasis, type 1 diabetes, and hypothyroidism. She was treated with ursodiol 500 mg daily, insulin levemir and aspart, and levothyroxine. She was also taking cefuroxime, flurbiprofen, a combination of acetaminophen, propyphenazone, and caffeine. The mother took the ursodiol for a total of 12 days, cefuroxime and the analgesic combination for 10 days and flurbiprofen for 15 days. No adverse effects were noticed during the period of ursodiol treatment.
Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.
de Vries E, Beuers U. Ursodeoxycholic acid in pregnancy? J Hepatol. 2019;71:1237–45. [PubMed: 31479696]
Rudi J, Schonig T, Stremmel W. Z Gastroenterol. 1996;34:188–91. [Therapy with ursodeoxycholic acid in primary biliary cirrhosis in pregnancy] [PubMed: 8650973]
Brites D, Rodrigues CM. Elevated levels of bile acids in colostrum of patients with cholestasis of pregnancy are decreased following ursodeoxycholic acid therapy. J Hepatol. 1998;29:743–51. [PubMed: 9833912]
Vitek L, Zelenkova M, Bruha R. Safe use of ursodeoxycholic acid in a breast-feeding patient with primary biliary cirrhosis. Dig Liver Dis. 2010;42:911–2. [PubMed: 20619755]
Goh SK, Gull SE, Alexander GJ. Pregnancy in primary biliary cirrhosis complicated by portal hypertension: report of a case and review of the literature. BJOG. 2001;108:760–2. [PubMed: 11467706]
Efe C, Kahramanoglu-Aksoy E, Yilmaz B, et al. Pregnancy in women with primary biliary cirrhosis. Autoimmun Rev. 2014;13:931–5. [PubMed: 24879082]
Erol-Coskun H, Karagur N, Akyol F, et al. Ursodiol use during breastfeeding: A case report. Reprod Toxicol 2018;80:59. Abstract. doi:10.1016/j.reprotox.2018.07.070. [CrossRef]
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Bile Acids and Salts
Cholagogues and Choleretics
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