Diuretics

Diuretics are medicines designed to stimulate the formation, excretion and secretion of bile from the gallbladder and bile ducts. They can be prescribed by a doctor to treat and prevent various diseases of the biliary system, as well as to improve digestion.

What is bile?

Bile is a fluid produced by the liver and stored in the gallbladder. It plays an important role in digestion and allows the body to break down and digest fats from food. Here are some of the main functions and characteristics of bile:

1. Digestion: The main function of bile is to participate in the digestive process. Bile is secreted into the intestine (duodenum) when food, especially fat-rich food, is ingested. It helps break down fats into tiny particles, making them easier for the body to digest.
2. Emulsification: Bile contains bile acids and bile salts, which play a key role in the emulsification of fats. They facilitate the mixing of fats with water and create tiny fat droplets (micromulses) that facilitate the action of pancreatic enzymes on fats.
3. Removal of Waste: Bile also serves to remove various metabolic products and waste products that are produced in the liver from the body. It helps in cleansing the body of slag and excess metabolic waste products.
4. Gallbladder: Bile is stored in the gallbladder until it is needed for digestion. When food enters the duodenum, bile is secreted from the gallbladder and enters the digestive process.
5. Color and consistency: Bile is greenish-yellow in color and may taste slightly bitter. Its consistency can vary from liquid to thicker, depending on its content in the gallbladder and the composition of food.

Bile plays an important role in the digestive process and ensures the normal functioning of the body. Disturbances in the biliary system can lead to various pathologies and diseases, such as cholelithiasis or biliary cholecystitis.

Classification of biliary drugs

Diuretic drugs (BGs) can be classified according to various features, including their chemical structure, mechanism of action, and origin. Here are some basic ways to classify biliary drugs:

1. By origin:

   • Plant-based: These are preparations containing plant extracts or components such as plant or animal bile, phytopreparations and herbal remedies.
   • Animal origin: This includes preparations containing animal bile or other animal ingredients.

2. By mechanism of action:

   • Drugs that stimulate bile secretion: These drugs help to increase the production and excretion of bile from the gallbladder.
   • Drugs that help dissolve gallstones: These drugs can help break up or dissolve cholesterol stones in the gallbladder or bile ducts.
   • Drugs that improve the contractile function of the gallbladder: They help to speed up the contractions of the gallbladder, which promotes the excretion of bile.

3. By chemical structure:

   • Bile acids and their derivatives: An example would be ursodeoxycholic acid.
   • Various components of plant origin, such as plant extracts.

4. By Application:

   • Prophylactic: Drugs that are used to prevent gallstone formation or improve digestion in individuals at risk of developing cholelithiasis.
   • Therapeutic: Drugs designed to treat specific diseases of the biliary system, such as cholecystitis or cholelithiasis.

This is only a general classification of choleretic drugs, and specific drugs may have different characteristics and mechanisms of action.

Choleretics

Choleretics are a class of drugs that stimulate the production and excretion of bile from the gallbladder and bile ducts. Choleretics are used to improve digestion, treat biliary disorders and prevent gallstone formation. Depending on their mechanism of action and composition, they can be classified as follows:

1. Diuretic medications:

   • These drugs increase the secretion of bile into the gastrointestinal tract by stimulating the gallbladder and bile ducts. Examples include ursodeoxycholic acid and allochol.

2. Bile-based preparations:

   • These medications contain animal bile, which can help improve bile secretion and digestion. Examples include allochol.

3. Drugs with choleretic components:

   • These drugs contain components that stimulate bile production but are not necessarily pure bile. Examples include cholenzyme and cholagol.

4. Plant choleretics:

   • These preparations contain extracts from plants that help improve digestion and stimulate bile production. Examples include artichoke and milkweed.

5. Synthetic choleretics:

   • Some choleretics can be synthesized chemically and are used in medical practice to treat biliary disorders.

The classification of choleretics may include different subcategories depending on the specific properties and mechanisms of action of the drugs.

Cholekinetics

Cholekinetics are a class of medications that stimulate gallbladder contraction and increase the release of bile into the gastrointestinal tract. They are used to improve digestion, reduce bile stasis, and relieve symptoms associated with biliary disorders. Cholekinetics can be classified based on mechanism of action and composition. The following is a general classification:

1. Cholekinetics of synthetic origin:

   • Drugs in this group usually contain synthetic substances that stimulate gallbladder contraction and increase bile secretion. Examples include domperidone and metoclopramide.

2. Natural Cholecokinetics:

   • These preparations contain natural herbal ingredients that stimulate gallbladder contraction and bile secretion. Examples include extracts of artichoke and milk chickweed.

3. Bile-based preparations:

   • Some cholekinetics may contain components derived from animal bile that also promote gallbladder contraction. Examples include allochol.

The classification of choleokinetics may include different subgroups depending on the specific properties and mechanisms of action of the drugs.

The following are some known cholekinetics and drugs that include cholekinetic properties:

1. Domperidone:

   • Domperidone is used to improve peristalsis and gallbladder contraction. It can be used for a variety of biliary disorders.
   • Trade names include Motilium, Domperan, and others.

2. Metoclopramide (Metoclopramide):

   • Metoclopramide stimulates gallbladder contraction and improves bile secretion. It can be used for digestive problems associated with bile stasis.
   • Trade names include Reglan and others.

3. Esmolol (Esmolol):

   • Esmolol is a beta-adrenoblocker that can also be used to stimulate gallbladder contraction and increase bile secretion.

4. Bile-based preparations:

   • Some medications, such as allochol, contain animal bile and can be used to improve the function of the biliary system.

5. Natural Cholecokinetics:

   • Extracts from plants such as artichoke and milkvetch may also have cholekinetic properties and are used in phytotherapy.

Dosage and regimen of cholekinetic drugs may vary depending on medical indications and doctor's recommendations.

Indications Choleretic drugs

Diuretic drugs are used in the following cases and indications:

1. Gallstone disease: Characterized by the formation of stones (biliary concretions) in the gallbladder or bile ducts. Diuretics can be used to prevent the formation of new stones and to improve the dissolution or breakdown of existing stones.
2. Bile stagnation in the gallbladder. Also known as cholestasis (bile stasis), is a condition in which bile is trapped or not properly secreted from the gallbladder into the duodenum. It can be caused by a variety of reasons and can have different symptoms and effects.
3. Gallbladder kink. Also known as a "kink" or "angry" gallbladder (angry gallbladder), is an abnormal condition in which the gallbladder takes on an unusual shape, usually curved or twisted.
4. Pancreatitis and bile stasis. The connection between these two conditions is that bile stasis can be a risk factor for developing acute pancreatitis. This can occur if bile lingers in the bile ducts and causes inflammation of the pancreas. Pancreatitis can also be caused by gallstones, which can block the bile ducts and cause inflammation of the pancreas.
5. Cholecystitis: It is an inflammation of the gallbladder. Diuretic medications can be used to relieve symptoms associated with this condition and stimulate gallbladder contractions.
6. Postcholecystectomy Syndrome: After surgical removal of the gallbladder (cholecystectomy), some patients may experience symptoms such as dyspepsia, pain, or digestive disturbances. Diuretic medications may help improve these symptoms.
7. Digestive disorders associated with insufficient bile function: If a patient has digestive disorders due to insufficient production or excretion of bile, biliary drugs may help improve digestion and reduce symptoms such as bloating, heartburn, or diarrhea.
8. Preventing gallstone formation: In some people at increased risk for gallstones, such as those with obesity or family predispositions, choleretic medications may be used prophylactically to prevent stone formation.

Release form

Diuretic medications are available in different dosage forms, and there are many medications with different names. Here are some examples of choleretic medicines and their dosage forms:

1. Ursodeoxycholic acid (Urso, Ursofalk, Ursodiol): This medication contains ursodeoxycholic acid and is available in capsule or tablet form.
2. Allochol (Allochol): Allochol contains dried bile salts of animal origin as well as plant extracts. It is available in tablet form.
3. Holenzyme (Holenzyme): This drug is a combination product containing pancreatic enzymes and bile. It may be available in tablet or capsule form.
4. Festal (Festal): Also a combination product containing pancreatic enzymes and bile. Available in tablet form.
5. Cholagol: This medicine contains extract of oregano plant and other herbal components. It is usually presented in the form of drops for oral intake.
6. Essentiale Forte N (Essentiale Forte N): This medication contains phospholipids that may help restore liver function and improve bile formation. It is available as capsules or ampoules for injection.
7. Cyclosporine (Cyclosporine): Cyclosporine, although commonly used as an immunosuppressant after organ transplantation, can also sometimes be used as a choleretic.
8. Plant extracts: Various plant extracts and phytopreparation such as artichoke or succession can be included in choleretic preparations. They may be available in various forms including tablets, capsules or liquid extracts.

These are just a few examples of choleretic drugs, and the choice of a particular drug and its form of release will depend on the needs and recommendations of the doctor, as well as the availability in a particular region. Before starting any medication, it is always important to consult your doctor and strictly follow the directions for use.

Pharmacodynamics

The pharmacodynamics of choleretic drugs depends on the specific drug and its active ingredients. However, the common mechanism of action is to stimulate bile secretion, improve digestion, and help prevent or treat biliary system disorders. Here are some of the key aspects of pharmacodynamics:

1. Stimulation of gallbladder contractions: Many choleretic medications stimulate gallbladder contractions, which promotes the release of bile into the duodenum. This improves the digestive process and helps to absorb fats from food.
2. Bile duct dilation: Some choleretic medications can help dilate the bile ducts, which helps bile move more efficiently.
3. Dissolving gallstones: Some medications are used to break up or dissolve cholesterol gallstones, allowing them to leave the gallbladder and pass through the bile ducts.
4. Improve liver function: Some choleretic drugs, such as ursodeoxycholic acid-based drugs, may help restore liver function and bile acid levels.
5. Prevention of gallstone formation: Some medications may be used prophylactically to prevent gallstone formation, especially in high-risk individuals.
6. Antioxidant Properties: Some herbal choleretic preparations contain antioxidants that may help protect the liver from harmful free radicals.

Pharmacokinetics

The pharmacokinetics of choleretic drugs may vary depending on the specific drug and its chemical structure. However, general principles of pharmacokinetics include the following aspects:

1. Absorption: Absorption depends on their dosage form. For example, tablets and capsules usually need to be dissolved in the stomach so that the active ingredients can be absorbed into the bloodstream through the digestive mucosa. Liquid forms of preparations (e.g. Drops) can be absorbed more quickly.
2. Distribution: Distribution throughout the body depends on their chemical properties. Some may be bound to proteins in the plasma, while others may circulate freely. Distribution may also depend on specific organs such as the liver and gallbladder.
3. Metabolism: Many choleretic drugs may be subject to metabolism in the liver. Metabolic pathways may vary depending on the specific drug.
4. Excretion: Excretion may be through the kidneys or bile. Some drugs may be reabsorbed in the kidneys and returned to the bloodstream, which may increase their duration of action.
5. Half-life (T1/2): The half-life (the time for half of the drug to be eliminated from the body) may vary for different choleretic drugs and may depend on their pharmacokinetic properties.

Dosing and administration

The method of administration and dosage may vary depending on the specific drug and the patient's medical conditions. Below are some general recommendations on the method of administration and dosage for some known choleretic preparations:

1. Ursodeoxycholic acid (Urso, Ursofalk, Ursodiol):

   • Dosage may vary depending on medical conditions, but it is generally recommended to take 10 mg to 15 mg per 1 kg of the patient's weight throughout the day, divided into 2 to 3 doses.
   • Ursodeoxycholic acid-based drugs are usually taken with food or milk.

2. Allochol:

   • The dosage for adults is usually 1-2 tablets 2-3 times a day.
   • For children, the dosage can be reduced to 0.5-1 tablet 2-3 times a day.
   • The drug is taken before meals with a small amount of water.

3. Holenzyme:

   • The usual dosage for adults is 1-2 tablets 3 times a day after meals.
   • For children, the dosage can be reduced to 0.5-1 tablet 3 times a day after meals.

4. Festal:

   • The dosage for adults is usually 1-2 tablets before or with meals.
   • For children, the dosage may be reduced to 0.5-1 tablet before or during meals.

5. Holagol:

   • Dosage is usually 1-2 drops on sugar or in a small amount of water 2-3 times a day before meals.

6. Essentiale Forte N (Essentiale Forte N):

   • Dosage may vary, but it is generally recommended to take 2 capsules 3 times a day with meals.

It is important to note that the dosage and route of administration may depend on the patient's specific medical needs and the physician's recommendations.

Biliary herbs

Diuretic herbs are often used in folk medicine and phytotherapy to improve gastrointestinal and biliary tract function. However, it is important to consult your doctor before using any herbs or recipes, especially if you have medical problems or are taking other medications. Below are some well-known choleretic herbs, their dosages and some recipes:

1. Chamomile (Matricaria chamomilla):

   • Chamomile can be used to make tea. The usual dosage: 1-2 teaspoons of dried chamomile for 1 cup of boiling water. Infuse for 5-10 minutes and drink before meals.

2. Artichoke (Cynara scolymus):

   • Artichoke leaves can be used to make an infusion or extract. The dosage can vary, but usually 1-2 teaspoons of dried leaves per 1 cup of boiling water is recommended.

3. Shavlia (Salvia officinalis):

   • Shavliya can be used to make tea. The usual dosage is 1-2 teaspoons of dried shawlia per 1 cup of boiling water. Infuse for 5-10 minutes and drink before meals.

4. Milkweed (Chelidonium majus):

   • Milk chaste can be used to prepare an infusion. The dosage may vary and it is better to consult a phytotherapist to determine the correct dose.

5. Immortelle (Helichrysum arenarium):

   • Immortelle flowers can be used to prepare an infusion. The usual dosage: 2-3 teaspoons of dried flowers for 1 cup of boiling water.

6. Cherada (Chrysanthemum parthenium):

   • Chasteberry can be used to make tea. The dosage can vary, but usually 1-2 teaspoons of dried succession per 1 cup of boiling water is recommended.

It is important to remember that dosage and recipes may vary depending on the composition and part of the plant used to make the tea or infusion. Also note that not all choleretic herbs are suitable for all patients, and they may have contraindications and may interact with other medications.

Use Choleretic drugs during pregnancy

The use of choleretic drugs during pregnancy should be done with caution and only under the supervision of a doctor. During pregnancy, it is important to minimize the use of any medications as they can affect the development of the fetus. However, in some cases, GIs may be prescribed to pregnant women if the patient has a medical indication and the risks to her health outweigh the potential risks to the fetus.

Here are some important points to keep in mind when using choleretic medications during pregnancy:

1. Consult a doctor: A pregnant woman should consult a doctor before starting any medication. The doctor will assess the benefits and risks of the treatment, taking into account the specific medical conditions and the condition of the pregnancy.
2. Choosing the safest drug: The doctor tries to choose the safest GI for the pregnant woman, taking into account her condition and needs.
3. Minimizing the dose: Your doctor may prescribe the lowest dose necessary to achieve the desired effect. This will help reduce the risk to the fetus.
4. Monitoring: Pregnant women may require regular medical monitoring to assess the effectiveness of treatment and to evaluate the fetus.
5. Alternative treatments: In some cases, alternative treatments that do not involve taking medication may be available. For example, dietary or lifestyle changes can help manage symptoms and improve gallbladder function.

It is important to emphasize that each pregnancy is unique, and the decision to take choleretic drugs should be made individually by the doctor and the expectant mother. You should never start or stop taking medications without prior consultation with a medical professional to avoid potential health risks for both mother and fetus.

Contraindications

Contraindications for the use of choleretic drugs may vary depending on the specific drug and its active ingredients. However, some common contraindications may include the following:

1. Allergic reaction: A contraindication may be a known allergy to the active ingredients of the drug or to any excipients.
2. Liver Disease: If the patient has serious liver disease, the use of LPs may be contraindicated as they may increase the burden on the liver.
3. Acute cholelithiasis: In case of acute cholelithiasis, when gallstones block the bile ducts and cause intense pain, the use of GI may be undesirable.
4. Pancreatitis: If a patient has acute pancreatitis or chronic pancreatitis, the use of some GIs may be contraindicated.
5. Alcohol dependence: Patients with alcohol dependence or alcohol abuse may be inadvisable to prescribe some GIs.
6. Pregnancy and breastfeeding: In some cases, GIs may be contraindicated in pregnancy or during breastfeeding because their safety for the fetus or baby has not been established. In this case, it is important to consult a doctor.
7. Pediatric age: Some choleretic drugs may be contraindicated in young children if their safety and efficacy have not been confirmed in this age group.
8. Specific Conditions or Allergies: Some drugs may have specific contraindications related to a patient's specific medical conditions or allergies.

Side effects Choleretic drugs

Diuretic medications can cause a variety of side effects, although they do not necessarily occur in all patients and their severity may vary. Side effects may depend on the specific drug and its active ingredients. Here are some of the possible side effects:

1. Diarrhea: Diuretics can sometimes cause diarrhea as a side effect, especially at high doses.
2. Abdominal pain: Some patients may experience abdominal pain or stomach discomfort.
3. Nausea and vomiting: These symptoms may be side effects of some GIs.
4. Allergic reactions: Rarely, but GIs may cause allergic reactions such as skin rash, itching, edema, or anaphylactic shock.
5. Headache: Some patients may experience headaches after taking LP.
6. Alteration of taste sensation: Some drugs may cause a change in taste perception in patients.
7. Anorexia: Decreased appetite or loss of appetite can also be a side effect of some choleretic drugs.
8. Liver dysfunction: In rare cases, LPs may cause liver dysfunction, therefore it is important to regularly monitor liver enzyme levels in the blood while taking them.
9. Increased size of gallstones: In rare cases, gallstones may increase in size when using drugs to dissolve gallstones.

It is important to note that not all patients taking choleretic medications experience side effects, and many of the effects listed above may be mild and temporary. If you experience any unwanted symptoms after taking the medication, it is important to discuss them with your doctor so that he or she can assess whether you need to make changes to your treatment regimen or discontinue the medication.

Overdose

An overdose of choleretic drugs can have serious consequences and may cause different symptoms and complications depending on the specific drug and dose. If an overdose is suspected, it is important to seek immediate medical attention or consult a doctor. Below are some common symptoms and measures that can be taken in the event of an overdose:

1. Symptoms of overdose: Symptoms of overdose may include nausea, vomiting, diarrhea, abdominal pain, headache, and liver and stomach pain. In case of severe overdose, more serious symptoms such as liver and other organ disorders may occur.
2. Seek medical attention: If an overdose is suspected, seek immediate medical attention or call an ambulance.
3. Gastric lavage: In some cases, your doctor may decide to gastric lavage to remove excess drug from the gastrointestinal tract.
4. Symptomatic treatment: Your doctor may administer symptomatic treatment, such as prescribing medications to relieve nausea and vomiting, restore electrolyte balance, and treat other symptoms of overdose.
5. Gastrointestinal Surveillance: Patients with overdose may require observation and monitoring of gastrointestinal and liver function.

Interactions with other drugs

Diuretics can interact with other medications and it is important to consider these interactions when prescribing or using BGs. The following are some known interactions of BGs with other drugs:

1. Antacids: Drugs containing antacids (e.g. Magnesium and aluminum hydroxides) may reduce the efficacy of LPs, as they may bind to the active ingredients of choleretic drugs and reduce their absorption.
2. Gastric acidity-lowering drugs: Drugs such as proton inhibitors (e.g., omeprazole) or H2-histamine receptor antagonists (e.g., cimetidine) may affect the absorption and efficacy of LP.
3. Drugs affecting gallbladder function: Drugs that affect gallbladder contractility (e.g., cicerone or methocin) may interact with choleretic drugs, altering their effectiveness.
4. Antimicrobials: Some antibiotics and antifungals may affect the metabolism and absorption of LDL.
5. Obesity medications: Drugs used to treat obesity (e.g., orlistat) may reduce the effectiveness of LDL because they may reduce the absorption of fat from food.
6. Diabetes medications: Some antidiabetic drugs, such as metformin, may interact with GI.

It is always important to notify your doctor of all medications you are taking, including choleretic medications, to avoid potential interactions and to consider the need to adjust dosages or choose alternative medications.

Literature used

Belousov, Y. B. Clinical pharmacology : a national guide / edited by Y. B. Belousov, V. G. Kukes, V. K. Lepakhin, V. I. Petrov - Moscow : GEOTAR-Media, 2014