3. Choleretic drugs. Classification. Mechanism of action. Indications for use. Side effects. Contraindications Comparative evaluation of drugs.

Choleretic drugs are drugs that activate liver function, increasing the secretion of bile.

1. Drugs that enhance the secretion or production of bile (choleretics, cholesecretics)

• Bile preparationsof animal origin, cholenzyme, allochol, decholin, hologon, liobil

• Herbal preparations cholosas, Liv-52, cholagol, olimetin, sandy immortelle flowers, flamin, corn silk extract

• Synthetic drugs oxafenamide (osalmide), cyclovalon (tsikvalone), hydroxymethylnicotinamide (nicodine)

2. Means that stimulate the excretion of bile

1.Cholekinetics: cholecystokinin, xylitol, sorbitol, magnesium sulfate, barberry preparations, tansy flowers, Karlovy Vary salt.

2. Cholespasmolytics: atropine, platifillin, belladonna tincture and extract, no-spa, mebeverin, olimetin, gimecromone.

Mechanism of action: Means increase the production of bile by hepatic cells. The mechanism of action of choleretics consists of several points:

• direct stimulation of the secretory function of the hepatic parenchyma;

• increased osmotic filtration of water and electrolytes into the bile capillaries;

• stimulation of receptors in the mucous membrane of the small intestine, which enhances bile formation.

HYDROCHOLERETICS

They increase the amount of bile due to the water component:

• the secretion of bile increases;

• the reabsorption of water and electrolytes in the gallbladder is limited. This leads to an increase in the colloidal stability of bile.

CHOLEKINETICS

Mechanism of action. They irritate the mucous membrane of the duodenum - cholecystokinin is released, which calls for contraction of the muscular wall of the gallbladder and relaxation of the sphincter of Oddi.

HOLESPASMOLYTICS.

They are used not only as cholespasmolytics, but ultimately they relieve spasm of the biliary tract, increasing the passage of bile. ...

Indications: Cholesecretics: chronic cholecystitis and cholangitis, chronic hepatitis, pancreatitis, flatulence, functional disorders of the gastrointestinal tract.

Cholekinetics: gallbladder atony with bile congestion and dyskinesia, chronic cholecystitis and chronic hepatitis.

Side effects: Allergic reaction, diarrhea.

Contraindications: Cholesecretics: acute hepatitis, cholangitis, cholecystitis, pancreatitis, peptic ulcer, jaundice.

Cholekinetics: in the acute phase of liver disease, in the presence of stones in the gallbladder, with exacerbations of hyperacid gastritis and peptic ulcer disease.

Comparative characteristics: Dehydrocholic acid (hologon) - causes a significant increase in the secretion of bile, at the same time has little effect on the secretion of cholesterol and phospholipids into bile.

The sodium salt of dehydrocholic acid (decholin) - the sodium salt of dehydrocholic acid - also stimulates the bile-forming function of the liver cells.

Allochol is an officinal film-coated tablet containing dry animal bile, dry garlic extract, dry nettle extract and activated charcoal.

Cholenzym is a preparation containing dry bile, powder of dried pancreas and mucous membrane of the small intestines of slaughter animals. Has a weak choleretic activity, but increases the content of cholates in bile. Cholenzyme improves the digestion of food in the intestine due to the content of trypsin and amylase in it.