8 best choleretic drugs

*Review of the best according to the editors. About the selection criteria. This material is subjective, not an advertisement and does not serve as a guide to purchase. Must be consulted with a health care professional before purchase.

Digestion is a holistic process, but it is divided into parts that seem to be opposite and incompatible. So, in the stomach the environment is very acidic, but in the duodenum it is already alkaline. In order to reduce the acidity of gastric juice entering the intestines and neutralize the activity of gastric enzymes, and to shift the change in digestive phases from acidic to alkaline (intestinal), the liver produces a special liquid called bile.

A little about bile

Our bile is produced by hepatocytes, or liver cells. Human hepatocytes are really tireless workers, they work day and night. Hepatocytes neutralize harmful substances, synthesize antibodies and proteins, take part in the synthesis of clotting factors, all types of plastic metabolism. And, in addition, they continuously produce bile.

The bile formed in the hepatocytes, on their biliary poles, gradually penetrates into the increasingly larger intrahepatic ducts, finally into the common bile duct, and for consumption and storage it is transported to the gallbladder. The gallbladder membrane has the ability to absorb water, and so the bile in the bladder is concentrated several times, and can be ten times stronger than the fresh, originally formed.

During digestion bile gradually enters the duodenum, and is actively involved in the digestion and absorption of fats. Bile enters the intestines through specific mechanisms, both nervous and reflexive. Cholecystokinin-pancreozymin, which is produced in the intestine, is actively involved in these. As soon as the stomach contents enter the intestine, cholecystokinin is released and causes the gallbladder to contract and empty. On its journey through the intestine most of the bile is absorbed through the intestinal wall, and the rest is eliminated in the feces, about 30% of the bile formed. Learn more about the physiology of digestion and about bile here.

What does our bile consist of??About 70% bile acids are bile acids: cholic acid, chenodeoxycholic acid, lithocholic acid, ursodeoxycholic acid, and others. The bile contains quite a lot of phospholipids (over 20%), and proteins (about 5%). Cholesterol, about 4%, and bilirubin, 0.3%, are present in the bile.

Bile acids are very important. First, it is the end product of cholesterol metabolism, and second, it is a very important means of digesting fats in the intestine. Bile acids cause their emulsification and absorption, since lipids, or fats, are water-soluble, but they are perfectly soluble in bile acids. It is on the presence of bile acids in the intestine that the absorption of vitamins, which we classify as fat-soluble, also depends. These are vitamins A, D, E, and vitamin K. If a person is deficient in bile acids, they may have symptoms of avitaminosis of the above vitamins. The pancreas will also not work well and digest food because the pancreatic enzymes secreted by the pancreas are activated in the presence of bile.

It improves the motility of the intestine and increases the production of digestive hormones. Its role in the binding and excretion of cholesterol and the breakdown product of hemoglobin in the blood is very important. It’s called bilirubin. As this substance is unable to filter through the kidney’s glomeruli, bilirubin is excreted through the bile, which also leaves the body with the feces.

Each day about one liter of this liquid is produced and excreted from the body of an adult. The bile of a healthy person is greenish or yellow in color and tastes extremely bitter.

Bile may not flow well into the duodenum for a variety of reasons. This is actually a pathology of the liver, problems with the biliary tract, or their dyskinesia, the propensity of bile to stone formation, or lithogenicity. Therefore, in order to properly prescribe and use choleretic drugs, it is necessary to know which part of the digestion they affect, and where their “point of application” is.

Most often in clinical practice there are conditions associated with delayed formation of this fluid, with difficulty in its entry into the small intestine, due to the development of cholelithiasis – stone disease, chronic inflammation of the bladder – cholecystitis and other pathology of the bile-conducting pathways. Occurring chemical or mechanical obstacles to the normal flow of bile into the intestine cause a number of distressing symptoms.

This discomfort in the abdomen on the right, bitterness, nausea, in severe cases, mechanical jaundice, abdominal bloating, stool discoloration may occur. In order to normalize the passage of this important fluid, and are used choleretic drugs.

What choleretic remedies can be

Diuretics are divided into two large groups, depending on their function. The first are drugs that increase the formation of bile and bile acids, and are called cholinesecretics, or choleretics. They are prescribed when the mechanism of bile excretion does not suffer, but there is a lack of its formation, and a deficiency of bile acids. The second large group of choleretic agents are cholokinetics, which promote more active bile drainage, first of all – from the gallbladder into the intestines, and secondly – from the hepatic bile ducts into the gallbladder. It is clear that this division is rather relative, since most cholelithics both enhance bile formation or secretion and facilitate its flow to gall bladder and further to intestines.

General contraindications to the prescription of choleretic

Immediately the contraindications in which choleretic drugs should not be prescribed become clear. Choleretic agents should not be prescribed for acute inflammatory processes in the liver, hepatitis, both alcoholic and autoimmune and viral. It is an inflammatory process in the area of the gallbladder, and bile ducts: cholecystitis and cholangitis and, not chronic, but acute processes. Unlike hepatitis – this may not be a therapeutic, but a surgical pathology.

Do not prescribe choleretic agents for pancreatitis, exacerbation of gastric and 12 duodenal ulcers, erosive-ulcerative gastritis. Choleretics are forbidden in cholelithiasis. If the exit ducts of the liver are blocked, and on this background to stimulate the formation of bile, then the condition will significantly worsen. Contraindications include obstructive or mechanical jaundice, as well as dystrophy of the liver parenchyma, such as cirrhosis, when the formation of bile is hampered due to the defective functioning of hepatocytes.

Choleretic drugs have a similar list of contraindications. Naturally, it is also acute liver and biliary tract diseases, cholelithiasis, exacerbation of gastritis with high acidity, as well as peptic ulcer. In other words, choleretic drugs, should always be prescribed by a physician taking into account the indications and contraindications.

Review of choleretic remedies

The use of choleretic drugs in practice of general practitioner and gastroenterologist is a crucial issue of modern medicine. This problem is described in some detail by the authors on the site of the Russian Medical Journal.Recall thatRMJ is included in the list of scientific periodicals peer-reviewed by VAK.

This list of bile diuretics consists of the effective, and rather frequently prescribed by gastroenterologists and general practitioners, choleretic drugs as well as choleretics. In case of one active substance with an international non-proprietary name (INN), it is given first and only then the brand name or the trade name of the medicine. There may be several, both expensive, imported and more affordable domestic medicines.

As a rule, the most expensive drug from the list is the original, that is, created for the first time, there is the greatest amount of data, scientific research, clinical studies of efficacy and safety. If possible, you should prefer the original drug, or, as a last resort, buy generics from well-known manufacturers and the middle price range. Do not buy the cheapest medicines because the quality of the substance used may not be as good as that of the originator product.

For each drug we give a price range, valid for January-February 2021 for pharmacies of all forms of ownership in the Russian Federation. This list is not an advertisement, a pretext for the purchase, the information is taken only from the official instructions for medicines, posted in the public domain. The prescription of any choleretic drug is the prerogative of the doctor, taking into account the diagnosis, indications and contraindications.

The information below is for informative purposes only, and should not be used as an argument for prescribing medications without examination by a physician and self-treatment. All drugs from this list exist in international and national clinical guidelines for gastroenterologists and are included to appropriate algorithms and treatment protocols. The review begins with choleretics.

Diuretics – choleretic agents: stimulants

The most well-known mechanism of action of choleretic drugs is to receive reflexes from the intestinal mucosa. Especially these are drugs that contain natural bile, namely bile acids. They have a remarkable effect on increasing the secretion of bile by hepatocytes. Apart from the general increase of bile quantity it increases the content of bile acids, and the gradient between bile and blood, being an osmotically active value, increases filtration of water and electrolytes into the bile capillaries. Bile begins to move through the biliary tracts faster, which reduces the possibility of its stagnation, precipitation of cholesterol and formation of gallstones. Thus, choleretic agents are not only drugs that prevent cholelithiasis, but also increase the ability of digestion to digest fats and improve motility of the small intestine.

Remedies that stimulate the formation of bile from its precursors, are natural, or true, synthetic, as well as herbal choleretic remedies that have a bile-forming effect. True choleretics are often drugs of animal origin. The most popular choleretic remedies of all subgroups will be listed below. Of these, Allochol is a true choleretic, Odeston is a synthetic remedy, and Cholosas is a choleretic drug consisting of a single herbal component.

Allochol

Rating: 4.9

Allochol is probably the most popular and available “folk” choleretic medicine. This is a combination remedy, and Allochol contains dried cattle bile, dried nettle and garlic, and activated charcoal. All of these components together give a stronger choleretic effect than just the bile alone. Allochol is able to increase contraction (peristalsis) of the intestine, and due to the presence of activated charcoal, which has antimicrobial and sorption action, it reduces the processes of putrefaction and fermentation that can occur in the intestine.

Allohol is indicated in the treatment of chronic cholecystitis, in cholangitis, and in the phenomena of atonic constipation. It is usually taken in two pills, after a meal, so he showed maximum choleretic action. If the patient is prescribed a fractional meal, it is necessary to take the remedy not more than 4 times. This intake should be observed for a month, and then it is halved in dosage. The course may be repeated, but at least two months between each treatment should be interrupted.

Allochol is produced by the domestic company Pharmstandard, and a large pack containing 50 coated tablets costs only 42 rubles. In some pharmacies you can find it for 33 rubles., And the smallest package of 10 tablets costs only 12 rubles.

Advantages and disadvantages

Allohol acts, “choleretic” is quite mild, in contrast to synthetic drugs. It does contain natural bile. But, nevertheless, at a high enough dosage it can cause diarrhea and abdominal flatulence, and Allohol is contraindicated in acute ulcer, in mechanical (obturation) jaundice, and if the gallbladder has concrements. This leads to a sharp increase in secretion, and if it has nowhere to go, the bladder may enlarge and even rupture with the development of peritonitis. Allochol is contraindicated in acute and subacute hepatitis – inflammation of the liver, and in the progression of its dystrophy. But this choleretic remedy, taken according to the indications, acts softly and helps to improve digestion and normalize stools in a variety of groups of patients.

Hymecromone (Odeston)

Rating: 4.8

Odeston belongs to the group of infrequently used synthetic choleretics, and it has a fairly pronounced choleretic action. This remedy contains gimecromone as an active ingredient, and is available as tablets of 200 mg each.

Odeston reduces the phenomenon of stagnation, reduces the processes leading to the formation of cholesterol stones, ie, reduces the deposition of cholesterol in the form of crystals, and is indicated in the treatment of diseases such as biliary dyskinesia by hyperkinetic type, chronic cholecystitis and cholangitis. It is prescribed after a gallbladder operation, and due to a chronic decrease in bile secretion.

Applies Odeston half an hour before meals, 1 or 2 tablets, three times a day. The daily dose should not exceed 6 tablets. The course of intake is about 2 weeks. Skipping a dose is not recommended, but you can not make up for it later by taking a double dose at once. Odeston is made by the Polish company Polfa.

Advantages and disadvantages

As with all choleretic drugs, Odeston has contraindications. Can be attributed to them obstruction formed in the biliary tract, the phenomenon of renal and hepatic failure, stomach ulcers, blood clotting disorders and childhood. This medicine has side effects, at the expense of its rather strong choleretic action. This can lead to abdominal bloating, diarrhea, allergic reactions, and abdominal pain. Since the remedy is synthetic, many doctors note along with its strong action some of its coarseness: Odeston is not designed for mild stimulation.

Cholosas and other herbal remedies

Rating: 4.8

Herbal choleretic drugs have a complex and complex effect on the gastrointestinal tract as a whole and on its organs in particular. They include phytosterols, essential oils, phytoncides, sometimes vitamins, flavones and various resins. For example, Kholosas, rosehip syrup, immortelle and Cholagol increase the secretion of bile, while improving its fluidity, that is, reduce the viscosity.

Herbal ingredients also increase the amount of chelates, or bile acids in the bile. These drugs can increase the tone of the gallbladder musculature and simultaneously relax the smooth muscles of the biliary tract as well as the sphincters of Oddi and Lutkens. Biliary remedies improve the secretion of the stomach and pancreas, improve the quality of gastric enzymes, and with decreased tone of the intestine improves its peristalsis. Some of the components, such as tansy and peppermint have antimicrobial action, and rosehip has anti-inflammatory and diuretic. Typically, choleretic include various tinctures and extracts, but you can also prepare decoctions from a collection of herbs. They should be used half an hour before meals 3 times a day, respectively, with more frequent and fractional meals, the frequency and dosage of choleretic phytopreparations is determined by the doctor.

Perhaps Kholosas belongs to one of the most palatable and pleasant medicines in general, because it is a concentrated syrup of rosehip fruits with sugar. In some cases, if it is not hidden from small children, they may drink the entire bottle, and after that they will suffer profuse diarrhea due to overdose, but still, nothing terrible will happen to them anymore.

Kholosas is indicated in various viral hepatitis, inflammation of the biliary tract and bladder, poisoning with various medications, drugs that are metabolized by secretion into the bile, it is indicated in poisoning with alcoholic beverages. Cholosas can be prescribed as a general tonic, and for vitamin C deficiency.

It should be used from 2 to 3 times a day, adults – 1 teaspoon per reception, and children – half a teaspoon, or even less. Produces Holosas domestic company ZAO Altayvitaminy, and the cost of a bottle of 140 ml is on average 140 rubles.

Advantages and disadvantages

Cholosas is a natural herbal monodrug, and the only contraindication will be an individual intolerance, as well as severe diabetes, because Cholosas contains sugar. The drug has no side effects, again, except for individual intolerance. Few people will have unpleasant side effects on the delicious syrup of rosehip fruit. This remedy is inexpensive, Cholosas can be added to boiling water and drunk with a general tonic purpose, Taking one teaspoon of Cholosas completely satisfies the daily requirement for ascorbic acid.

Sibektan

Rating: 4.8

Sibektan is a complex phytopreparation, which is produced by the domestic company Farmacentre Vilar. Its composition includes dry extracts of birch, St. John’s wort, silimar extract (or dried milk thistle fruit extract), dried flowers of common tansy, or tanacechol extract. The drug, in addition to its choleretic effect, protects liver cells, has a hepatoprotective effect, as well as membrane stabilizing and antioxidant.

It can be used for gall bladder dyskinesia of the hypotonic type, chronic cholecystitis and chronic persistent hepatitis. It is also used in the treatment of cirrhosis and fatty degeneration of alcoholic genesis. Adults are prescribed two tablets 4 times a day for a month, Sibektan taken 20-40 minutes before a meal.

Advantages and disadvantages

The drug is relatively inexpensive, has a mild action, with contraindications should be considered a general contraindication to choleretic, ie, cholelithiasis. Do not use Sibektan in children under the age of eighteen, the drug is not prescribed to pregnant and lactating, as well as those with individual intolerance. Otherwise, the preparation containing choleretic herbs is very good, but not as a monotherapy, but in complex therapy, for example, with the same bile acids.

Ursodeoxycholic acid (Ursosan, Ursofalk, Urdoxa, Ursodez)

Rating: 4.8

Ursosan is a representative of a large group of drugs containing bile acids. They improve bile parameters, the biliary function of hepatocytes increases, and these drugs not only prevent cholelithiasis, but also in some cases dissolve already existing cholesterol stones in the gallbladder. UDH, or ursodeoxycholic acid, which is part of Ursosan, also lowers the amount of cholesterol in the bile. And one of the important indications for prescribing this remedy would be dissolution of gallstones, if they are small in size, and consist of cholesterol. It is possible to try to treat the patient conservatively, or it is possible to supplement Ursosan with surgical or shock-wave (remote lithotripsy) treatment of cholelithiasis.

Ursosan is produced by Promed Prague, Czech Republic, and capsules containing 250 mg of ursodeoxycholic acid costs from 750 to 850 rubles. For a pack of 50 capsules. The drug can be used in uncomplicated cholelithiasis, for the prevention of recurrent stone formation, in various forms of chronic hepatitis, and even in primary biliary cirrhosis and primary sclerosing cholangitis. The drug is shown in the complex disease of non-alcoholic and alcoholic fatty liver dystrophy, for the treatment of chronic viral hepatitis and in biliary dyskinesia.

The drug should be prescribed in different dosages. For example, to dissolve cholesterol stones, a patient can be given Ursosan up to 15 mg per kilogram of weight, that is, a patient weighing 100 kg will receive 1500 mg daily, or 1.5 grams, or 6 tablets. Accordingly, after 8 days a pack of 50 tablets will run out. And dissolution of stones is an indication for long-term treatment: 6 months, and even one year, until the stones are completely dissolved. Therefore, the patient uses four packs per month, and the monthly course of treatment will cost more than 3000 rubles., Therefore, it is necessary to immediately assess your financial capabilities.

There is also Ursosan Forte, when the tablets have twice the dosage: 0.5 g. The largest pack of 100 of these tablets will cost an average of 3000 rubles, produced by the same company. Similarly, this pack will also be enough for a patient weighing 100 kg for a month, 3 tablets a day.

In chronic hepatitis, biliary tract pathology, there are similar dosages, which are also calculated by the doctor according to the body weight.

Advantages and disadvantages

In some cases, long-term administration of bile acids significantly alleviates digestive function, and quality of life in many diseases, such as viral hepatitis and cirrhosis. However, the contraindication will be:

1. The presence of X-ray-positive calcium gallstones that will not dissolve;
2. non-functioning gallbladder;
3. Decompensated stage of liver cirrhosis, when only a liver transplant can save a man;
4. Acute inflammatory diseases, both of the bile ducts and bladder, as well as of the intestines;

Ursosan is not prescribed for children under three years of age.

Diarrhoea or softening of the stools were the most frequently reported side effect. The drug should not be taken in chronic and acute hepatic and renal insufficiency, as well as in gallstones of non-cholesterol genesis. But cholesterol stones must also be small, up to 2cm, and the patency of the vesicular and common bile duct must be preserved to keep the bile flowing efficiently. Against the background of treatment of cholelithiasis by prescription, regularly determined liver transaminases – ALT and AST, as well as monitoring the effectiveness of treatment according to ultrasound of the gall bladder. Ursodeoxycholic acid is a remedy with internationally proven efficacy:

About Hydrocholeretics

Hydrocholeretic is the name given to some therapeutic mineral waters. They simply reduce the density, viscosity of the bile, and make it more fluid. Unlike regular water, when mineral water is absorbed in the intestinal lumen and penetrates into the portal bloodstream, it is first assimilated by the liver cells, and increases the pressure in the biliary passages by osmosis.

Essentuki-17, Essentuki-4, Naftusya, Slavyanovskaya and Smirnov mineral water work perfectly. In addition to increasing the pressure in the biliary passages, the reverse absorption of water and electrolytes in the gallbladder and biliary tracts is also greatly reduced, which also reduces the potential for lithogenicity, or the possibility of formation of gallstones.

Also the effect of mineral water on the bile-excretory ducts depends on the so-called sulfate anion, or sulfuric acid residue, SO₄, which is usually combined with sodium and magnesium cations. These salts of sulfuric acid, magnesium and sodium sulfate, have a strong choleretic effect. Many metal cations do useful work. Thus, calcium (Ca2+) forms a complex compound with bile acids, which greatly reduces the chance of hard-to-dissolve bile sludge, which then promotes the formation of stones. These mineral salts make the bile more fluid, and in its colloidal state it becomes more stable. Mineral water should be consumed 30 minutes before a meal, preferably warm and with the gas released, if present.

Diuretic-kinetics: bile-diverting stimulants

Choleretic drugs that stimulate bile diversion can work in two different ways, and choleretic drug kinetics are divided into two types of opposite action. In the case that the bladder is hypotonic, its smooth muscles are flabby and weak, then it is necessary to increase its tone and strengthen its ability to contract. At the same time, these remedies reduce the tonic tension, and increase the lumen of the common bile duct structures. They simply irritate the intestines by activating the cascade of gastrointestinal hormones (cholecystokinin). An example of such a choleretic drug would be magnesium sulfate, or magnesia.

These drugs are prescribed mainly for biliary dyskinesia of the hypotonic type, stasis in the gallbladder with a decrease in its tone. These remedies are indicated for gastritis with reduced acidity, as well as cholekinetics, which shrink the gallbladder, is shown during duodenal probing in a healthy person.

The second group of drugs includes antispasmodics, which relax the overly contracted gallbladder, reduce its spasm, and concomitantly relax the biliary tracts. This improves the drainage of bile, and examples of such cholokinetics are No-Spa, Papaverine, or the stronger atropine and platifylline, which are used in medical institutions and when calling an ambulance.

These remedies are necessary in the hypertensive form of dyskinesia, in the presence of stones in the gallbladder and bile ducts. They can reduce the pain syndrome, which often occurs against the background of biliary tract spasm and in the presence of cholelithiasis.

Consider the most popular and effective cholekinetics, which are sold in pharmacies and included in the rating.

Magnesium sulfate (magnesia)

Rating: 4.9

Magnesia is the simplest and most accessible choleretic and laxative. This colorless powder, easily soluble in water, has an intense bitter-salty taste, and it is unpleasant to drink magnesia. But it, in addition to its choleretic effect, has another anticonvulsant effect, helps normalize heart rhythm, has a hypotensive effect and can fight constipation. Magnesia is used in cholecystitis and cholangitis, to obtain a bubble portion of bile during duodenal probing, in gallbladder dyskinesia of the hypotonic type, to cleanse the bowels. Apply magnesia should be dissolved one sachet (25 g) in one glass of warm water, and drank between meals 3 times a day, before meals. In this case, already after an average of one or two hours, the drug will have the necessary choleretic effect, which will last for 4 or even 6 hours. There is usually some loosening of stools afterwards, because the osmotically active magnesia solution will promote an intense inflow of water into the intestinal lumen.

Magnesium sulfate is produced by the Moscow Pharmaceutical Factory, and one 20 g bag weighs an average of 38 rubles.

Advantages and disadvantages

The advantages of magnesia include its affordability and low cost, the onset of rapid effect, and a simple and clear mode of application. But there are also contraindications to this medicine. Do not take magnesia if the patient has liquid stools, symptoms of renal failure, against a background of low blood pressure and slow heart rate (bradycardia). Magnesia is contraindicated in patients with various cardiac arrhythmias because it may worsen their condition significantly, especially in cases of complete atrioventricular block, when impulses from the atria are disconnected from the ventricular contractions.

Sorbitol (Sorbitol)

Rating: 4.8

Sorbitol, or more precisely sorbitol, is a polyatomic alcohol, and in addition to its choleretic, osmotic and laxative effect. Also use sorbitol in some cases to reduce the symptoms of intoxication: it removes the poisonous substance in the intestinal lumen.

Available in powder form for oral administration, in sachets of 5 g, sometimes – in powder form, in packages of 200, 300, 500 g. Sorbitol is indicated for use in biliary dyskinesia by hypotonic type, in chronic hepatitis in complex therapy, with a tendency to constipation.

Sorbitol must be used for choleretic purposes by dissolving 5 g of the drug in a half glass (100 ml) of water, slightly warmed. Take this sweet solution 10 minutes before a meal twice a day. The course of treatment is 1 month. Produces sorbitol domestic company Fruktovoe Schastie, and you can buy the largest package of 500 grams for an average price of 145 rubles.

Advantages and disadvantages

The advantage of sorbitol is its great cheapness, a wide range of applications, because it can be prescribed not only for dyskinesia and cholecystitis, but also for the treatment of constipation. However, sorbitol is contraindicated in all acute conditions, with intolerance to fructose, which is in its composition, and if you exceed the required amount, and make the solution either too strong or drink it too much, you may experience intense diarrhea, dry mouth, nausea, and symptoms of dehydration. But sorbitol can be safely used by diabetics, since it does not contain glucose.

No-Spa (drotaverine)

Rating: 4.8

The best known antispasmodic tablets No-shpa, or drotaverine hydrochloride, is produced by the Hungarian pharmaceutical company Hinoin. No-shpa is the drug that can reduce spasms of the smooth muscles not only of the gallbladder and biliary ducts, but also of the smooth muscles of the urinary tract, so this drug is indicated for renal colic.

No-shpa can reduce the pronounced pain syndrome in the hypertensive form of biliary dyskinesia, in cholangitis, and in cholecystitis. No-shpa is available not only in tablets, but also in solutions, so it is very often administered intramuscularly. Only antispasmodics are indicated for pain syndrome in the abdomen, in the condition of “acute abdomen”. The fact is that if you use strong painkillers, you can relieve pain, and miss the condition when you need urgent surgery, such as acute appendicitis. Antispasmodics have no analgesic effect, and all they can do is relax muscles.

Therefore, if there is a nidus of progressive inflammation in the abdomen, for example, in the same calculous cholecystitis, No-Spa will not help, but if the pain is due to spasm in the neck of the gallbladder, then the necessary effect will be achieved, the spasm will be resolved, the bile will go into the intestine, and the patient’s condition will improve.

Apply No-shpa in tablets should be from 1 tablet of 40 mg to 6 tablets per day, that is, no more than 2 tablets three times a day, it is desirable to take it before a meal, so that during the meal it showed its effect and relaxed the smooth muscles of the biliary tract. It costs about 130 rubles for a pack of 24 tablets of No-Shpa.

Advantages and disadvantages

A big plus of No-Spa is that it is quite active and fast acting. Overdose symptoms such as arrhythmias are quite rare, but the patient must initially have severe heart disease for this. No-shpa is a universal drug, it not only helps to increase the outflow of bile, but it also helps to normalize the outflow of urine, since both the ureters and the biliary tract have the same smooth muscle elements. Few side effects have been reported. Rare symptoms include tachycardia, headache and nausea, allergic reactions. But despite all the minor disadvantages, No-Spa is quite in demand, and has long existed in every home medicine cabinet as the means of choice for abdominal pain, because only taking antispasmodics will avoid serious complications in the case of the need for surgical intervention.