Gallstones (Cholelithiasis): Drug Therapy

Therapeutic Targets

  • Freedom from symptoms
  • Avoidance of complications

Therapy recommendations

  • Symptomatic therapy can be attempted for acute symptomatic cholelithiasis:
    • Butylscopolamine (parasympatholytic); rectal (“into the rectum”) or parenteral (“bypassing the intestine”) administration preferred!
    • Analgesics (painkillers): paracetamol or metamizole or opioids (for severe colic)Cave! Do not use opioid analgesics except pethidine or buprenorphine! due torisk of sphincter Oddi spasm (spasm of the sphincter in the area of the mouth of the bile duct in the duodenum).
    • In addition to drug therapy should be observed for at least 24 h food abstinence (abstention from food), then low-fat diet.

    However, an elective cholecystectomy (removal of the gallbladder) should be performed early (within 72 hours after diagnosis or at the interval after six weeks; see “Surgical Therapy“).

  • If bacterial cholecystitis (gallbladder inflammation) is suspected: antibiotic therapy with ampicillin + sulbactam (acylaminopenicillin + ß-lactamase inhibitor) [first-line agent]; in septic course and high-risk patients: Antibiotic therapy with piperacillin + tazobactam.
  • Systemic litholysis (“stone dissolution”) with ursodeoxycholic acid (UDCA) is now performed only in exceptional cases for non-calcareous stones < 5 mm (10 mg/kg bw/d for several months) due to the high recurrence rate (recurrence).
  • Note due tohospitalization: in case of persistence (persistence) of colic, occurrence of icterus (jaundice) or fever (> 38.5 °C rectally), hospitalization is required.
  • See also under “Further therapy”.

Prevention of gallstones