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# Tab Voihep
## Overview
Tab Voihep (unconjugated ursodeoxycholic acid) is a naturally occurring bile acid.
## Primary Indications
* Primary Biliary Cholangitis (PBC)
## Adult Dosing
* **PBC:** 13-15 mg/kg/day orally, divided into 2-3 doses.
* Maximum dose: Generally not to exceed 25-30 mg/kg/day. Specific maximum doses may vary based on local guidelines or manufacturer recommendations.
* Dosing is typically continued long-term.
## Pediatric Dosing
* Established pediatric dosing is not widely available. Use in pediatric populations should be guided by specialist consultation and available literature, with careful consideration of weight-based dosing.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Dose adjustments may be necessary, but specific guidance is limited.
* **Renal Impairment:** Use with caution. Dose adjustments are not well-established.
## Contraindications
* Biliary obstruction (complete or near-complete).
* Hypersensitivity to ursodeoxycholic acid or any component of the formulation.
* Recurrent severe upper abdominal pain, nausea, vomiting, particularly after meals (may indicate gallbladder disease).
## Adverse Effects
* **Common:** Diarrhea, nausea, abdominal pain.
* **Less Common:** Rash, itching, headache, dizziness, fatigue, changes in liver enzymes.
* **Rare:** Gallstone formation/calcification, worsening liver function (particularly with advanced liver disease).
## Key Drug Interactions
* **Bile Acid Sequestrants (e.g., cholestyramine, colestipol, sevelamer):** May decrease the absorption of ursodeoxycholic acid. Administer ursodeoxycholic acid at least 2 hours before or 4-6 hours after bile acid sequestrants.
* **Estrogens and Oral Contraceptives:** May increase the risk of cholestasis.
* **Cimetidine, cyclosporine, nitrendipine, oral contraceptives:** May increase serum concentrations of these drugs.
## Monitoring
* Baseline and periodic monitoring of liver function tests (AST, ALT, ALP, bilirubin).
* Assessment of symptom improvement.
* Imaging (e.g., ultrasound) to assess for gallstones may be considered.
## Clinical Pearls
* Ursodeoxycholic acid improves liver function and may slow the progression of PBC.
* It is generally well-tolerated.
* Effectiveness may take several months to become apparent.
* Ensure adequate hydration.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature before making clinical decisions. Dosing and recommendations may vary based on individual patient factors, institutional protocols, and evolving clinical guidelines.
