Actigall

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Actigall

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Medically reviewed

Marina Burgos

Last updated on 10/01/2026

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Actigall

Property Description
Active ingredient Ursodiol (Ursodeoxycholic acid, UDCA)
Form Oral capsule
Pharmacological class Gallstone dissolution agent, Bile acid agent
Common use Modifying bile composition (general purpose)
Origin Synthetic derivative of a naturally occurring bile acid

What Type of Medicine is Actigall and What is Its Active Ingredient?

Actigall is a prescription-only pharmaceutical preparation whose active ingredient is Ursodiol, formally known as ursodeoxycholic acid (UDCA). Actigall is a gallstone dissolution agent and falls under the broader category of hepatobiliary agents, which are medications intended to influence the liver, bile ducts, and gallbladder. Actigall is manufactured as an oral capsule, making it a medication taken exclusively by mouth.

Actigall is a single-ingredient product focused solely on delivering Ursodiol. The specific presentation of the capsule facilitates the accurate, consistent delivery of the Ursodiol required to initiate the necessary chemical changes in the bile fluid. UDCA is utilized for its role in the management of hepatobiliary disorders.


Is Ursodiol a Natural or Synthetic Compound?

Ursodiol is a synthetic derivative of a naturally occurring substance. The molecule is a secondary bile acid that naturally exists within the human bile acid pool in minimal amounts. To ensure the high purity and consistent concentration required for therapeutic use, the substance in Actigall is produced through a controlled synthetic process.

This synthetic derivative is distinguished by being comparatively hydrophilic ("water-loving"), a chemical characteristic that makes it less cytotoxic than other naturally occurring, more hydrophobic bile acids. This property is key to its mechanism of action.


What is the General Purpose of Ursodiol’s Action?

The general purpose of Ursodiol’s action is to modify the composition of bile to reduce the risk of solid precipitation. It achieves this by acting directly within the digestive system to suppress the liver's synthesis and secretion of cholesterol into the bile fluid, thereby decreasing biliary cholesterol saturation.

By consistently reducing the concentration of cholesterol in the bile fluid, Ursodiol lowers the bile’s lithogenic index—its tendency to form solid precipitates. This primary effect is utilized as a means to encourage the gradual, pharmacological dissolution of existing cholesterol-based stones.

Regulatory References

  1. Ursodiol Drug Information
  2. Ursodiol NCI Drug Dictionary

What side effects are possible with Actigall?

Possible Side Effects and Safety Information

The safety profile of Actigall (ursodiol) is formally documented by regulatory authorities, classifying possible adverse reactions primarily by frequency and the organ system affected. The most frequently documented effects are generally mild and often involve the Gastrointestinal system.

Frequency-Classified Adverse Reactions

Adverse reactions are organized based on the official frequency criteria established by regulatory agencies:

Classification Examples of Documented Reactions
Very Common Diarrhea, abdominal pain, headache.
Common Nausea, vomiting, constipation, dyspepsia, pruritus, skin rash, alopecia, back pain, arthralgia.
Very Rare Calcification of gallstones, decompensation of hepatic cirrhosis (in advanced Primary Biliary Cirrhosis).

Safety Constraints and Special Considerations

The official labeling includes specific safety restrictions and required monitoring. Ursodiol is contraindicated in conditions involving complete biliary obstruction (common or cystic duct) and the presence of radio-opaque calcified gallstones. It should not be used in cases of acute gallbladder inflammation.

For safety, liver function tests (including ALT, AST, gamma-GT, and bilirubin) must be monitored at the start of treatment and periodically thereafter to detect any potential changes in hepatic function. Diarrhea is noted as a potential dose-dependent effect that may resolve upon dose reduction. Specific safety observations are included for patients with advanced stages of Primary Biliary Cirrhosis (PBC).

Overdose and Emergency Response

Information concerning an overdose of Actigall (ursodiol) is strictly defined in official government regulatory labeling, detailing the recognized clinical signs and mandated emergency response.

Official Overdose Statement Regulatory Documentation
Documented Manifestation The predominant clinical manifestation reported following exposure to excessive doses of ursodiol is diarrhea.
Severe Outcome Potential No specific severe or life-threatening systemic outcomes are explicitly documented. However, severe and persistent diarrhea resulting from overdose necessitates intervention to manage potential fluid and electrolyte imbalances.
Antidote Status Regulatory documents explicitly state that no specific antidote is known for ursodiol overdose.
Mandated Emergency Action Immediate medical attention must be sought for a known or suspected overdose, requiring contact with a doctor or emergency services.

Treatment for Actigall overdose is officially designated as symptomatic and supportive. This intervention includes the immediate interruption of drug administration to curtail continued exposure. Regulatory sources also describe specific supportive procedures, such as the potential administration of ion-exchange resins which function to bind the bile acids in the gastrointestinal tract and reduce systemic absorption. Close observation or hospital monitoring may be required following a significant overdose event, primarily focusing on correcting severe disturbances to the body's fluid status and electrolyte levels arising from the pronounced gastrointestinal effects.

Therapeutic Uses of Actigall

Actigall (ursodiol) is used across domains where additional symptomatic support is needed. The medication is generally applied across domains where additional symptomatic support is needed in situations where patients experience symptoms related to physical discomfort or systemic imbalance. It is relevant in contexts involving heightened systemic burden and may assist with easing the overall symptom load.

It is commonly used across conditions presenting with acute episodes and those involving inflammatory or irritative processes. The drug is often used when symptoms intensify and supportive relief is needed, particularly during phases when the patient experiences increased discomfort. It is helpful in situations requiring additional symptomatic assistance and provides support that may help patients cope more steadily with symptom fluctuations.


Quick Fact: Relief for Functional Strain

The medication supports general well-being during symptomatic phases and may help with managing symptoms that create noticeable functional strain.

Regulatory References

  1. NIH MedlinePlus Drug Information

Eligibility and Restrictions for Use

Eligibility Map: Who Can and Cannot Use Actigall (Ursodiol) — Official Regulatory Information


Eligibility Scope

Category Official Regulatory Statement
Populations for whom use is allowed (as stated in label) Adults with radiolucent, noncalcified cholesterol gallstones leq 20 mm who face increased surgical risk or refuse cholecystectomy. Adults for the prevention of gallstone formation during rapid weight loss [4.2].
Populations for whom use is not recommended (if applicable) Pediatric patients (children and adolescents): Safety and effectiveness have not been established (US/FDA). Use is not recommended (EU/EMA).
Populations for whom use is contraindicated Patients with known hypersensitivity to ursodiol. Individuals with complete biliary obstruction, radio-opaque calcified gallstones, or acute inflammation of the gallbladder/biliary tract.
Age-related eligibility rules Pediatric: Safety and effectiveness have not been established (US). Geriatric: No geriatric-specific problems that limit usefulness have been demonstrated.
Condition-specific eligibility rules Hepatic: Use caution in patients with decompensated hepatic cirrhosis. Gastrointestinal: Caution is advised in patients with conditions predisposing to intestinal stenosis or stasis, such as Crohn's disease.
Pregnancy and lactation eligibility status (if explicitly documented) Pregnancy: Must not be used unless clearly necessary (EMA). Lactation: Use is not recommended; the need to discontinue the drug or breastfeeding should be assessed.
Eligibility-related restrictions Use is limited to gallstones less than 20 mm in greatest diameter. Women of childbearing potential should use effective non-hormonal contraception when taking the drug for gallstone dissolution.

Eligibility Classifications (High-Level)

Category Official Regulatory Classification
Eligibility severity classification (as defined in official documents) Contraindicated (e.g., Biliary Obstruction). Not Recommended (e.g., Pediatric use, Lactation). Use with Caution (e.g., Crohn's disease).
Regulatory basis (EMA / FDA / etc.) US FDA Prescribing Information / EMA Summary of Product Characteristics (SmPC).
Eligibility-context constraints (as defined in official documents) Dependent on gallstone type and size, presence of biliary obstruction, and necessity of cholecystectomy.

Resulting Eligibility Structure

Official eligibility statements define absolute exclusions, primarily for patients with a complete biliary obstruction, acute gallbladder inflammation, or calcified gallstones. Use is strictly limited to adults who meet specific criteria for non-calcified stone characteristics and surgical risk. Furthermore, the medicine is not recommended for children and adolescents because safety and effectiveness have not been established in this population, and use during pregnancy and lactation is generally restricted or discouraged.

What should I know about interactions with other medicines?

Interactions Affecting Ursodiol Absorption

Certain non-prescription agents and medicines are officially documented to reduce the absorption of Ursodiol into the body, leading to decreased exposure. Bile Acid Sequestering Agents (such as cholestyramine or colestipol) and Aluminum-based Antacids (containing aluminum hydroxide) interfere with absorption by physically binding to bile acids in the gastrointestinal tract. To mitigate this interference, regulatory labels require a mandatory separation of administration times. For example, Ursodiol must be taken at least four to six hours after bile acid sequestering agents. Activated Charcoal is also expected to interfere with absorption in this manner.

Interactions Affecting Treatment Efficacy

Other drug classes are documented to increase the secretion of cholesterol into the bile. This pharmacodynamic effect directly opposes the principal action of Ursodiol and may counteract its intended efficacy. This group includes Estrogens, Oral Contraceptives (containing estrogen/progestin), and lipid-lowering agents such as Clofibrate. Co-administration with these agents is restricted by regulatory documents.

Metabolic Interactions

Ursodiol is officially documented as an inducer of CYP3A. This pharmacokinetic effect means that co-administration with other drugs metabolized by the CYP3A enzyme may require consideration, as Ursodiol can affect the metabolic clearance of those substances.

Mechanism of Action

Actigall (ursodiol) is a hydrophilic secondary bile acid that, upon systemic absorption and conjugation in the liver, becomes a major fraction of the total bile acid pool, significantly altering its physiochemical properties. This molecule competitively displaces more hydrophobic, endogenous bile acids, such as deoxycholic and chenodeoxycholic acid, at the level of the hepatocyte and ileal reabsorption. This exchange results in a shift from a hydrophobic to a more hydrophilic bile acid composition.

At the molecular level, ursodiol attenuates the concentration and secretion of cholesterol into bile by the liver, decreasing cholesterol saturation. It also interferes with the intestinal absorption of dietary cholesterol. Furthermore, ursodiol modulates several membrane transport proteins in cholangiocytes and hepatocytes, including the upregulation of the Cl^-/ HCO3^- anion exchanger (AE2) and other bile acid transporters like BSEP and MRP2. This modulation generates a bicarbonate-rich hyper-osmotic ductular bile flow, promoting the systemic clearance and secretion of bile acids and other organic anions. Intracellularly, it stabilizes mitochondrial membranes against hydrophobic bile acid-induced permeability transition and subsequent anti-apoptotic signaling pathways.

Dosage and Administration Information

Administration and Dosing Guidelines

Actigall (ursodiol) is an oral capsule that must be taken exactly as prescribed by a healthcare provider. The drug is generally administered with food to enhance absorption. The total daily dosage is typically divided into two, three, or four separate doses, depending on the condition being treated.

Condition Recommended Adult Dosage Frequency
Gallstone Dissolution 8 to 10 mg/kg/day (based on body weight) Divided into 2 or 3 doses
Gallstone Prevention (during rapid weight loss) 600 mg/day (fixed dose) Divided into 2 doses (300 mg twice daily)

Procedural and Timing Rules

Actigall should be taken with meals unless otherwise directed. If an aluminum-based antacid is being used, it must be administered at least 1 hour before or 2 hours after taking Actigall to prevent the antacid from reducing Actigall's absorption and efficacy.

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the patient should resume their regular dosing schedule. A double dose must not be taken to make up for a missed one.

Usage of Actigall in the pediatric population is not established, and dosage for children must be determined by a physician.

Recent Clinical Evidence

Research Evidence / Overview of Studies for Actigall (Ursodiol)


Evidence for Use in Dissolving Gallstones

Research has primarily used Randomized Controlled Trials (RCTs) to evaluate Actigall (ursodiol) in research exploring the measurement of gallstone size. These studies were used in research exploring how symptoms change over time and research explored the measurement of gallstone dissolution of non-calcified cholesterol stones. Researchers monitored participants for an intermediate-term period, tracking changes in stone diameter and observing whether the stones disappeared completely or partially, often using imaging methods like ultrasound.

Studies reported measurements indicating a reduction in gallstone size was observed in a portion of the participants over the study period. Studies report how stones evolved in the observed populations, and research described patterns where the measurement of dissolution was associated with smaller stones (under 20 mm) that were not hardened by calcium.


Evidence for Use in Preventing Gallstone Formation

This use of Actigall was evaluated in studies focusing on obese adults undergoing a phase of rapid weight loss, such as those on very low-calorie diets. The research relied on placebo-controlled trials where new gallstone formation (incidence rate) was the primary outcome being monitored over defined time intervals. These studies were conducted during a period when the risk of gallstone formation was elevated in the study setting.

The findings describe patterns observed where the rate of new gallstone formation was measured to be lower in the group receiving the study drug compared to the group that received an inactive substance (placebo). Findings indicated a lower rate of new stone formation was recorded during the observed phase.


Evidence for Use in Primary Biliary Cholangitis (PBC)

Actigall was evaluated in long-term Randomized Controlled Trials (RCTs), and these findings were pooled into systematic reviews and meta-analyses to explore its use in individuals with Primary Biliary Cholangitis (PBC). Studies monitored how symptoms evolved in the observed populations and tracked outcomes related to systemic or functional imbalance, such as changes in liver biochemistry markers (like ALP and GGT levels).

The research described consistent patterns in the measurement of key liver markers observed during the study periods. Furthermore, some consolidated evidence from meta-analyses data showed patterns related to a lower rate of progression to long-term clinical endpoints was observed in the group studied.

However, findings were mixed regarding other outcomes. Research provides limited insight into short-term changes in patient-reported outcomes describing perceived discomfort, such as fatigue and pruritus (itching), where data show patterns related to minimal or uncertain changes.

Frequently Asked Questions (FAQ)

Common questions about Actigall (FAQ)


Q: Why would a doctor prescribe Actigall for a condition other than gallstones?

A: Regulatory documents indicate that Actigall (ursodiol) is officially designated for the treatment of Primary Biliary Cholangitis (PBC), which is a chronic liver disease. It is also used for the dissolution and prevention of gallstones. The use of the medication is restricted to these specific health conditions as determined by authoritative sources.

Q: How long does it usually take for Actigall to start working?

A: The length of time before effects are observed depends on the condition being addressed. For the dissolution of gallstones, official information indicates that an initial response is typically observed after three to six months of regular use.

Q: What are the most common side effects patients mention when taking Actigall?

A: Regulatory safety information lists certain effects as very common. These documented reactions are generally mild and may include diarrhea, headache, and abdominal pain. It is noted that diarrhea can sometimes be related to the size of the dose.

Q: Does Actigall cause weight gain?

A: Regulatory adverse reaction reports have noted unusual or rapid weight gain as a possible effect. However, the frequency with which this may occur is not specifically known or classified in the official safety information.

Q: Can Actigall affect my sleep or cause insomnia?

A: Insomnia, which involves trouble sleeping, is listed as an adverse reaction documented in regulatory safety information. This suggests that some individuals may experience sleep-related changes while using the medication.

Q: Can Actigall interact with commonly used over-the-counter pain relievers?

A: The official product label states that aluminum-based antacids can reduce the absorption and effectiveness of Actigall. To address this potential reduction, the administration of aluminum-based antacids is typically separated by a specific time interval (one to two hours) in official guidelines. Other common non-prescription pain relievers are not generally restricted in the main regulatory labeling.

Q: How long does a person typically need to stay on Actigall treatment?

A: The required duration of treatment varies depending on the medical reason for its use. For gallstone dissolution, therapy is often continued for at least six months after the gallstones are no longer visible via imaging, which is done to help prevent recurrence.

Q: Can Actigall be used by elderly patients?

A: Official regulatory information specifies that studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of Actigall in the elderly population. This suggests no special age-related restrictions apply based on the official data.

Q: Are there restrictions on driving or operating machinery while taking Actigall?

A: While there is no specific blanket regulatory warning against operating machinery, documented adverse effects such as dizziness and headache may be experienced. These effects could potentially affect a person's ability to drive or safely operate complex equipment.

Q: Does Actigall treatment mean I can avoid surgery?

A: Actigall is indicated for use in adults who have specific types of non-calcified gallstones and who either face an increased surgical risk or have chosen not to undergo gallbladder removal surgery (cholecystectomy). Its use is intended as an alternative option for these specific patient circumstances.

Q: Is Actigall safe for long-term use?

A: The duration of use can extend over many months for conditions like gallstone dissolution to achieve the required effects. Additionally, long-term studies have been conducted as part of the evidence review for its use in Primary Biliary Cholangitis (PBC).

Q: Why is Actigall sometimes prescribed for liver conditions?

A: Actigall (ursodiol) is officially designated by regulatory bodies for the treatment of Primary Biliary Cholangitis (PBC). PBC is recognized as a chronic liver condition, which explains its use in treating this disorder in addition to gallbladder indications.

Q: Can Actigall cause hair loss?

A: Yes, regulatory safety documents list hair thinning, known as alopecia, as a common adverse reaction associated with the drug. This is a recognized effect noted in clinical experience.

Q: How often do I need to see my doctor while on Actigall?

A: Official guidance indicates that laboratory measurements, such as liver function tests, are typically monitored by a healthcare provider at the start of treatment and periodically thereafter. For patients taking the drug for gallstones, ultrasound images of the gallbladder are typically obtained at six-month intervals for the first year to track progress.

Q: Can Actigall affect my blood pressure?

A: Regulatory safety documentation does not describe an impact on cardiovascular function or high blood pressure as a documented side effect of the medicine.

Q: Is Actigall known to cause headaches or migraines?

A: Yes, headache is listed as a very common adverse reaction in the official regulatory safety information. This suggests that headaches are among the most frequently observed effects reported by patients.

Q: Do I need to follow a special diet while taking Actigall?

A: The drug is typically administered with food to enhance absorption and effectiveness. While Actigall acts to reduce the liver's secretion of cholesterol into bile, official documentation does not mandate following a specific restrictive diet.

Q: Can Actigall interfere with cholesterol-lowering medications?

A: Yes, certain medications known to increase the secretion of cholesterol into the bile, such as specific lipid-lowering agents, may counteract the intended effect of Actigall. Regulatory documentation identifies this potential interaction as a consideration during use.

Q: Can I take other medications at the same time as Actigall?

A: Certain drugs, such as aluminum-based antacids and bile acid sequestering agents, are subject to mandatory separation from Actigall administration by several hours. This rule is in place to help prevent a reduction in Actigall's absorption, as described in official guidance.

Q: What happens to the dissolved gallstones once Actigall has done its job?

A: The primary purpose of Actigall is to decrease cholesterol saturation in the bile fluid, making the bile less likely to form solids. As the gallstones dissolve, the cholesterol is thought to become more soluble, allowing it to be processed and eliminated through the body's digestive and excretory processes.

Q: What is the shelf life of Actigall tablets?

A: Official regulatory requirements describe that the product is to be stored at controlled room temperature (20 C to 25 C; 68 F to 77 F), kept in the original, tightly closed container, and protected from excessive heat, moisture, and light to support its stability.

Q: Does Actigall interact with birth control pills?

A: Yes, regulatory documents state that oral contraceptives that contain estrogen/progestin may counteract the effectiveness of Actigall. This is because they can increase the secretion of cholesterol into the bile, opposing the drug's intended action.

Q: Can Actigall change the color of urine or stools?

A: Changes in the color of urine (such as dark urine) or stools (such as clay-colored stools) are documented as serious adverse reactions. Official information notes that such changes are serious adverse reactions which are required to be addressed promptly by a healthcare provider.

Q: How is the long-term effectiveness of Actigall measured in studies?

A: Studies measured effectiveness in different ways depending on the condition. This included monitoring outcomes such as the size reduction of non-calcified gallstones, the incidence rate of new gallstone formation, and tracking changes in key liver biochemistry markers over time.

Q: Does Actigall have any effect on general metabolism?

A: The drug is classified chemically as a bile acid agent, and its primary action is to modify the composition of bile. This is achieved by reducing the synthesis and secretion of cholesterol by the liver, which is a key part of the body's lipid processing.

Q: Is it common to feel stomach pain or discomfort when first starting Actigall?

A: Abdominal pain is listed as a very common adverse reaction in regulatory safety documents. This suggests that discomfort in the stomach or abdominal area is frequently reported and may be observed early in the course of treatment.

How should Actigall be stored and disposed of?

Actigall (ursodiol) must be stored and disposed of according to official regulatory requirements to ensure product stability and safety.

Storage & Disposal Scope Official Regulatory Requirement
Storage Temperature Store at Controlled Room Temperature (20 C to 25 C; 68 F to 77 F).
Protection and Handling Keep from freezing. Protect from heat, moisture, and direct light.
Packaging Keep in the original container and ensure it is tightly closed.
Stability (Scored Tablets) Broken half-tablets are stable for up to 28 days and must be stored separately from whole tablets.
Child Safety Keep out of the reach of children.
Disposal Dispose of unused or expired medicine via a drug take-back program or, if unavailable, mix with an undesirable substance (e.g., used coffee grounds), seal in a bag, and place in the household trash. Do not flush unless specifically instructed.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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