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ursodeoxycholate

First FDA approval 12/31/1987: 39 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

C

Score breakdown (66/100)

Safety ×35%
B
Evidence ×25%
F
Regulatory ×15%
A
Money & lawsuits ×15%
A
Options ×10%
C

Safety: 82

Evidence: 6

Regulatory history: 91

Money & lawsuits: 100

Options: 70

What the FDA label says

Approved uses

250 and URSO Forte (ursodiol) tablets are indicated for the treatment of patients with primary biliary cholangitis (PBC). URSO 250 and URSO Forte (ursodiol) tablets are bile acids indicated for the treatment of patients with primary biliary cholangitis. ( 1 )

Contraindications

Patients with complete biliary obstruction and known hypersensitivity or intolerance to ursodiol or any of the components of the formulation. Patients with complete biliary obstruction and known hypersensitivity or intolerance to ursodiol or any of the components of the formulation. ( 4 )

Warnings and precautions

Abnorma l Liver F unction T ests : Liver function tests (γ-GT, alkaline phosphatase, AST, ALT) and bilirubin level should be monitored. Treatment discontinuation should be considered if parameters increase to a level considered clinically significant in patients with stable historical liver function test levels. Caution should be exercised to maintain patients’ bile flow. ( 5.1 ) Enteroliths in Patients with Risk for Intestinal Stenosis or Stasis : Monitor for obstructive gastrointestinal symptoms; if symptoms occur, hold ursodiol until a clinical evaluation has been conducted. ( 5.2 ) 5.1 Abnormal Liver Function Tests Liver function tests (γ-GT, alkaline phosphatase, AST, ALT) and bilirubin levels should be monitored every month for three months after start of therapy, and every six months thereafter. This monitoring will allow the early detection of a possible deterioration of the hepatic function. Treatment discontinuation should be considered if the above parameters increase to a level considered clinically significant in patients with stable historical liver function test levels. Caution has to be exercised to maintain the bile flow of the patients taking ursodiol. 5.2 Enterol...

Adverse reactions (label)

Most common adverse reactions reported with the use of ursodiol during worldwide postmarketing and clinical experience (≥1%) are, in alphabetical order: abdominal discomfort, abdominal pain, alopecia, diarrhea, nausea, pruritus, and rash. ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Allergan at 1-800-678-1605 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Studies Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. The following table summarizes the adverse reactions observed in two placebo-controlled clinical trials. ADVERSE REACTIONS VISIT AT 12 MONTHS VISIT AT 24 MONTHS UDCA n (%) Placebo n (%) UDCA n (%) Placebo n (%) Diarrhea --- --- 1 (1.32) --- Elevated creatinine --- --- 1 (1.32) --- Elevated blood glucose 1 (1.18) --- 1 (1.32) --- Leukopenia --- --- 2 (2.63) --- Peptic ulcer --- --- 1 (1.32) --- Skin rash --- --- 2 (2.63) --- Thrombocytopenia --- --- 1 (1.32) --- Note: Those adverse reactions occurring at the same or highe...

Recent major label changes

Warnings and Precautions ( 5.2 ) 1/2023

Source: FDA SPL label for Urso 250 (Allergan, Inc.), effective 20230112. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

30,036reports that mention this drug
29,904of those blame this drug, not another one the person was taking
84%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
14.4%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Off Label Use · 2,540Pruritus · 1,621Diarrhoea · 1,575Pyrexia · 1,422Nausea · 1,345Fatigue · 1,318Drug Ineffective · 1,238Pneumonia · 1,081Death · 948Vomiting · 944Anaemia · 940Decreased Appetite · 813Headache · 807Dyspnoea · 776Acute Kidney Injury · 737

Reports per year

20192020202120222023202420252026
3,0092,8222,8342,5132,3252,3142,5801,202

12,361 reports blaming this drug for every million Medicare prescriptions filled, which is 4.5× the typical drug on this site. (6,043 reports in 2024–2026, against 488,896 Medicare fills in one year. This is the one number here that accounts for how many people take the drug.)

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

0recall actions on file
2 / 22brand / generic applications
3label changes since 2021
NoREMS program

Evidence base

7randomized trials (PubMed)
0systematic reviews
220registered trials
28%of completed trials posted results
14%terminated or withdrawn
27%industry-funded

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this drug across 0 transactions.

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

111,500Medicare Part D patients (2024)
488,896prescriptions filled
$160average cost per fill
$78Mtotal Medicare spend
ProductFills$/fill
Ursodiol488,500$159
Reltone343$1,752
Urso28$1,113
Urso Forte25$1,166

Same-class alternatives

No same-class alternatives found in RxClass.

Questions to ask your prescriber

  1. The most-reported problems in FDA's adverse event data are pruritus, diarrhoea, pyrexia. How would we recognize and handle those?
  2. Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?
  3. What result are we expecting, by when, and what is the plan if it does not happen?
  4. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)