Who Should Not Take TUDCA? Interactions and Cautions

TUDCA's medicine labels say it should not be taken in pregnancy, with an active peptic ulcer, with frequent gallbladder attacks, or with a blocked or inflamed gallbladder or bile duct, and the Italian label adds breastfeeding. The labels also list medicines to space or avoid, such as bile acid binders, aluminum antacids and estrogens, and say blood levels of cyclosporine should be checked.

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Most TUDCA product pages say little about who shouldn't take it, and the interaction lists online are often unsourced or inferred from laboratory work. Yet TUDCA has been a licensed medicine in Italy since 1991, and its official labels set out the cautions clearly [1].

This guide goes through those cautions in plain language: the situations in which TUDCA shouldn't be taken, the medicines to space, avoid or monitor, and what is known about kidneys, older adults, children and people with liver disease. It finishes with the questions worth asking a pharmacist.

Who Should Not Take TUDCA?

The Italian and Turkish medicine labels say TUDCA should not be taken in these situations [1, 2]:

• pregnancy
• breastfeeding, which the Italian label rules out and the Turkish label says to weigh carefully
• an active peptic ulcer
• frequent gallbladder attacks
• acute inflammation of the gallbladder or bile ducts, or a blocked bile duct
• after removal of the last part of the small intestine, with an ileostomy, or with severe pancreatic or bowel conditions that disturb how bile acids are recycled

For people who still have a gallbladder, the labels add more. They rule out calcified gallstones, and two labels rule out a gallbladder that contracts poorly; one also rules out conditions in which gallbladder removal is recommended, such as gallbladder inflammation that doesn't respond to treatment or pancreatitis caused by gallstones [1, 3, 2].

The labels were written for TUDCA prescribed as a medicine, mainly for gallstone problems and, in Turkey, for liver conditions too, with a doctor overseeing treatment [1, 3, 2]. As a supplement, TUDCA is used to support healthy bile flow and fat digestion, but the same cautions are the best guide available.

Is TUDCA Safe During Pregnancy or Breastfeeding?

We found no study of TUDCA in pregnant women, and both labels count pregnancy as a reason not to take it [1, 2]. Their animal data differ: the Italian label points to studies of other bile acids that raised concerns for the baby in early pregnancy, while the Turkish label describes rat and rabbit studies of TUDCA itself that didn't show that problem.

Both labels also ask women who could become pregnant to use reliable contraception, and the Turkish label specifies a non-hormonal method [1, 2]. No one knows yet whether TUDCA reaches breast milk; the Italian label rules it out while breastfeeding, and the Turkish label leaves it to a careful weighing of benefit to mother and baby [1, 2].

What Medicines Interact With TUDCA?

The labels list these medicines to keep in mind [1, 2]:

• bile acid binders such as cholestyramine and colestipol, to be taken at least two hours apart from TUDCA
• antacids containing aluminum, also two hours apart
• cyclosporine, an anti-rejection drug, whose blood levels should be checked
• estrogens, found in most menopausal hormone therapy, and hormonal contraceptives, which the labels advise avoiding
• some cholesterol-lowering drugs, with clofibrate given as an example on the Italian label
• the antibiotic ciprofloxacin, the anti-infective dapsone and the blood pressure drug nitrendipine, whose effect the labels say TUDCA may reduce in rare cases
• on the Italian label, drugs that can harm the liver

None of these interactions has been tested in a study designed for the purpose, so they are cautions rather than proven effects [1]. Cholestyramine's own label adds that other drugs should be taken at least an hour before or four to six hours after it [4].

What about medicines not on the label?

We found no study in people testing TUDCA together with blood thinners such as warfarin, statins, metformin, GLP-1 medicines or thyroid medicine, and none of these is named on the labels, although statins could fall under "some cholesterol-lowering drugs". Some people in trials took TUDCA alongside medicines such as insulin without problems being reported [5], but that is not the same as testing for an interaction.

Is TUDCA Good for the Kidneys?

We found no study of TUDCA in people with kidney disease. The Turkish label says not to use it in severe kidney failure [2]. In one six-week study in people with ulcerative colitis, kidney tests did not change [6], but that says little about people whose kidneys are already affected.

Can Older Adults Take TUDCA?

None of the trials was set up for older adults, and none broke its side effects down by age. Where trials gave an average age, it was in the late 40s to late 50s [7, 8, 9, 10], the 199-person liver trial enrolled people up to age 70 [11], and the Turkish label notes it has no reports for this age group [2]. If you take several medicines, the interaction list above is the part to check.

Can Children Take TUDCA?

According to the labels, TUDCA's safety in children hasn't been shown, and they don't foresee its use in children [1, 2]. One trial gave it to newborns on intravenous nutrition [12], but that was a hospital study in newborns, and it gives no guide to use in children.

Can You Take TUDCA With Liver Disease?

Many of the studies of TUDCA were in people with liver disease, under medical care [13, 11]. When TUDCA is prescribed, the Italian label calls for liver tests every four weeks for the first three months and every three months after that, especially in advanced primary biliary cholangitis [1]. If you have a liver condition, any supplement is worth discussing with the doctor who manages it. Our guide to TUDCA for liver health covers the research.

Can You Take TUDCA With Gallstones?

The labels rule out TUDCA during frequent gallbladder attacks or with acute inflammation or blockage of the gallbladder or bile ducts [1]. Gallstones that cause symptoms are a matter for your doctor, who can discuss options such as surgery or a prescription bile acid [14]. See a doctor right away for a gallbladder attack that lasts several hours, nausea and vomiting, fever or chills, yellowing of the skin or eyes, or tea-colored urine and light-colored stools [15].

What If You've Had Your Gallbladder Removed?

Gallbladder removal isn't on the labels' list of reasons not to take TUDCA [1, 2]. In the one study after gallbladder removal, side effects were reported in 2 of 101 people on TUDCA and 3 of 102 who took nothing [7]. We found no study of how TUDCA is absorbed in people without a gallbladder, and two trials, the year-long ALS trial and an ulcerative colitis study, excluded people who had had it removed [8, 16].

Dr.Primal's TUDCA is made for life after gallbladder removal and taken with meals, to support healthy bile flow and fat digestion. Our guide to TUDCA after gallbladder removal covers it in detail.

Questions to Ask Your Pharmacist

A pharmacist can check TUDCA against everything else you take, so bring the bottle and your medicine list. These questions cover what the labels raise:

• Do any of my medicines bind bile acids, contain aluminum, or affect the liver?
• Do any of my medicines or hormone treatments contain estrogen, cyclosporine, ciprofloxacin or dapsone?
• How should I space TUDCA from my other medicines during the day?
• Does anything in my history, such as an ulcer or bile duct problems, rule it out?

In Summary: Who Should Not Take TUDCA

TUDCA's medicine labels say it shouldn't be taken in pregnancy, with an active peptic ulcer, with frequent gallbladder attacks, or with a blocked or inflamed gallbladder or bile duct, and the Italian label adds breastfeeding. They also list medicines to space, avoid or monitor. Kidney disease, older age and children have little or no data, so the cautions above are the best guide.

If you are working out what is behind your symptoms after meals, our digestion quiz is a quick way to put your symptoms and habits in order.

This article is for general education and is not a substitute for advice from your doctor. TUDCA is sold as a dietary supplement. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.