Medical therapy for gallstones. 2. Initiation and monitoring.

After review of the history and baseline laboratory studies, gallstone dissolution therapy with chenodeoxycholic acid is begun at a dosage of 500 mg/day and gradually increased to an optimum dosage of 15 mg/kg/day. Periodic assessment is necessary to monitor progress of stone dissolution and to detect hepatocellular injury or bile duct obstruction. The risks of complications of biliary tract disease do not abate until the stones are dissolved. Unless there is unequivocal evidence of progressive dissolution within 16 months, treatment should be discontinued.