Which specific antimuscarinic drugs are used as chole-spasmolytics?

The provided reference materials do not list specific brand names or INNs of antimuscarinics used as chole-spasmolytics. They only mention the pharmacological group of atropine-like substances without detailing specific drugs.

What drugs belong to synthetic choleretics?

The synthetic choleretics group includes compounds with a chemical structure that stimulates bile secretion. The main representatives of this subgroup are Hydroxymethylnicotinamide (Nicodine), Cyclobalhone, and Osmalide (Oxaphenamide). In addition to choleretic action, these drugs often exert anti-inflammatory and antimicrobial effects.

Which bile acid preparations are used for medical dissolution of gallstones (cholelitholytic therapy)?

Bile acid preparations are used for the medical dissolution of cholesterol gallstones in the gallbladder. This group includes chenodeoxycholic acid (Chenofalk) and ursodeoxycholic acid (Ursofalk). These cholelitholytic agents promote the dissolution of existing stones by impairing intestinal cholesterol absorption, inhibiting its hepatic synthesis, and forming liquid crystals.

Which gastrointestinal hormones are involved in regulating bile secretion and elimination?

Gastrointestinal hormones and peptides participate in the regulation of bile formation and elimination. Humoral factors stimulating bile secretion include secretin, glucagon, gastrin, and cholecystokinin-pancreozymin. Bile elimination and gallbladder motility are regulated by cholecystokinin, which is released by endocrine cells of the small intestine.

What is the difference between true choleretics and hydrocholeretics?

True choleretics stimulate the synthesis of bile acids by hepatocytes. Hydrocholeretics (e.g., mineral waters) increase bile volume solely through water, reducing its viscosity and increasing fluidity.

Why are preparations containing bile contraindicated in mechanical jaundice?

In the presence of an outflow obstruction (such as a duct stone), additional stimulation of secretion leads to a sharp increase in pressure within the biliary tract, causing severe colic and liver damage.

What is the mechanism of action of cholekinetics?

They irritate duodenal receptors, provoking the release of the hormone cholecystokinin. This results in the simultaneous contraction of the gallbladder and relaxation of the sphincters, ensuring bile ejection.

Home › Pharmacology › Cholagogues: Classification, Mechanism of Action, and Clinical Use

Cholagogues

Cholagoga

For medical students2 min readUpdated 2026-10-10

Cholagogues are a pharmacological group of medications that increase hepatic bile secretion or promote its release into the duodenum. They are used to improve digestion, prevent gallstone formation, and resolve inflammatory processes within the biliary system.

Site of actionHepatic hepatocytes and smooth muscle of the biliary tract

Main contraindicationObstructive (mechanical) jaundice

HydrocholereticsIncrease bile volume exclusively by increasing water content

CholekineticsContract the gallbladder while simultaneously relaxing the sphincters

Classification by Mechanism of Action

Globally, all cholagogues are divided into two major categories depending on the stage of bile dynamics they affect:

Choleretics — stimulate the bile-forming function of the liver.
Bile-expelling agents — affect the tone and motility of the biliary tract. This group is further subdivided into cholekinetics (increase gallbladder tone) and cholespasmolytics (decrease biliary tract tone).

Choleretics: Stimulators of Bile Formation

The primary mechanism of choleretics is the direct stimulation of hepatocyte secretory function. In addition to increasing bile volume, they provide a kinetic "washing" effect, preventing ascending infection, and a litholytic effect by increasing the concentration of bile acid salts (cholates) to prevent cholesterol precipitation.

There are four subgroups:

True choleretics (contain bile acids): Animal-derived preparations. Holenzyme contains dry bile combined with pancreatic and intestinal mucosal enzymes. Allochol is supplemented with garlic and nettle extracts, as well as activated charcoal (to suppress fermentation). Liobil features a high concentration of bile acids (5 times greater than analogues). Combined enzyme preparations (Festal, Panzinorm) are also included here.
Synthetic choleretics: Chemical compounds that often possess additional antimicrobial and anti-inflammatory properties (Hydroxymethylnicotinamide). Some agents, such as Osmalide, provide a hypolipidemic effect by lowering blood cholesterol and bilirubin levels.
Herbal choleretics: Extracts of Helichrysum arenarium (Flamin), rose hips (Holosas), corn silk, and the multi-herb complex Liv-52. They act via essential oils and flavonoids, exerting a complex secretory, anti-inflammatory, and antimicrobial effect.
Hydrocholeretics: Mineral waters (containing sulfate anions) and valerian root rhizomes. They increase bile volume through the water component by limiting water reabsorption, thus making the bile more fluid.

Agents Regulating Bile Elimination

These agents act at the level of the gallbladder and biliary sphincters.

Cholekinetics irritate the mucosal receptors of the duodenum, triggering the release of endogenous cholecystokinin. As a result, the gallbladder actively contracts while the sphincters relax, leading to substantial gallbladder evacuation. These include:

Polyhydric alcohols: xylitol and sorbitol (administered as 10% solutions).
Saline agents: magnesium sulfate (hypertonic 20–25% solution on an empty stomach) and artificial Carlsbad salt.
Herbal components: the alkaloid berberine, tansy flowers, and vegetable oils (olive, sunflower, sea buckthorn).
Chole-spasmolytics (cholelithics), conversely, relax the smooth muscle of the biliary system. They are necessary to relieve spasm, facilitate bile outflow, and eliminate hyperkinetic dyskinesias. This effect is produced by antimuscarinics (anticholinergics), nitrates (nitroglycerin), methylxanthines, and combination medications (e.g., Olimetin, containing a complex of essential oils and purified sulfur).

Contraindications and Safety

When prescribing cholagogues, contraindications must be strictly considered. An absolute contraindication for all bile-containing and secretion-stimulating preparations is mechanical obstruction to bile outflow (obstructive jaundice).

Furthermore, many preparations (e.g., Allochol, Olimetin) are contraindicated in peptic ulcer disease of the stomach and duodenum, acute hepatitis, and active hepatic dystrophy.

Mnemonic

For quick memorization: Choleretics Reproduce (form) bile in the liver. Cholekinetics provide kinetics (movement), pushing bile out of the gallbladder. Chole-spasmolytics relieve spasm of the ducts.

Frequently asked questions

Which specific antimuscarinic drugs are used as chole-spasmolytics?: The provided reference materials do not list specific brand names or INNs of antimuscarinics used as chole-spasmolytics. They only mention the pharmacological group of atropine-like substances without detailing specific drugs.
What drugs belong to synthetic choleretics?: The synthetic choleretics group includes compounds with a chemical structure that stimulates bile secretion. The main representatives of this subgroup are Hydroxymethylnicotinamide (Nicodine), Cyclobalhone, and Osmalide (Oxaphenamide). In addition to choleretic action, these drugs often exert anti-inflammatory and antimicrobial effects.
Which bile acid preparations are used for medical dissolution of gallstones (cholelitholytic therapy)?: Bile acid preparations are used for the medical dissolution of cholesterol gallstones in the gallbladder. This group includes chenodeoxycholic acid (Chenofalk) and ursodeoxycholic acid (Ursofalk). These cholelitholytic agents promote the dissolution of existing stones by impairing intestinal cholesterol absorption, inhibiting its hepatic synthesis, and forming liquid crystals.
Which gastrointestinal hormones are involved in regulating bile secretion and elimination?: Gastrointestinal hormones and peptides participate in the regulation of bile formation and elimination. Humoral factors stimulating bile secretion include secretin, glucagon, gastrin, and cholecystokinin-pancreozymin. Bile elimination and gallbladder motility are regulated by cholecystokinin, which is released by endocrine cells of the small intestine.
What is the difference between true choleretics and hydrocholeretics?: True choleretics stimulate the synthesis of bile acids by hepatocytes. Hydrocholeretics (e.g., mineral waters) increase bile volume solely through water, reducing its viscosity and increasing fluidity.
Why are preparations containing bile contraindicated in mechanical jaundice?: In the presence of an outflow obstruction (such as a duct stone), additional stimulation of secretion leads to a sharp increase in pressure within the biliary tract, causing severe colic and liver damage.
What is the mechanism of action of cholekinetics?: They irritate duodenal receptors, provoking the release of the hormone cholecystokinin. This results in the simultaneous contraction of the gallbladder and relaxation of the sphincters, ensuring bile ejection.

Go deeper

Specific features of enzyme preparations containing bile components (Panzinorm, Festal, Enzistal).
Synthetic choleretics with marked anti-inflammatory action (Hydroxymethylnicotinamide, Cyclobalhone).
Pharmacodynamics of complex herbal preparations (Liv-52, Cholagol).
Polyhydric alcohols and saline solutions: schedules for course administration of cholekinetics.
Combined chole-spasmolytics: composition and homeopathic action of Olimetin.