Pharmacological Group and Classification
Cholenzym (Cholenzymum) belongs to the subgroup of choleretics — cholagogue agents that specifically stimulate the bile-producing function of the liver (unlike cholekinetics, which stimulate the release of already formed bile).
To understand the drug's place in clinical practice, it is essential to know the classification of choleretics by origin. They are divided into four main groups:
- Bile acid-containing preparations (true choleretics). These are agents of animal origin. They include single-ingredient drugs and extracts (Cholenzym, Allochol, Lyobil), as well as combined enzyme preparations containing bile components (Panzinorm, Festal, Digestal, Enzistal).
- Synthetic choleretics. These possess a specific chemical structure that stimulates bile secretion. Representatives include Hydroxymethylnicotinamide (Nicodine), Cyclovalone, and Osalmid (Oxaphenamide).
- Herbal choleretics. These include immortelle flowers (Flamin), corn silk, rose hips (Holosas), and complex herbal preparations (Liv-52).
- Hydrocholeretics. These increase the volume of bile exclusively through the water component, thereby reducing its viscosity. A typical representative is valerian root rhizomes.
Composition and Mechanism of Action
Cholenzym is a combination drug consisting of natural components of animal origin. Its composition includes:
- Dry bile — serves as a source of bile acids, providing a direct choleretic effect (stimulating bile production by the liver).
- Dried slaughterhouse cattle pancreas tissue — contains pancreatin, which is necessary for the digestion of macronutrients.
- Dried small intestine mucosa of slaughterhouse cattle.
Due to this composition, the drug exerts a combined effect: it not only enhances bile formation but also improves digestive processes in the gastrointestinal tract through enzymatic support.
Comparative Characteristics with Other True Choleretics
On pharmacology exams, students are frequently asked to compare Cholenzym with other drugs from the group of true choleretics:
- Allochol (Allocholum). Unlike Cholenzym, it contains dry animal bile in combination with herbal extracts (garlic, nettle) and activated charcoal. In addition to its cholagogue effect, Allochol inhibits intestinal fermentation processes. It is prescribed for chronic hepatitis, cholangitis, cholecystitis, and atonic constipation. However, it has a broader range of specific contraindications: acute hepatitis, hepatic dystrophy, and peptic ulcer disease of the stomach and duodenum. Potential side effects include diarrhea and allergy.
- Lyobil (Lyobilum). This represents lyophilized ox bile. Its key feature is an extremely high concentration of bile acids (5 times greater than in Cholenzym or Allochol). It is taken strictly at the end of a meal.
- Enzyme preparations with bile (Panzinorm, Festal, Digestal, Enzistal). Unlike Cholenzym, where the emphasis is on the choleretic effect, these drugs are primarily designed to improve digestion in the gastrointestinal tract (comprehensive enzymatic action).
Indications and Contraindications
Indications for Use: Cholenzym is prescribed for chronic diseases of the liver and biliary tract.
Contraindications: The primary, absolute contraindication for Cholenzym (as well as for the entire group of choleretics) is a mechanical obstruction to bile outflow — obstructive jaundice. Prescribing cholagogues in the presence of bile duct blockage (e.g., by a gallstone or tumor) leads to a sharp increase in pressure within the biliary system, severe pain, and the risk of duct rupture.
Dosage Form and Prescription Writing
The drug is available as compound tablets. The standard route of administration is oral, with a single dose of 1 tablet.
Example of a prescription for Cholenzym: ```latin Rp.: Tab. Cholenzymi N. 50 D.S. Take 1 tablet orally. ``` (Note: because the drug has a complex composition, its proprietary brand name is used in the prescription).