Therapeutic Benefits and Risks of Tauroursodeoxycholic Acid (TUDCA)

Mechanism of Action

TUDCA increases the secretory capacity of hepatocytes through post-transcriptional mechanisms that stimulate vesicular exocytosis and insertion of transporters into the canalicular membrane 1
TUDCA strengthens the "biliary bicarbonate umbrella" that protects hepatocytes and cholangiocytes from bile acid-mediated damage 1

The American Association for the Study of Liver Diseases recommends UDCA (the parent compound of TUDCA) for treatment of primary biliary cholangitis (PBC) at doses of 13-15 mg/kg/day 2
In intrahepatic cholestasis of pregnancy (ICP), UDCA is recommended for treatment of maternal pruritus and to reduce the risk of spontaneous preterm birth, particularly when serum bile acid concentrations exceed 40 μmol/L 3, 4
UDCA treatment in ICP has been associated with reduction in maternal ALT and bilirubin concentrations 1
UDCA treatment in ICP has been associated with protection against adverse fetal outcomes, including reduction in spontaneous preterm birth 1
UDCA treatment in ICP has been associated with protection against cholic acid-induced arrhythmia in fetal cardiac myocytes 1
The American Association for the Study of Liver Diseases specifically does not recommend UDCA for treatment of primary sclerosing cholangitis (PSC) 5

Most evidence for non-liver applications of TUDCA comes from animal studies or small pilot human trials 5
The optimal dosing for various conditions is not well-established outside of liver diseases 5
For liver conditions, UDCA (the parent compound) is better studied and has more established clinical guidelines 2

For liver conditions like PBC and ICP, UDCA (rather than TUDCA) is the established treatment with strong guideline support 2, 3, 6