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Cholagogue is usually divided into 2 groups: agents that enhance the formation of bile and bile acids (Choleretica or Cholesecretica), and agents that promote the secretion of bile from the gallbladder into the intestines (Cholagoga, or Cholekinetica).
Subgroup I includes preparations containing bile acids and bile: allochol, liobil, cholenzyme, etc., a number of herbal remedies (immortelle flowers, corn stigmas, flacumin, konflavin, berberine, etc.), as well as some synthetic preparations (oxafenamide, nicodine, cyclovalon).
The mechanism of action of choleretic substances is due to reflexes from the intestinal mucosa (especially when using preparations of bile and bile acids and preparations containing essential oils), as well as their effect on the secretory function of the liver parenchyma. They increase the amount of secreted bile, increase the osmotic gradient between bile and blood, which enhances the osmotic filtration into the bile capillaries of water and electrolytes, increase the flow of bile through the bile ducts and the content of cholates in the bile, and reduce the possibility of precipitation of bile cholesterol, which prevents the formation of gallstones. They also enhance the secretory and motor functions of the gastrointestinal tract.
Preparations containing bile and bile acids can serve as substitution therapy for endogenous bile acid deficiency.
Drugs that promote the secretion of bile can act by increasing the tone of the gallbladder (cholekinetics) and (or) lowering the tone of the bile ducts and sphincter of Oddi (cholespasmolytic).
Magnesium sulfate, barberry and some other drugs have a cholekinetic effect. The relaxation of the tone of the biliary tract is caused by various antispasmodic drugs (papaverine, no-spa, olimetin, etc.), anticholinergics, as well as nitrates, aminophylline, etc.
Most choleretic drugs have a combined effect, enhancing the secretion of bile and facilitating its entry into the intestine, and some drugs simultaneously have anti-inflammatory (cyclavalone) and antibacterial (nicodine) effects.
It should be borne in mind that the action of choleretic drugs to a certain extent has a "hepatoprotective" character. By facilitating the outflow of bile and thereby reducing the burden on the liver parenchyma, facilitating blood flow, and reducing inflammation, choleretic drugs help improve the overall functional state of the liver.