Ursosan: therapeutic effects and new application possibilities. XXI International Congress “Hepatology Today”. Satellite symposium of the company PRO.MED.CS Praha as

Pharmacodynamics and pharmacokinetics

The composition determines the effect of this medicine. Its active component is ursodeoxycholic acid . Ursodeoxycholic acid has high polar properties and creates non-toxic mixed micelles with toxic bile acids. This leads to a decrease in the ability of gastric reflux to damage cell membranes with the appearance of reflux esophagitis and biliary reflux gastritis . In addition, the drug Ursosan creates double molecules that enter the cell membranes of hepatocytes, epithelial cells of the gastrointestinal tract, and cholangiocytes. These molecules stabilize them and make them immune to the influence of cytotoxic micelles.

The active substance of the drug also reduces the content of bile acids, which are toxic to hepatocytes, and stimulates choleresis, saturated with bicarbonates. Thanks to this, intrahepatic cholestasis disappears. Ursodeoxycholic acid reduces the lithogenic index of bile and cholesterol by preventing its absorption in the intestine, reducing secretion in bile, and inhibiting synthesis in the liver. As a result, cholesterol gallstones dissolve. The product also prevents the appearance of new stones.

The drug acts as an immunomodulatory agent by inhibiting the expression of HLA-2 and HLA-1 and improving the normal killer activity of lymphocytes . In addition, it prevents the development of fibrosis in people with primary biliary cirrhosis , as well as alcoholic steatohepatitis and cystic fibrosis . Reduces the likelihood of varicose veins in the esophagus, slows down premature aging and cell death.

The active substance of the drug is absorbed from the small intestine by passive diffusion (absorption rate is approximately 90%), and in the ileum by active transport. The maximum concentration is reached after approximately 60-180 minutes.

The degree of binding to plasma proteins is up to 99%. With chronic use, ursodeoxycholic acid becomes the main bile acid in the blood serum. The therapeutic effect of the drug depends on its content in bile.

The drug is broken down in the liver with the formation of metabolic such as glycine and taurine conjugate. They are secreted into bile. Approximately 60% of the total dosage is excreted in bile. Some of the active substance is also transported to the colon, where it is broken down by bacteria. Lithocholic acid is absorbed to a small extent from the colon, sulfated in the liver and excreted as sulfolithocholylglycine or sulfolitocholyltaurine conjugate.

Effect of the drug

According to the study, it has been proven that ursodeoxycholic acid is quickly absorbed in the intestine and is integrated into liver cells and provides them with protection from various negative factors, including toxic and alcohol damage. When taking the medicine, congestion in the organ decreases and the removal of acids accelerates.

Ursosan, the instructions for use emphasize this, has a choleretic effect. The active substance is capable of:

• Reduce cholesterol production in the liver and slow down its absorption in the intestines.
• Reduce the saturation of bile with cholesterol.
• Increase the content of bile acids.
• Increase the solubility of cholesterol in the biliary system.

Indications for use of Ursosan

On forums people often ask what pills can help with in this or that case. Experts do not recommend taking them without consulting a doctor. Only he can determine whether there are indications for the use of Ursosan. In addition, he selects the desired treatment regimen.

If you have been prescribed Ursosan tablets, the indications for use are usually as follows:

• uncomplicated cholelithiasis ;
• the need to prevent recurrent stone formation after cholecystectomy ;
• acute hepatitis;
• alcohol disease and primary biliary cirrhosis ;
• biliary dyskinesia
• cystic fibrosis of the liver;
• biliary dyspeptic syndrome;
• toxic liver damage;
• chronic active hepatitis ;
• non-alcoholic steatohepatitis;
• atresia of the intrahepatic biliary tract;
• primary sclerosing cholangitis ;
• biliary reflux gastritis and reflux esophagitis ;
• the need to prevent liver damage when taking hormonal contraceptives and cytostatics.

Contraindications

This drug should not be used in case of hypersensitivity to its components, non-functioning gallbladder, chronic hepatitis , pancreatitis , acute cholecystitis , liver cirrhosis (with decompensation), acute cholangitis , acute infectious diseases of the gallbladder, diseases of the bile ducts, pregnancy , breastfeeding , bile -gastrointestinal fistula, gallstones with high Ca2+ content, inflammatory diseases of the small and large intestines, liver failure , renal failure , empyema of the gallbladder, obstruction of the biliary tract.

Contraindications and adverse reactions

The main contraindication is hypersensitivity to the active ingredient. In addition, ursosan is not prescribed in the presence of gallstones with a high calcium content, as well as in cases of impaired contractility of the gallbladder and its diseases in the acute stage.

Contraindications include:

• Liver cirrhosis in the stage of decompensation.
• Liver and/or kidney failure.

It is not recommended to take the medicine in the 1st trimester of pregnancy and during lactation. Treatment of children with the drug should be carried out only in exceptional cases.

No cases of drug overdose have been recorded. Adverse reactions during treatment with urososan may include diarrhea. In rare cases, abdominal pain has been reported.

Side effects of Ursosan

Reviews of side effects appear infrequently. However, if any unwanted reactions occur, you should definitely consult a doctor.

The following side effects of Ursosan are known:

• vomit;
• exacerbation of psoriasis ;
• nausea;
• diarrhea;
• transient increase in the activity of liver transaminases;
• constipation;
• painful sensations in the back;
• allergy;
• alopecia.

In rare cases, gallstones may become calcified.

Special instructions for the use of the drug Ursosan

Successful conservative treatment of cholelithiasis is possible in the presence of purely cholesterol (X-ray negative) stones with a diameter of no more than 2 cm, preserved gallbladder function; stones should not fill more than half the volume of the gallbladder. During long-term treatment (more than a month), periodically, once a month, it is necessary to determine the activity of liver transaminases, especially in the first 3 months of treatment. Unlike chenodeoxycholic acid, the embryotoxicity of ursodeoxycholic acid has not been proven. Therefore, the decision to use Ursosan during pregnancy is made by the doctor. The use of Ursosan during breastfeeding is recommended only in case of urgent need.

Instructions for use of Ursosan (Method and dosage)

For those who have been prescribed Ursosan tablets, the instructions for use indicate that they should be taken orally with liquid.

The medicine has different dosage regimens depending on the disease. For those who are interested in how to take Ursosan: before or after meals, it is also reported that this is individual, depending on the indications for use.

In the case of diffuse liver diseases and cholelithiasis , the course of treatment can last from several months to several years, the daily dosage is usually 10-15 mg per 1 kg of the patient’s body weight (2-5 capsules). For cholelithiasis, the daily dosage is taken once immediately before bedtime. Treatment is carried out until the stones dissolve, and then another 3 months to ensure that the stones do not form again. For diffuse liver diseases, the instructions for use of Ursosan indicate that the daily dosage should be divided into 2-3 doses. The product should be taken during meals.

After cholecystectomy and for the purpose of preventing recurrent cholelithiasis , 250 mg is usually prescribed 2 times a day. The course lasts several months.

For primary biliary cirrhosis, the medicine is taken in a dosage of 10-15 mg per 1 kg of patient body weight per day. If necessary, it can be increased to 20 mg per 1 kg. The dosage should be divided into 2-3 doses. The course of treatment lasts from 6 months to several years.

If the patient has non-alcoholic steatohepatitis , take 13-15 mg per 1 kg of the patient’s weight per day. The dosage should be divided into 2-3 doses. The course of treatment can last from 6 months to several years.

In the case of biliary reflux gastritis and reflux esophagitis, the medicine is taken 1 capsule (250 mg) per day immediately before bedtime. Therapy is carried out from 10 days to 6 months. If necessary, it can be extended up to 2 years.

For liver damage , biliary atresia alcoholic liver disease, the daily dosage is usually 10-15 mg per 1 kg of patient weight. The daily dosage should be divided into 2-3 doses. The course is designed for six months, a year or more.

If the patient has primary sclerosing cholangitis , the doctor usually prescribes 12-15 mg per 1 kg of the patient’s body weight per day. If necessary, the dosage can be increased to 20 mg per 1 kg of weight. The total daily dose is divided by the patient into 2-3 doses. The course of admission is from six months to several years.

For cystic fibrosis, the drug is taken in dosages of 20-30 mg per kg per day. The dose should be divided into 2-3 doses. The course lasts from six months to several years.

For children over 2 years old, the amount of the drug taken per day is determined individually by a specialist. Typically 10-20 mg per kg per day is prescribed.

In order to eliminate severe and dangerous jaundice, specialists in some cases prescribe this remedy to newborns. Therapy is designed for 2-4 weeks. Instructions for use of Ursosan for newborns indicate that the dosage for children of this age is a quarter of a capsule every day. The powder in it is poured onto a saucer. Then it is divided into four equal parts, one of which is given to the baby. It must first be dissolved in water or breast milk. If treatment is successful, the course can be reduced to 10 days. In this case, you need to monitor the level of bilirubin in the blood every week. On average, its level decreases by 50 units per week. Once the blood concentration reaches 100 mg/ml, the medicine can be discontinued.

Composition and release form

Ursosan, the instructions for use indicate this, contains ursodeoxycholic acid. Today, hepoprotective drugs based on it are considered the most effective.

The medicine is produced in the form of gelatin capsules filled with a mixture of white powder and powder granules in an amount of 250 mg. You can purchase Ursosan in blister packs of 10 or 20 capsules. The medicine is also offered in polyethylene jars containing 10, 20, 50 or 100 capsules. Cardboard packages must contain instructions for use.

Analogues of Ursosan

Level 4 ATC code matches:
Ursodex

Henofalk

Ursoliv

Ursofalk

Choludexan

Ursohol

Ursodez

Urdoxa

Livodex

The names of analogues of this drug are presented in the following list:

• Ursolak
• Ursoliv
• Ursolysin
• Ursomax
• Ursonost
• Ursofalk
• Ursohol
• Essentiale
• Choludexan

All analogues of Ursosan have their own characteristics of action and application. None of them should be replaced independently without consulting a doctor. The price of analogues may vary depending on the amount of medicine in one package. However, in most cases their cost is higher than the described drug in a similar quantity.

Let's take a closer look at some Ursosan analogues.

Ursofalk or Ursosan - which is better?

In most cases, when choosing between these two drugs, experts believe that the first remedy is better. This has been confirmed by many clinical observations, patient reviews and many years of practice. People who have taken both drugs note that Ursofalk is easier to tolerate. And experts report that it dissolves gallstones faster and improves liver condition.

However, the difference between Ursosan and Ursofalk for each specific case can only be understood in practice. There are people for whom a medicine like Ursosan is more suitable. So you can first prescribe a course of Ursofalk, and, if the treatment is not effective enough, move on to another drug. In this way, the best treatment method can be selected.

Ursosan or Essentiale - which is better?

As a hepatoprotector , Essentiale is much more effective in maintaining liver function. In addition, this remedy does not have as many side effects. So for those who choose the drug when it is necessary to normalize liver function, doctors in most cases recommend a second remedy. Ursosan is more expensive and has less effect on the cellular structure.

Urdoxa or Ursosan - which is better?

Urdoxa is a domestically produced product, which is a generic version of Ursosan. However, all the necessary components for its manufacture are purchased abroad. Thus, all the components in it are the same as in the original drug. In fact, these are complete analogues, and the difference between them lies only in the country of origin. Many, however, choose a domestic product, since its cost is much lower.

Ursoliv or Ursosan - which is better?

Both drugs have the same main component. Some patients tolerate one drug better, while others tolerate the other. In this situation, individual effectiveness can only be verified in practice. All this depends on the characteristics of the body, so you should start taking one of the remedies, and if it does not help, move on to another. There are no objective signs to help determine the effectiveness of each of these drugs. Many patients prefer to try each of the remedies and then choose the most effective one.

Treatment and non-treatment during pregnancy

Pregnancy is a special state of the body when all systems are reconfigured in a protective manner: you need to protect the fetus. But pregnant women also get sick, both from common colds and from something more serious. Well, and, of course, toxicosis, which spoils part of the happy period for almost all expectant mothers. Everyone around, and sometimes doctors, perceive a pregnant woman as the Holy Grail, into which it is better not to send any pills again, but often the lack of proper treatment is more harmful than the policy of “wait it out, it will go away on its own.” Even more dangerous is self-medication, especially with herbs - for some reason people often underestimate their potential harm. Let's figure out what medications pregnant women can and cannot take. Toxicosis The most common complaints are nausea, vomiting and heartburn. All “matryoshkas” can take acid-lowering drugs, and the best of them are proton pump inhibitors: pantoprazole (Nolpaza, Controloc) is the most reliable, esomeprazole (Emanera, Nexium) is the strongest, rabeprazole (Razo) can be taken regardless of food intake. But the old and well-known omeprazole (Omez), although approved, has a number of disadvantages, including insensitivity to it in 13% of people, an unknown elimination rate (and the required frequency of administration, respectively) and side effects with long-term use.

Gaviscon is added to “-prazoles” upon request - it envelops the esophagus, relieves heartburn and creates a protective “raft” on the surface of food (taken after meals) that does not allow acid to rise up. Maalox, Phosphalugel and Almagel are less preferable because contain magnesium or aluminum, and they affect the stool: magnesium softens, aluminum strengthens.

Bismuth preparations (De-nol, Ulcavis) are prohibited. For persistent nausea, Itopride (Ganaton, Itomed) is taken before meals, but Domperidone (Motilium, Motilak) is less preferable, because may cause arrhythmia.

Stagnation of bile Against the background of increased levels of sex hormones, bile thickens, and gallstones may even form. If there is heaviness in the right side or a bitter taste, then the doctor, based on the results of the examination (ultrasound of the obstructive system, blood biochemistry), will select a choleretic agent (Ursosan or its brothers, Hofitol) or an antispasmodic (mebeverine) for spasms of the biliary tract. It must be said that for any cramps or abdominal pain, pregnant women can take mebeverine (Duspatalin, Sparex), and, unlike no-shpa (which, in principle, is also possible), it is allowed to drink it for as long as desired.

They write different things about Ursosan during pregnancy on the Internet; in fact, the drug has been used for a long time, and the benefits of it for cholestasis (stagnation of bile) are much greater than the fears of it. Heptral is used during pregnancy, and although its effectiveness has recently been questioned by some researchers, it has been successfully used for damage to liver cells. However, its appointment is always within the competence of the attending physician only. Other drugs that present themselves as hepatoprotectors are NOT such. Karsil, Legalon, Silymarin, Gepabene, Liv52 and other milk thistle are ways for pharmaceutical companies to make money. And the advertised Essentiale and Phosphogliv can also cause harm, giving a phospholipid load to the already suffering liver (they are not prescribed for normal liver tests, but for elevated ones they are not prescribed, as you can read about even in the instructions).

Toilet issue As pregnancy progresses, the intestines move away and are pressed by the uterus, plus progesterone slows down intestinal peristalsis, which causes constipation. They can be treated for a long time with lactulose (Duphalac), bran (Eubicor), PEG (Forlax) or, on demand, Bisacodyl or Fitolax. At the end of gestation (and for some even earlier), diarrhea appears; this is a consequence of the influence of interleukins, substances that prepare the cervix for dilatation. If you need to “go out into the world” where there is no restroom nearby, loperamide (Immodium) or Smecta is used on demand. For diarrhea due to poisoning, Enterosgel or Polysorb are used. Of course, it is not recommended to buy Kolofort and other homeopathic medicines, because homeopathy does not work and cannot work.

We live in a world of evidence-based medicine, as the World Health Organization and the Russian Ministry of Health taught us all, so don’t waste money on “bullshit”, rather have a wonderful weekend, it will even be more effective as a placebo. And more pleasant.

Drugs like Hilak Forte have proven ineffectiveness and additionally increase the acidity of gastric juice, and there is a lot of controversy about probiotics. In fact, everything is clear: Bifiform, Probiologist, Buck Set and some of their brothers are able to suppress a mild intestinal infection without being absorbed as “their” new flora (they come like riot police, which is why all the “swindlers” scatter, giving them the opportunity to grow on their own native lacto- and bifido-intestinal protectors). A similar mechanism occurs when using antibiotics - both “enemies” and “friends” die, which is why the opportunistic flora multiplies to alarming limits, but lacto-bifido is always stronger and will always suppress the uprising of dubious bacteria.

Enzymes It is worth talking separately about pancreatic enzymes. Pancreatins are not needed by everyone and not always; They are prescribed by a doctor based on the results of stool tests (coprogram, elastase), if the pancreas cannot cope with the entire volume of work. This allows food to be better absorbed, which is especially important during pregnancy, when a lack of nutrients can threaten the mother with problems with teeth and more. By the third trimester, the load on the pancreas increases threefold, which can also manifest as gestational diabetes mellitus (the pancreas secretes both enzymes and insulin).

That is why expectant mothers are sent to check their glucose levels with enviable regularity. It is easy to suspect a lack of enzymes: bloating, pieces of undigested food in the stool and, most importantly, stool that is difficult to flush, sticky due to the content of undigested fats.

Food, as we know, is the best medicine, and expectant mothers need to think about what they eat. The main principle is everything, but in moderation. The child will most likely never develop an allergy to the foods that the mother ate while pregnant, which is why the food should be varied. And delicious.

Herbal medicine As already mentioned, herbal medicine is not as safe as we would like. For example, chamomile and echinacea in the first trimester can greatly harm the course of pregnancy and even terminate it.

In a tablet, all the substances have been studied inside and out, but in herbs there are hundreds of active ingredients in unknown concentrations, and how they will all interact with your body is unknown, and therefore dangerous. Herbs are often prescribed for kidney disease or cystitis in the form of drugs Cyston, Urolesan, Canephron. There have been no serious studies on the drugs, but Cyston definitely cannot be taken during pregnancy, Urolesan is not prohibited, and whether Canephron is effective is a big question. But mineral waters (acidic or alkaline, depending on the type of kidney disease) are reliably curative.

Here I would like to mention vitamins. The story with them is different: they are drunk by all groups of the population, although in reality they are needed only by pregnant and lactating women. To make the right choice, carefully study the composition. Alphabet, Elevit, Vitrum quite well fill the increased needs for “utilities”.

Colds In addition to digestive problems, pregnant women, like all people, face colds. Respiratory infections can be viral or bacterial, which determines how they are treated. To get rid of bacteria, antibiotics are prescribed, which expectant mothers usually fear like fire. And in vain, because the potential harm to the baby due to infection in the mother’s body can be much higher. In addition, such medications are prescribed only for severe infections (tonsillitis, pyelonephritis), and a number of antibacterial drugs have shown sufficient safety during pregnancy.

These are amoxicillin, cefazolin, cefatoxime and azithromycin. The sensitivity to other approved antibiotics (ampicillin, erythromycin) in the microorganisms around us is lower, so they are prescribed less often. Antibiotic sprays cannot create an adequate bactericidal dose and have not been recommended since 2013; only tablets are used.

Local remedies for bacterial infections in the throat include Lyzobact (contains lysozyme, a natural salivary antiseptic) and Sinupret (herbs), although their effectiveness has not been proven in large studies. But what has been definitely proven is the absolute absence of anti-ARVI viral drugs and immunomodulators. Interferons are not able to be absorbed from mucous membranes; they are used only for hepatitis C and only in the form of injections. The list of “Fuflomycins” is huge, because everyone who has the flu wants to believe in a “cure pill”, and pharmaceutical companies make their billions from this.

Drugs that are reliably not working include: Antigrippin, Amiksin, Anaferon, Arbidol, Aflubin, Viferon Imudon, Immunal, Ingavirin, Irs19, Cytoflavin, Polyoxidonium... Separately, it is worth mentioning Tamiflu. For a long time, doctors from different countries, including Russia, England, and France, were honestly mistaken about it, but after the patent expired it turned out that the studies were fabricated, and its effectiveness is not comparable with its price. To facilitate the discharge of sputum, there are also fictitious drugs that you should not take: Gelomirtol, Gedelix, Pertussin. They work and are allowed for pregnant women, however, only in the 2-3 trimesters Bromhexine, Ascoril, ACC and Fluifort.

It is better to try not to catch a cold and activate the body’s natural defenses using natural methods: walks in the fresh air, a balanced diet and long sleep.

Matters of the heart Both from anxiety in anticipation of a new life, and from an increase in body weight and the number of blood vessels during pregnancy, the load on the heart increases, and sometimes blood pressure changes. Usually, if a woman is healthy, her blood pressure decreases because the pregnancy hormone progesterone turns on a protective “sleepy” mode. But if there were prerequisites (kidney disease, atherosclerosis), as well as under stress, blood pressure and pulse may increase. There are hypertension that existed before pregnancy and gestational hypertension that arose in connection with pregnancy. Regardless of how long ago it is, high blood pressure needs to be corrected, and here is an important point: almost all of the most prescribed heart medications and blood pressure pills are strictly prohibited.

Among them are everyone’s favorite Enap, Prestarium, Lozap, Valz, Hypothiazide, Furosemide. In the second and third trimesters, if you are careful, you can use Physiotens and Amlodipine; there are discussions regarding Concor. To quickly reduce elevated blood pressure, you need to take nifedipine orally, for pain in the heart - nitroglycerin, and then call an ambulance: blood pressure and the heart are not to be trifled with, and self-medicating in such a situation can be dangerous for both lives.

As always, and here there are many drugs that do not work, “fuflomycins” have not been spared in the cardiovascular field. What no one, especially pregnant women, should have at home: Validol, Corvalol, Valocordin, Cavinton, Mildronate, Mexidol, Cerebrolysin, Preductal, Actovegin, Solcoseryl, Gliatilin, Glycine, Pantogam, Octolipen, Piracetam, Phenotropil. Many note the subjective effect of Mexidol, Octolipen and Mildronate, but this is personal experience, not a proven effect. Forget about them.

Of the vascular products used to treat varicose veins, which always worsen during pregnancy due to weight bearing on the legs, only Detralex works well, which is not contraindicated for expectant mothers.

For nerves The birth of a child radically changes a woman’s life: there will be less time for usual hobbies, but the joys of communicating with the baby will appear. And, of course, fears may arise: “Will I be a good mother? Which school should I choose? What if he becomes a football player?..” It `s naturally. Although sometimes experiences that are not necessarily related to the baby can be very disturbing.

Among the sedatives often prescribed to expectant mothers are Novopassit, Phenibut, Afobazol, Tenoten. In general, it is possible to take them, but it is pointless: if they work, it is as a placebo. The decision to prescribe serious medications is made by the doctor in each case individually. To date, it has been proven that taking antidepressants during pregnancy does not cause a risk of heart defects in the fetus, does not reduce the IQ of the child, and does not increase the mortality of either the fetus or the child. Don't be afraid, but don't do anything on your own. But what every expectant mother can do herself is to take care of her peace of mind, walk, enjoying the beautiful scenery, listen to her favorite music, create and read good books.

Bruises Changes occur in the coordination of movements as the abdomen enlarges, and maintaining balance is no longer so easy, so not everyone can avoid bruises and sprains. Locally, in such situations, it is absolutely possible to apply creams and gels with NSAIDs (painkillers-anti-inflammatory), Diclofenac and Airtal penetrate the skin best. But chondroitins like these - Piaskledin, Structum, Teraflex, Alfutop - you guessed it, nonsense. A special nod to Traumeel, who not only doesn’t work, but relates to homeopathy in general. Group B drugs in certain concentrations and ratios (Milgamma or Combilipen) can provide pain relief no worse than diclofenac; this is a proven fact without a described mechanism of action, i.e. we don't know how, but it works.

If the pain is severe, enduring it may be more harmful than taking a pill. The safest choice is Nurofen. And No-spa, if the pain is due to muscle tension, spasms (any pain in the abdomen) or due to high blood pressure.

Pregnancy is the best time in a woman’s life; it is the peak of hormone levels, thanks to which she can perceive the world even more deeply, see colors more vividly, and perceive harmony in everything. Pregnancy is an inspiring flight of inspiration! So let it be easy and pleasant for all continuers of the family, and let the doctor help with the little things.

Enjoy motherhood and be healthy!

Reviews about Ursosan

Reviews of drug treatment can often be found on specialized forums. Doctors also express their opinions. They note the effectiveness of this drug. Patient reviews are also mostly positive. Some also take it as a prophylactic in cases where a large load on the liver is expected.

With regard to use for newborns, doctors' reviews of Ursosan usually report that the treatment was effective. Parents turn to them when their children develop jaundice. Those who gave the medicine according to the specialist’s instructions leave reviews about Ursosan, which say that the drug helped.

Ursosan price, where to buy

This medicine can be bought in Ukraine, Belarus and Russia. How much this drug costs depends largely on the number of capsules in one package.

You can buy this product in Moscow and other Russian cities at the following prices:

• price of Ursosan 100 tablets (250 mg) - approximately 1,500 rubles;
• price of Ursosan 50 capsules – approximately 800 rubles;
• the price of a package of 10 capsules is approximately 200 rubles.

Average price of Ursosan in Ukraine:

• capsules of 50 pieces per package – approximately 600 hryvnia;
• capsules of 100 pieces per package - approximately 1000 hryvnia;
• capsules of 10 pieces per package - approximately 100 hryvnia.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Ursosan capsules 250 mg 10 pcs. Pro.Med.Cs
  161 rub. order
• Ursosan forte tab. p.p.o. 500 mg 100 pcs. PRO.MED.CS Prague j.s.

  RUB 3,152 order

• Ursosan forte tab. p.p.o. 500 mg 50 pcs. PRO.MED.CS Prague j.s.

  RUB 1,574 order

• Ursosan caps. 250 mg No. 100 ZiO-Zdorovye ZAO

  RUB 1,586 order

Pharmacy Dialogue

• Ursosan (tab.p.pl/vol.500mg No. 50)Pro.Med.Cs.

  1580 rub. order

• Ursosan (caps. 250 mg No. 10) Pro.Med.Cs.

  150 rub. order

• Ursosan (caps. 250 mg No. 100)ZiO-Zdorovye CJSC

  RUB 1,558 order

• Ursosan (caps. 250 mg No. 10) Pro.Med.Cs.

  RUB 174 order

• Ursosan (caps. 250 mg No. 50) Pro.Med.Cs.

  RUB 843 order

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Pharmacy24

• Ursosan 250 mg No. 100 capsules PRO.MED.CS Prague a.t., Czech Republic/ PRO.MED.CS Prague a.s., Czech Republic
  1022 UAH.order

PaniPharmacy

• Ursosan capsule Ursosan caps. 250 mg No. 50, PRO.MED.CS Prague

  610 UAH. order

• Ursosan capsule Ursosan caps. 250 mg No. 100, PRO.MED.CS Prague

  1048 UAH order

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