Cholenzim

Pharmacological group and classification

Cholenzym (Cholenzymum) belongs to the subgroup of choleretics — choleretic agents that specifically stimulate the bile-forming function of the liver (as opposed to cholekinetics, which stimulate the release of already formed bile).

To understand the drug's place in the physician's arsenal, it is necessary to know the classification of choleretics by origin. They are divided into four main groups:

1. Preparations containing bile acids (true choleretics). These are agents of animal origin. They include monopreparations and extracts (Cholenzym, Allochol, Lyobil), as well as combined enzyme preparations with bile components (Panzinorm, Festal, Digestal, Enzistal).
2. Synthetic choleretics. They possess a specific chemical structure that stimulates bile secretion. Representatives: Hydroxymethylnicotinamide (Nicodin), Cyclovalone, Osalmid (Oxaphenamide).
3. Plant-based choleretics. Include immortelle flowers (Flamin), corn silk, rose hip fruits (Cholosas), and complex herbal preparations (Liv-52).
4. Hydrocholeretics. They increase bile volume exclusively through the water component, thereby reducing its viscosity. A typical representative is valerian rhizomes.

Composition and mechanism of action

Cholenzym is a combined preparation consisting of natural animal-derived components. It includes:

• Dry bile — acts as a source of bile acids, providing a direct choleretic effect (stimulation of bile production by the liver).
• Dried pancreatic tissue of slaughter livestock — contains pancreatin, which is necessary for the breakdown of macronutrients.
• Dried mucosa of the small intestine of slaughter livestock.

Due to this composition, the drug has a complex effect: it not only enhances bile formation but also improves digestive processes in the gastrointestinal tract through enzyme support.

Comparative characteristics with other true choleretics

In pharmacology exams, students are often asked to compare Cholenzym with other drugs from the true choleretics group:

• Allochol (Allocholum). Unlike Cholenzym, it contains dry animal bile combined with plant extracts (garlic, nettle) and activated charcoal. In addition to its choleretic effect, Allochol suppresses fermentation processes in the intestine. It is prescribed for chronic hepatitis, cholangitis, cholecystitis, and atonic constipation. However, it has a broader range of specific contraindications: acute hepatitis, hepatic dystrophy, gastric ulcer and duodenal ulcer. Side effects may include diarrhea and allergies.
• Lyobil (Lyobilum). It is lyophilized bovine bile. Its key feature is an ultra-high concentration of bile acids (5 times higher 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 focus is on the choleretic effect, these drugs are primarily intended to improve digestion in the GI tract (complex enzyme action).

Indications and contraindications

Indications for use: Cholenzym is prescribed for chronic diseases of the liver and biliary tract.

Contraindications: The main, absolutely strict contraindication for Cholenzym (as well as for the entire group of choleretics) is mechanical obstruction to bile outflow — obstructive jaundice. Prescribing choleretics during bile duct blockage (e.g., by a calculus or tumor) will lead to a sharp increase in pressure in the biliary system, a severe pain attack, and the risk of duct rupture.

Formulations and prescription guidelines

The drug is available as compound tablets. The standard route of administration is oral, with a single dose of 1 tablet.

Sample prescription for Cholenzym: ```latin Rp.: Tab. Cholenzymi N. 50 D.S. Oral, 1 tablet. ``` (Note: since the preparation has a complex composition, its patented trade name is used in the prescription).

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Complete classification of choleretic agents (choleretics and cholekinetics)
• Synthetic choleretics: mechanisms of action of Nicodin and Oxaphenamide
• Plant-based choleretics and hydrocholeretics: indications for use
• Combined enzyme preparations with bile (Festal, Panzinorm)
• Pathophysiology of obstructive jaundice and risks of using choleretics

Other topics in the «Drugs and Prescriptions» section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.