Biliary excretion of drugs in man

Biliary excretion is an important route for the elimination of some drugs and drug metabolites in man. The factors which determine elimination via the biliary tract include characteristics of the drug such as chemical structure, polarity and molecular size as well as characteristics of the liver such as specific active transport sites within the liver cell membranes. A drug excreted in bile may be reabsorbed from the gastrointestinal tract or a drug conjugate may be hydrolysed by gut bacteria, liberating original drug which can be returned to the general circulation. Enterohepatic circulation may prolong the pharmacological effect of certain drugs and drug metabolites, but the quantitative importance of this in man appears to be less than in animals. Biliary elimination may play a role in the interindividual differences in drug response observed in healthy subjects and in patients with certain diseases. Cholestatic disease states, in which normal bile flow is reduced, will influence drug elimination by this route resulting in increased risk of drug toxicity. Bile may serve as an alternate route of elimination in renal failure, but this has not been determined in man. Lack of reliable information regarding the biliary excretion of drugs in man is partly due to the relative inaccessibility of the human biliary tract. Most studies of drug excretion in human bile have been performed in post-surgical patients with T-tube drainage. This method of bile collection is not ideal because bile flow and composition are often severely altered during the period of study, not all bile is collected and enterohepatic circulation is partially interrupted. Recent advances in the methods of collection of bile may improve future studies of drug excretion in human bile.

Uptake of unconjugated bilirubin by isolated rat hepatocytes

The mechanism responsible for the hepatic uptake of unconjugated bilirubin was examined in isolated rat hepatocytes from control and phenobartital-pretreated rats. The uptake was extremely rapid and the equilibrium between cell and medium was attained within 60 s with a 100-fold higher concentration in the cell than the medium. The initial velocity of uptake (Vo) exhibited a linear relationship to the bilirubin concentration in the medium. Pretreatment of cells with various metabolic inhibitors had no effect on the uptake of unconjugated bilirubin. Ouabain did significantly decrease Vo, but replacement of sodium ion with choline or lithium had no effect on bilirubin uptake. The organic acids sulfobromophthalein (112 muM) and taurocholic acid (50 (muM) and two steroidal compounds, diethylstilbestrol (50 muM) and spironolactone (50 muM), had no effect on the uptake of bilirubin. It is suggested that bilirubin gains access to the hepatocyte interior by passive diffusion into and through the lipid membrane and that intracellular binding may explain the high degree of bilirubin accumulation associated with the isolated hepatocytes.

Carrier-mediated transport of the organic cation procaine amide ethobromide by isolated rat liver parenchymal cells

Using hepatocytes isolated by collagenase perfusion, we studied the kinetic characteristics of the uptake process for procaine amide ethobromide (PAEB). Determination of initial uptake velocities (Vo) at substrate concentrations from 30 to 400 micrometer demonstrated a saturable process with a Km of 54 +/- 10 micrometer and a Vmax of 0.13 +/- 0.01 nmol/min/mg of protein. Pretreatment of cells with metabolic inhibitors and reduction of the incubation temperature significantly reduced the Vo of 100 micrometer PAEB. Replacement of sodium ions with lithium had no effect, while replacement with choline decreased Vo by 75%. The intracellular concentration of PAEB was 18 times the medium concentration after 90 min, but 33% of that was in the acetylated form. Uptake of N4-acetyl PAEB occurred at a much lower rate and reached a cell/medium ratio of only 6 after 90 min. Only one of seven quaternary amines tested inhibited PAEB uptake at an inhibitor/substrate ratio (I/S) of 7.5, while four out of five tertiary amines significantly decreased Vo at an I/S of 0.75 and all five decreased it at a ratio of 7.5. Some organic acids and steroidal compounds also significantly decreased PAEB Vo at an I/S of 0.75, while others from each group had no effect at an I/S of 7.5. Because uptake is saturable, requires metabolic energy, and occurs against an electrochemical gradient, it is suggested that the hepatic accumulation of PAEB occurs via an active, carrier-medicated transport process.

Comparison of biliary excretory function and bile composition in male, female, and lactating female rats

The rates of excretion of phenol-3,6-dibromphthalein disulfonate, ouabain, indocyanine green, and amaranth into the bile of male and female rats were found to be similar. The rates of bile production in male and female rats were also similar whereas that of lactating rats was 50% greater. The increase in bile production occurred during pregnancy and decreased rapidly after removal of the pups from the dam. The increased bile production was of canalicular origin and was due to an increase in both the bile salt-dependent and independent fractions. The lactating rats tended to excrete some xenobiotics more rapidly than did the other rats, but no difference in the biliary excretion was observed in male and female rats.

Digoxin in hyperthyroidism

A patient with chronic atrial fibrillation developed hyperthyroidism. Increasing doses of digoxin were required to maintain satisfactor ventricular rate control. The systemic availability of oral digoxin was decreased in this patient. The metabolism of digoxin was studied in the hyperthyroid rats. The plasma digoxin concentrations were significantly decreased in the hyperthyroid rats. A threefold increase in digoxin excretion in the bile of the hyperthyroid rats was associated with these changes in plasma digoxin concentrations. Conversely, hypothyroid rats excreted less digoxin in the bile when compared with control and hyperthyroid rats. Thus, changes in digoxin absorption and its biliary excretion result, in part, in a decreased therapeutic effect of digoxin based on dose in hyperthyroidism.

First-pass effect of morphine in rats

In order to evaluate the first-pass effect of morphine, the pharmacokinetic parameters of 3H-morphine (5 mg/kg) were studied in male Sprague-Dawley rats by comparing the plasma concentrations after oral, intravenous and intraportal administration. Morphine was almost completely absorbed from the gastrointestinal tract, since no significant difference was found in the cumulative urinary excretion of radioactivity after intravenous and oral administration. Route of administration had no affect on plasma half-life (about 115 minutes) of unchanged morphine. In contrast, the area under the plasma concentration vs. time curve for morphine after oral administration was only about 18%, and after intraportal administration about 40% of that observed after intravenous administration. It can be estimated that approximately two-thirds of the overall first-pass effect (82%) of morphine is due to extraction and/or metabolism in the intestine and the remaining one-third by the liver.