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Phenobarbital Effects in Cholestatic Liver Disease

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Grant support: General Clinical Research grants RR 125 from Yale University, New Haven, Connecticut, and RR 55 from University of Chicago, Chicago, Illinois; and a grant from G. D. Searle & Co., Chicago, Illinois. Dr. J. R. Bloomer is an Investigator, Howard Hughes Medical Institute; Dr. J. L. Boyer is a recipient of an Academic Career Development Award in Digestive Diseases from the United States Public Health Service.

Presented in part in May 1973 at the annual meeting of the American Gastroenterological Association, New York, New York, and published in abstract form (Gastroenterology 64:702, 1973).

▸Requests for reprints should be addressed to Joseph R. Bloomer, M.D., Yale University School of Medicine, 333 Cedar St., New Haven, CT 06510.

Ann Intern Med. 1975;82(3):310-317. doi:10.7326/0003-4819-82-3-310
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Fifteen patients with cholestatic disorders were treated for 1 to 5 months with phenobarbital. Primary biliary cirrhosis was diagnosed in seven, sclerosing cholangitis in two, intrahepatic biliary hypoplasia in three, and cholestatic hepatitis in three. Except for the patients with cholestatic hepatitis, in whom marked cholestasis was virtually the only abnormality in liver biopsy specimens, serum bilirubin and bile acid concentrations were diminished during therapy, the hepatic clearance of sulfobromophthalein and 131I-rose bengal was variably enhanced, and there was relief from pruritus. Serum cholesterol concentrations and other measures of hepatic function were not significantly changed during therapy except for serum alkaline phosphatase activity, which rose in twelve patients. Parallel changes occurred in 5′-nucleotidase, suggesting a hepatic origin for the alkaline phosphatase activity. These studies indicate that phenobarbital therapy is associated with improvement in organic anion clearance in some patients with cholestatic disorders and may be beneficial to such patients.





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