Medications that are poorly intrinsically absorbed and undergo
enterohepatic circulation are likely to be underabsorbed after a malabsorptive bariatric procedure.
It is well-absorbed from the gastrointestinal tract with a significant
enterohepatic circulation.
The jury is still out whether reduced
enterohepatic circulation of COCs caused by disrupted gut flora is fact or textbook theory.
Background & objectives: Organic anion transport protein 1B1 (OATP1B1) is a major transporter protein for bile salt uptake in the
enterohepatic circulation of bile salts.
It also remains unknown whether puerarin is eliminated through the bile and thereby undergoes extensive
enterohepatic circulation as for other isoflavones (Sfakianos et al.
Anion exchange resins, such as cholestyramine, can be helpful, too; they bind bile acids and decrease their
enterohepatic circulation.
In addition, the
enterohepatic circulation of warfarin--in which it is excreted in the bile and then reabsorbed--results in a "second pass" anticoagulant effect and a second interaction with the binder, which can lead to a further decrease in warfarin effectiveness.
