[Elimination of drugs in cholecystectomized patients. Studies with silymarin in patients with extrahepatic complications].

Following a single oral administration of silymarin (Legalon) approx. 7-15% of its main component silybin was determined in the 24 h-bile of 10 cholecystectomized patients with T-drainage. In one case the value was 25%. Considering that through the T-tube only one to two thirds of the bile output can be collected and consequently analysed, the total amount of silybin eliminated via the bile must be estimated higher. There didn't appear to be a relationship between the amounts of bile and silybin. In further 4 female patients the silybin excretion measured for 24 h was decreased (values of 1-4%) and the elimination was considerably delayed. Two of these 4 females with reduced elimination of silybin suffered from diabetes mellitus, one from pancreatitis and the fourth from a carcinoma of the stomach metastasising into the liver. Only in the patient with liver metastasis and in that with pancreatitis was the reduced silybin elimination linked with a decrease in bile output. The remaining two females neither showed a correlation between bile output nor amount of silybin excreted. In the one diabetic female the bile collected for 24 h was considerably high, i.e. more than 1 litre. As reasons for the decrease in the biliary elimination of silybin an impairment of metabolism and absorption are discussed.