The Effects of Phenobarbital on Bile Salts and Bilirubin in Patients with Intrahepatic and Extrahepatic Cholestasis

In two children with intrahepatic cholestasis treated with phenobarbital (10 mg per kilogram of body weight per day) for four days, serum bile salt concentration decreased from 100 to 400 to 1 to 10 μg per milliliter, and pruritus disappeared. The serum bilirubin concentrations were reduced to 20 to 50 per cent of pretreatment values, and the 131I-Rose Bengal fecal excretion increased during treatment. In contrast, phenobarbital had no effect on serum bile salts, bilirubin, 131I-Rose Bengal excretion and pruritus in a child with extrahepatic biliary obstruction. Decreased serum bile salt concentrations and concomitantly increased fecal excretion of Rose Bengal in phenobarbital-treated patients suggest that the barbiturate stimulates bile secretion and biliary excretion of bile salts. It may be helpful in the management of young patients with intrahepatic cholestasis.