Digoxin secretion into bile

Hedman A. Inhibition by basic drugs of digoxin secretion into human bile. Eur J Chn Pharmacol 1992 42(4) 457-9. 

Liver disease or injury may impair bile secretion and thereby lead to accumulation of certain drugs, for example probenecid, digoxin, and diethylstilbestrol. Impairment of liver function can lead to decreased rates of both drug metabolism and secretion of drugs into bile. These two processes, of course, are frequently interrelated, since many drugs are candidates for biliary secretion only after appropriate metabolism has occurred. 

Certain drugs are excreted in urine only in small amounts but appear in high concentrations in the bile for example, erythromycin, novobiocin, tetracycline, phenolphthalein etc. The abnormality or any disease related to liver may impair bile secretion which can lead to the accumulation of certain drugs like probenecid, digoxin etc. This can also lead to decreased drug metabolism and decreased rates of secretion of drugs into bile. 

Several studies highlight the use of mdrl-knockout mice to investigate P-glyco-protein function in vivo [45, 46]. In bile duct-ligated mice, 16% of digoxin administered i.v. was secreted into the gut lumen of control animals, whereas only 2% was secreted in mdrl-knockout mice [47], This finding supports the earlier observations... 

Drugs in Class II have low aqueous solubility (but high membrane permeability), and any factor affecting dissolution rate would be expected to have an impact on the absorption of such compounds. Factors that are noted in Fig. 11, such as fluid pH, volume and viscosity, and bile secretion (especially in response to fatty foods), might be expected to play a role in dissolution rate and thereby affect absorption. Compounds that fall into this class include carbamazepine, cyclosporin, digoxin, griseofulvin, and spironolactone. Food would be expected to exert a potentially significant affect on... 

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