MDAC was given in view of the long elimination half-life and enterohepatic circulation
If there is any disturbance in the enterohepatic circulation
of bile salts, it can decrease the relative concentration of bile salts in gallbladder and can lead to the formation of cholesterol stones (5,6).
It also remains unknown whether puerarin is eliminated through the bile and thereby undergoes extensive enterohepatic circulation
as for other isoflavones (Sfakianos et al.
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.
Partial diversion of the enterohepatic circulation
using BAS depletes the endogenous bile acid pool by approximately 40%, thus stimulating an increase in bile acid synthesis from cholesterol, which lowers low-density lipoprotein cholesterol (LDL-C) by 15 to 26%.
3) In the intestines, most bile acids are reabsorbed into the enterohepatic circulation
by the ileal bile acid transporter.
Ezetimibe, a Schering-Plough drug, inhibits cholesterol absorption both from the gut and the enterohepatic circulation
The mammalian lignans, enterodiol and enterolactone, can be excreted directly in the feces, or after being absorbed in the gut, they enter the enterohepatic circulation
where they are conjugated with glucuronate, and then excreted in urine and bile [10,11].