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Pharmacokinetics and bioavailabilities of hymecromone in human volunteers.

Specific and ultrasensitive reverse-phase HPLC assays of the choleretic and biliary antispasmodic hymecromone (down to 0.05 ng ml-1) and its glucuronide, using fluorimetric detection, and sulfate metabolites using UV detection, were developed. Sodium salt solutions of 400 mg (over 3 min) and 800 mg (over 5 min) were infused i.v. into 6-8 normal human volunteers. The half-life of the major rate constant averaged 28 +/- 2 min (SE). Subsequently, less than 0.8 per cent of the dose was eliminated with terminal half-lives of 70-359 min. The apparent volume of distribution of hymecromone, referenced to the total plasma concentration, averaged 20.8 +/- 1.41 (Vc, central compartment volume) and 36.4 +/- 2.11 (Vss steady state volume). Hymecromone's total body clearance averaged 1413 +/- 89 ml min-1. The pharmacokinetics of hymecromone were dose-independent. Only 0.3 +/- 0.3 per cent unchanged hymecromone was renally excreted. Mostly dose-independent glucuronidated drug (93 +/- 4 per cent of the dose) was excreted in the urine; a smaller amount was renally excreted as the sulfate (1.4 +/- 0.3 per cent of the dose). The oral bioavailability estimated from the relative areas under the hymecromone plasma concentration-time curves following oral and i.v. administration of hymecromone to six volunteer subjects showed no dose-dependence and was 1.8 +/- 0.6 per cent. However, an anomalous c. 200 per cent of the glucuronide produced by i.v. hymecromone was produced from orally administered hymecromone as determined from the ratio of the AUC values of glucuronide obtained after peroral and i.v. administration of the same dose of hymecromone to demonstrate a high first-pass effect and implicate renal glucuronidation.

Administration, Oral

Postprandial bile-duct kinetics under the influence of 4-methylumbelliferone (hymecromone).

The physiological correlate of biliary colic is a rapid increase in pressure in the presence of biliary obstruction. The relaxing action of hymecromone on the biliary tract provides a pharmacotherapeutic approach. As the symptoms usually occur postprandially we used ultrasonography to examine whether hymecromone was able to reverse the contraction of the common bile duct (CBD) after ingestion of a standardized test meal. The study was designed as prospective, double-blind randomized crossover study versus placebo in 20 healthy volunteers. The width of the CBD was measured ultrasonographically in the fasting subjects and at 1, 3, 5, 10, 15 and 20 minutes after ingestion of a test meal. Then the subjects were given either 400 mg of hymecromone or placebo and the measurement series was repeated. After ingestion of the test meal the width of the CBD decreased by a maximum of 20% after 15 minutes. While there was only a slight increase in the width of the CBD after subsequent administration of placebo, a maximum increase of 36% was measured 10 minutes after administration of hymecromone. The postprandial contraction of the CBD can be reversed within a short time by i.v. administration of hymecromone.

Adult

The relaxant action of hymecromone and lignocaine on induced spasm of the bile duct sphincter.

The retained stone in the common bile duct remains a problem for the surgeon. Although more effective methods are available, mechanical flushing of the bile duct is, when successful, a simple solution. Pharmacological dilatation of the sphincter of Oddi is a logical adjunct to flushing. Pressure changes in the bile duct during flushing were studied in 20 postoperative patients with T-tube drains and the effectiveness of two drugs in reducing Omnopon induced spasm of the sphincter was compared. Hymecromone intravenously and lignocaine via the T-tube were equally effective, reducing sphincter activity in the majority of patients, but there was considerable individual variation.

Adult

[Studies on the effect of 4-methyl-umbelliferon (Hymecromone) in patients following surgical revision of the biliary pathways].

The effect of 4-methylumbelliferone (hymecromone) on postoperative gall volume and residual pressure, serum enzymes, and other parameters in 50 patients after cholecystectomy and choledochotomy with T-tube drainage is measured by a clinical double-blind study. There were several interesting findings: (a) significant less gall flowing from the T tube, (b) highly significant less activity of the enzymes basic phosphatase and of the gamma-glutamyltranspeptidase, and (c) fewer need of analgesics.

Adult

[Pharmacological effects on the motor activity of Oddi's sphincter. Postoperative electromanometric measurements of the bile ducts].

Besides the high diagnostical value of the electromanometric measurement, this method is especially useful for the registration of pharmacological effects upon the sphincter of Oddi. In this study the influence of hymecromon on sphincter function was tested in 138 patients. Hymecromon induced a significant decrease of pressure by prolonging the opening time (p < 0.001). In clinical experiments it could be shown that the increase of pressure induced by morphine in the common bile duct could be equalized by hymecromon within a short time. Depending significantly on the dosage (p < 0.01) there were identical results on the intravenous or intraductal application of hymecromon. An increase of activity of the liver-specific enzymes could not be seen after hymecromon treatment.

Ampulla of Vater

Gallbladder dyskinesia in acalculous biliary colic.

AIMS: To test the hypotheses that: 1) postprandial gallbladder emptying might be abnormal in patients with acalculous biliary colic; and 2) that hymecromone, a drug that increases bile flow and relaxes biliary muscle might improve symptoms. METHODS: Twenty-four women were studied. Twelve patients presented recurrent biliary type of pain in the absence of gallstones, and persistence of contrast in the gallbladder, 24 hours after an oral cholecystogram, suggesting cholesterolosis. Twelve healthy volunteers used as controls had no symptoms and the gallbladder was not visible the day after an oral cholecystogram. Gallbladder emptying induced by an oral meal was studied with ultrasound in both groups before and after the administration of hymecromone. RESULTS: Gallbladder volumes were similar in both groups (23 +/- 10 ml vs. 31 +/- 11 ml; NS). Gallbladder emptying in the control group was simple exponential (R2 = 0.948 +/- 0.059) with a rate of 32 +/- 16 minutes. Gallbladder emptying was bimodal in patients. Gallbladder volume increased to 120% in the first 10 minutes, to empty exponentially thereafter (R2 = 0.964 +/- 0.040. Rate: 29 +/- 22 minutes). This resulted in a marked reduction in gallbladder volume emptied at 40 minutes when compared to controls (30% +/- 27% vs. 54% +/- 14%; p = 0.012). Pretreatment of controls with hymecromone induced an emptying pattern similar to that of patients. In patients, emptying after hymecromone did not change but symptoms were improved. CONCLUSIONS: An abnormal emptying pattern of the gallbladder was identified in patients with acalculous biliary colic, and hymecromone was partly effective to reduce pain, despite a minor effect on gallbladder emptying pattern.

Biliary Tract Diseases