Effect of Clofibrate on the Metabolism of Bilirubin, Bromosulphophthalein and Indocyanine Green and on the Biliary Lipid Composition in Gilbert's Syndrome

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Abstract
Clofibrate (20 mg/day per kg body wt) given orally for 2 wk to 18 subjects with Gilbert''s syndrome reduced the total serum bilirubin concentration from 44.4 (22.1-71.7) .mu.mol/l (median, range) to 15.0 (7.9-28.9) .mu.mol/l, mainly by decreasing the indirect fraction to 34.5% of pretreatment values. In contrast to treatment with phenobarbitone, clofibrate did not change the ratio of bilirubin mono- to diconjugates in bile. The initial plasma disappearance rate of indocyanine green and of bromosulfophthalein did not show consistent changes during clofibrate treatment but the apparent maximal biliary secretion capacity of bromosulfophthalein (Tm) decreased in most of the patients studied, whereas the relative storage capacity (S) tended to increase. The cholesterol saturation of bile increased in all subjects. Clofibrate apparently increases mainly the glucuronidation of bilirubin, promoting as such the overall hepatic transport in Gilbert''s syndrome. It decreases the maximal biliary secretion of bromosulfophthalein, possibly by an increased hepatic retention. These phenomena might be linked to the augmented content of Z protein in the liver.