Bile is a yellowish green fluid secreted by the liver that contains bile acids, cholesterol, and bilirubin. It travels from the liver through ducts to the gallbladder where it is stored. Bile's main functions are to facilitate lipid digestion and eliminate waste from the body. Some drugs can affect bile flow by either increasing or decreasing it. Drugs like phenobarbital, theophylline, glucagon, and insulin increase bile flow, while ethacrynic acid, oestrogens, and chlorpromazine decrease bile flow.

1. BILE FLOW
BILE
Bile is a yellowish green fluid secreted by the liver.
Composition:
It contains bile acids or bile salts, cholesterol, phospholipids, bilirubin,
electrolytes and water.
Pathway
Bile travels through the liver in a series of ducts, eventually exiting through
the common hepatic duct.
Bile flows through this duct into the gallbladder, where it is stored.

3. FUNCTION
The main functions of bile are:
• To facilitate lipid absorption and digestion
• To eliminate waste products from the body.

4. AFFECT OF DRUGS
Many drugs are eliminated via the hepatobiliary routes, after
biotransformation in the liver. Some of them may affect bile flow or
the hepatic secretion of biliary lipids such as bile ducts , cholesterol
and phospholipids.
There are several drugs which affect the bile flow. these drugs affect
bile flow in two ways:
• By increasing bile flow
• By decreasing bile flow

5. INCREASE IN BILE FLOW
The drugs which cause increase in bile flow includes:
a. Phenobarbital
b. Theophylline
c. Glucagon
d. Insulin

6. PHENOBARBITAL
• Phenobarbital, like other barbiturates works by increasing the activity of
inhibitory neurotransmitter (GABA)
• It is recommended by World Health Organization (WHO) for the treatment of epilepsy
and seizures in young children.
• It usually begins working within five minutes when used intravenously and half an hour
when administered by mouth. Its effects last for between four hours and two days.
• Phenobarbital at doses of 5mg/kg per day increases bile flow 30_50% in all animals .
• Phenobarbital is useful for insomnia and anxiety.

7. THEOPHYLLINE
• Theophylline is used together with other medicines to treat the symptoms
of asthma, bronchitis, emphysema, and other lung diseases.
• Theophylline is used to prevent and treat wheezing, shortness of
breath, and chest tightness caused by asthma, chronic bronchitis,
emphysema, and other lung diseases. It relaxes and opens air
passages in the lungs, making it easier to breathe
• Theophylline stimulates gastric secretions, and it should also be used
with caution in people with chronic gastritis, gastroesophageal reflux
disease (GERD), hiatal hernia, or an active peptic ulcer, as it may
exacerbate gastrointestinal symptoms.

8. THEOPHYLLINE
Common Side Effects Of Theophylline Include:
• Abdominal Discomfort Or Pain
• Diarrhea
• Headache
• Insomnia
• Dizziness
• Restlessness
• Nausea And Vomiting
• Skin Redness

9. GLUCAGON
• Glucagon is a peptide hormone, produced by alpha cells of the pancreas.
• It raises concentration of glucose and fatty acids in the blood stream.
• Glucagon has short duration of action.
• It is used to treat hypoglycemia in diabetes mellitus as a part of
gastrointestinal imaging procedure.
• If 1mg dose in injected intramuscularly , it show action within 8_10
minutes and lasts for 12_27 minutes.

10. INSULIN
• Insulin is a peptide hormone produced by beta cells of the pancreatic
iselets encoded in humans by ins gene.
• It is considered to be the main anabolic hormone of the body.
• It decreases glucose level in body.
• It insulates its action by binding to a glycoprotein receptor on the surface
of the cell.
• Insulin is a hormone that helps to control your bodys blood sugar level
and metabolism .

11. DECREASE IN BILE FLOW
Drugs which causes decrease in bile flow are:
• Ethacrynic acid
• Oestrogens
• Chlorpromazine

12. ETHACRYNIC ACID
• Ethacrynic acid is used to treat high blood pressure and swelling caused
by diseases like congestive heart failure, liver failure and kidney failure.
• Furosemide , orally taken 80mg and IV dose is 40mg.
EFFECTS
• Nausea
• Vomiting
• Stomach Pain
• Loss Of Appetite
• Thirst

13. CHLORPROMAZINE
• Chlorpromazine is used to treat the symptoms of schizophrenia and other
psychotic disorders.
Doses:
Nausea and vomiting ………10_25mg in 4_6 hours.
During surgery……….125mg repeated in 30 minutes.