Decreased hepatic microsomal reserve in patients with cirrhosis. Studies using aminopyrine as model drug

It is unclear whether hepatic drug metabolism which is decreased in patients with liver disease, can be stimulated by enzyme-inducing drugs. Hepatic microsomal reserve, defined as the difference between the basal and phenobarbital-stimulated ABT, was therefore studied in eight healthy control subjects and 12 patients with stable alcoholic cirrhosis. The ABT increased significantly (p less than 0.01) from a basal value of 6.1% +/- 0.8 (mean +/- S.D.) to 8.9% +/- 0.8 in the eight control subjects after phenobarbital ingestion. In the 12 patients with alcoholic cirrhosis the basal ABT was 2.9% +/- 1.5 and did not change significantly after phenobarbital ingestion, when the value was 3.0% +/- 1.6. A small increase in the ABT occurred after phenobarbital ingestion in five of the patients with alcoholic cirrhosis, but in no patient did this increase bring the ABT within normal limits. We conclude that in many patients with stable alcoholic cirrhosis aminopyrine metabolism is decreased and cannot be corrected by treatment with phenobarbital.