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AIM:To investigate the systemic availability of budesonidein a patient with Child A cirrhosis due to autoimmune hepatitis(AIH) and primary hepatocellular carcinoma,who developedserious side effects.METHODS:Serum levels of budesonide,6β-OH-budesonideand 16α-OH-prednisolon were measured by HPLC/MS/MS;portosystemic shunt-index (SI) was determined by 99mTcnuclear imaging.All values were compared with a matchedcontrol patient without side effects.RESULTS:Serum levels of budesonide were 13-foldincreased in the index patient.The ratio between serumlevels of the metabolites 6β-OH-budesonide and 16α-OH-prednisolone,respectively,and serum levels of budesonidewas diminished (1.0 vs.4.0 for 6β-OH-budesonide,4.2 vs.10.7 for 16α-OH-prednisolone).Both patients hadportosystemic SI (5.7 % and 3.1%) within the range ofhealthy subjects.CONCLUSION:Serum levels of budesonide Vary uP to 13-fold in AIH Patients with Child A eirrhosis in the absenee ofrelevant Portosystemic shunting.Redueed hePatiemetabolism,as indicated by redueed metabolite-to-drugratio,rather than Portosystemie shunting may explainsystemic side effects of this drug in cirrhosis
AIM: To investigate the systemic availability of budesonide in a patient with Child A cirrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma, who developed serous side effects. METHODS: Serum levels of budesonide, 6β-OH-budesonide and 16α-OH-prednisolon were measured by HPLC / MS / MS; portosystemic shunt-index (SI) was determined by 99mTcnuclear imaging. All values were compared with a matched control patient without side effects .RESULTS: Serum levels of budesonide were 13-fold increased in the index patient. ratio between serum levels of the metabolites 6β-OH-budesonide and 16α-OH-prednisolone, respectively, and serum levels of budesonide was diminished (1.0 vs.4.0 for 6β-OH-budesonide, 4.2 vs.10.7 for 16α- Patients hadportosystemic SI (5.7% and 3.1%) within the range of heart subjects.CONCLUSION: Serum levels of budesonide Vary uP to 13-fold in AIH Patients with Child A eirrhosis in the absenee ofrelevant Portosystemic shunting. Redueed he Patiemetab olism, as indicated by redueed metabolite-to-drugratio, rather than Portosystemie shunting may explainystemic side effects of this drug in cirrhosis