This system is illustrated by the bile salts, which are conserved by circulating through liver, intestine and portal blood about eight times a day. A number of drugs form conjugates with glucuronic acid in the liver and are excreted in the bile. These glucuronides are too polar (ionised) to be reabsorbed; they therefore remain in the gut, are hydrolysed by intestinal enzymes and bacteria, releasing the parent drug, which is then reabsorbed and reconjugated in the liver. Enterohepatic recycling appears to help sustain the plasma concentration and thus the effect of sulindac, pentaerythritol tetranitrate and ethinyloestradiol (in many oral contraceptives).
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