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The biliary excretion and apparent oral clearance of metoclopramide (MCL) were determined after oral administration of 1 mg MCL/kg body weight to 10 patients suffering from extrahepatic cholestasis with nasobiliary tube for drainage of the common bile duct. A bilioduodenal endoprosthesis was subsequently fitted in 6 of these patients, i.e. the enterohepatic circulation was restored, and the apparent oral clearance was re-determined. Biliary excretion, comprising free MCL and the products of conjugation, accounted for less than 1% of the administered dose. In accordance with this, the median areas under the plasma concentration-time-curves AUC(0-15 h) in patients with intact and interrupted enterohepatic recirculation were of similar size. The pharmacokinetic values in patients with cholestasis (median apparent oral clearance 0.5 l.kg-1.h-1; median t1/2 4.5 h) were similar to those previously reported in patients with healthy liver function. We conclude that it is not necessary to adjust single doses of MCL in patients recovering from obstructive jaundice.

The purpose of this randomized controlled trial was to evaluate the analgesic efficacy of a series of applications of sulfurated mud baths in outpatients suffering from back pain. Within 2 weeks 13 patients took 6 sulfurated mud baths (group A) and 12 patients 6 tap water baths (group B) at home. Before the bath and over 48 h after starting the 1st and the 6th bath, pain intensity was evaluated by the patients according to a visual analogue scale (VAS). The main outcome parameter was the weighted (for time of observation) sum of pain intensity (SPI) after the 6th bath. The mean SPI in group A was 741 mm × h (95% CI 594–864 mm × h) and in group B 1,112 mm × h (95% CI 929–1,252 mm × h) (p = 0.009), suggesting a significantly stronger analgesic effect of a series of sulfurated mud baths than of a series of tap water baths.

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