Review of Drug Use in Gilbert's Syndrome

G ilbert's syndrome is a hereditary disorder char­ acterized by mild, persistent unconjugated hy­ perbilirubinemia due to the partial deficiency of hepatic uridine diphosphate-glucuronyl transferases (UDPGTs). It has been reported that there may be at least seven or eight molecular forms of these enzymes present in different mammals. 1 UDPGTs make up the major enzyme system involved in the hepatic elimina­ tion of toxic endogenous substances such as bilirubin and exogenous agents such as drugs. Several drugs such as phénobarbital, spironolactone, Clofibrate, and nicotine have been shown to stimulate the activity of UDPGTs. However, other drugs such as salicylamide and dicumarol have been reported to inhibit these en­ zymes. 3 , 4 Gilbert's syndrome was first described by Gilbert and Lereboullet in 1901, 5 and it is considered to be the most common inherited disorder of hepatic bil­ irubin metabolism. Gilbert's syndrome occurs in ap­ proximately seven percent of the population, and it ap­ pears to be autosomal dominant in some patients. Most studies have indicated that this syndrome occurs in males more than females. The mild unconjugated hy­ perbilirubinemia is usually recognized incidentally dur­ ing the course of another underlying disease. Gilbert's syndrome is most often diagnosed during the second or third decade of life.