Interindividual variability in the absorption of ciprofloxacin and hydrocortisone from continent ileal reservoir for urine

Abstract Objective: The neobladder created with a
detubularized segment of ileum as standard treatment for
the transitional cell carcinoma of the bladder may permit
absorption of drugs. As a consequence, on the one hand the
elimination of drugs excreted in the urine may be delayed
and a change of dosage may be required, and on the other
hand the intravesical administration of a drug may produce
blood levels capable of inducing unwanted systemic effects.
The purpose of the present study was to explore the
possibility of drug absorption from a continent ileal
reservoir for urine. Methods: The possibility of drug reabsorption
from a continent ileal reservoir for urine was
studied in 12 patients with well functioning reservoirs after a
time interval of 3 months from surgery and also, in 7 of
them, 6 months later. Saline solutions of ciprofloxacin or
hydrocortisone were instilled and maintained in the reservoir
for 2 h, and drug concentrations in plasma were
measured 1 and 2 h after instillation. Results: Both ciprofloxacin
and to a lower extent hydrocortisone were adsorbed
from the reservoir, but with large interindividual variability.
A comparison of the plasma concentrations produced by the
two drugs 3 and 9 months after creation of the new bladder
revealed that after 9 months the absorption was decreased in
3 patients, substantially unchanged in 2, and increased in 2.
Conclusions: The results of this study show that both ciprofloxacin,
chosen for its use as possible radiosensitizing
agent in bladder cancer patients, and hydrocortisone, chosen
as an example of lypofilic endogenous compound, can be
absorbed through the intestinal mucosa of a continent ileal
reservoir, but to a different extent and with high interindividual
variability.
Keywords Ciprofloxacin . Continent ileal reservoir . Drug
re-absorption . Hydrocortisone . Urine