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The effect of phenobarbital on bile acids and bilirubin in two patients with prolonged severe intrahepatic cholestasis Hironao KOMATSU, Satoshi MONNO, Yukio GIBO, Yoshihiro AKAHANE, Kendo KIOSAWA, Atsuo NAGATA and Seiichi FURUTA* We reported two patients of prolonged severe intrahepatic cholestasis who showed a rapid response to the phenobarbital (PB) administration, followed with the disappearance of jaundice. Case 1, 27-year-old male, and case 2, 22-year-old female, were admitted to our department because of severe jaundice and pruritus of long duration. Glucocorticoid therapy for 100 and 190 days was not effective in both cases. In case 1, after three months of PB (3mg per kg of body weight per day) treatment, total serum bile acids concentration (TBA) decreased from 140ƒÊMol/l to 7.9ƒÊMol/l and total serum bilirubin level (T. Bil) from 30mg/dl to 0.7mg/dl. In case 2, after about fifty days of PB (2mg per kg of body weight per day) TAB decreased from 270ƒÊMol/l to 14.6ƒÊMol/l and T. Bil from 35.8mg/dl to 1.8mg/dl. PB was very effective in relieving the pruritus and decreasing the jaundice. The mechanism of the therapeutic effect of PB on prolonged intrahepatic cholestasis was discussed.