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Drugs, whether endogenous or exogenous, are affected by enterohepatic recirculation. In the liver, drugs and their metabolites undergo glucuronidation. This process involves Uridine diphosphate glucuronosyltransferase / . The result is drug-glucuronide conjugates. These conjugates are excreted through the intestinal tract. However, gut microbial beta-glucuronidases can break down these conjugates. This releases free drugs. These free drugs can then be reabsorbed into the systemic circulation. One-quarter of the medications potentially metabolized by beta-glucuronidase are opioids, estrogens, NSAIDs, benzodiazepines, antihypertensives, and antidiabetics
Studies looking at the bulk enzymatic activity of the gut microbiota have shown that bacterial beta-glucuronidases are involved in deconjugating xenobiotics in the gut, allowing them to be reabsorbed through the portal vein thus prolonging their time in the body.
see also:
Beta-glucuronidases & Irinotecan
Diclofenac & Gut microbiota
Gut microbiota & Indomethacin
Gut microbiota & Ketoprofen