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Therapeutic use aims at replacement. Mostly, vit. D is given; in liver disease calcifediol may be indicated, in renal disease calcitriol. Effectiveness, as well as rate of onset and cessation of action, increase in the order vit. D. < 25-OH-vit. D < 1,25-di-OH-vit. D.
The effects of acetylcholine and histamine can be abolished by orally applied antagonists that reach parietal cells via the blood. The cholinoceptor antagonist pirenzepine, unlike atropine, prefers cholinoceptors of the M1 type, does not penetrate into the CNS, and thus produces fewer atropine-like side effects. The cholinoceptors on parietal cells probably belong to the M3 subtype.


Cholekinetics stimulate the gallbladder to contract and empty, e. g. , egg yolk, the osmotic laxative MgSO4, the cholecystokinin-related ceruletide (given parenterally). Cholekinetics are employed to test gallbladder function for diagnostic purposes.
This fact assumes practical significance with any drug that may be rapidly transformed or possibly inactivated in the liver (first-pass hepatic elimination). Even with rectal administration, at least a fraction of the drug enters the general circulation via the portal vein, because only veins draining the short terminal segment of the rectum communicate directly with the inferior vena cava.


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