• Deals with absorbtion,distribution,
biotransfermation(metabolism) and excreation
3. EXCRETION OF DRUGS
“ Excretion is defined as the process where by drugs or
metabolites are irreversibly transferred from internal to
external environment through renal or non renal route.”
Excretion of unchanged or intact drug is needed in
termination of its pharmacological action.
The principal organ of excretion are kidneys.
Agent that excreted in urine are :
1. water soluble 2.non volatile
3. small in molecular size(< 500 daltons.)
6. Major Excretory Processes in the Nephron
• Glomerular filtration
–Increase drug conc. in lumen
• Tubular secretion
–Increases drug conc. in lumen
• Tubular re-absorption
–Decreases drug conc. in lumen
1) GLOMERULAR FILTRATION
It Is non selective , unidirectional process
Ionized or unionized drugs are filtered, except those that are bound to
Driving force for GF is hydrostatic pressure of blood flowing in
capillaries. Molecules of low molecular weight are filtered out of the blood
• Most drugs are readily filtered from the blood unless they are tightly bound to
plasma protein or have been incorporated into red blood cells.
• Normal GFR in healthy individuals is 110 to 130 ml/min.
• About 10% of the blood which enters the glomerulus is filtered
GLOMERULAR FILTRATION RATE:
• Out of 25% of cardiac output or 1.2 liters of blood/min that goes to the
kidney via renal artery only 10% or 120 to 130ml/min is filtered through
glomeruli. The rate being called as glomerular filtration rate
• GFR can be determined by an agent which are excreted by filtration and is
neither reabsorbed nor secreted in tubules. This filtration rate is often
measured by determining the renal clearance of inulin.,creatinine
• Inulin is readily filtered in the glomerulus, and is not subject to tubular secretion
or re-absorption. Thus inulin clearance is equal to the GFR.
• The normal GFR rate is 120-130 ml/min.
2) ACTIVE2) ACTIVE TUBULAR SECRETIONSECRETION
It is carrier mediated active process(requires a carrier and a
supply of energy)
This mainly occurs in proximal tubule.
• The process; also subject to competitive inhibition (e.g. Penicillin
& Probenecid), and is saturable.
• Not affected by pH and protein binding.
• Drugs or compounds which are extensively secreted, such as p-
aminohippuric acid (PAH), may have clearance values
approaching the renal plasma flow rate of 425 to 650 ml/min,
Two secretion mechanisms are identified.
System for secretion of organic acids/anions
E.g. Penicillin, salicylates etc uric acid secreted
System for organic base / cations
3) TUBULAR REABSORPTION
It occurs after the glomerular filtration of drugs.
It takes place all along the renal tubules.
Reabsorption of drugs indicated when the
excretion rate value are less than the GFR
TR can be active or passive processes.
Active Tubular Reabsorption:
Its commonly seen with endogenous substances
or nutrients that the body needs to conserve e.g.
electrolytes, glucose, vitamins, amino acids.
Passive Tubular Reabsorption:
It is common for many exogenous substances
including drugs. The driving force is Conc. Gradient
which is due to re-absorption of water, sodium and
If a drug is neither secreted nor re-absorbed its conc.
In urine will be 100 times that of free drug in plasma.
Reabsorption is mainly depend on several factor that
are pH, pKa, lipophilicity of drug, urine flow rate.
FACTORS AFFECTING RENAL
1) Urine pH and pKa.
2) Urine flow rate.
3) Physicochemical properties of drug.
4) Distribution and Binding characteristic of drug.
5) Blood flow to the kidneys.
6) Biological factors.
7) Drug interactions.
8) Disease states.
12. i) pH and pKa OF THE URINE :
It varies between 4.5 to 7.5 depending on the diet (e.g. meat can cause a more
acidic urine) or food rich in carbohydrate ↑ pH
Many drugs are either weak bases or acids and therefore the pH of the
filtrate can greatly influence the extent of tubular re-absorption for
When urine is acidic, weak acid drugs tend to be reabsorbed.
Alternatively when urine is more alkaline, weak bases are more
Excretion of some drugs can be increased by suitable adjustment of urine
pH e.g. pentobarbital (a weak acid) overdose may be treated by
making the urine more alkaline with sodium bicarbonate injection.
• Acetazolamide(carbonic anhydrase inhibitor) and antacids produce
alkaline urine, while ascorbic acid makes it acidic
• Relative amount of ionized ,unionized drug in the urine at particular
pH & % drug ionized at this pH can be given by “ HENDERSON-
For weak acids :
pH= pKa +log [ ionized ]
% of drug ionized = 10 X 100
For weak base :
pH=pKa +log [unionized]
% of drug ionized = 10 X 100
(pH – pKa)
(pH – pKa)
(pKa - pH)
(pKa - pH)
14. • A polar & ionized drug will be poorly reabsorbed passively
& excreted rapidly.
Reabsorption is also affected by the lipid solubility of drug ;
an ionized but lipophilic drug will be reabsorbed while an
unionized but polar one will be excreted.
The toxicity due to overdose of the drug whose excretion is
sensitive to pH change can be treated by acidification or
alkalinisation of the urine.
ii) PHYSICOCHEMICAL PROPERTIES OF DRUG :
Like molecular size, pKa , lipid solubility
• Molecular size
Drugs with Mol.wt <300 are excreted in kidney.
Mol.wt 300 to 500 Dalton are excreted both through urine
iii)BINDING CHARACTERISTICS OF THE DRUGS :
Drugs that are bound to plasma proteins behave as
macromolecules and cannot be filtered through glomerulus.
Only unbound or free drug appear in glomerular filtrate.
Protein bound drug has long half lives.
16. iv) BIOLOGICAL FACTORS :
• Age, sex, species, strain difference etc alter the excretion of
• Sex – Renal excretion is 10% lower in female than in males.
• Age – The renal excretion in newborn is 30-40 % less in
comparison to adults.
• Old age – The GFR is reduced and tubular function is altered
which results in slow excretion of drugs and prolonged half
v) BLOOD FLOW TO THE KIDNEY :
• Important in case of drug excreted by glomerular filteration
and those are actively secreted only.
• Increase the perfusion enhance the elimination.
17. vi) URINE FLOW RATE :
Polar drug are not affected by urine pH hence not get
reabsorbed so unaffected by urine flow rate.
Only those drugs whose reabsorption is pH sensitive Ex.
Weak acids and bases depend on urine flow rate.
Urine flow rate can be incresed by forced diuresis by large
fluid intake or other diuretics.
vii)DRUG INTERACTIONS :
Any drug interaction that result in alteration of binding
characteristics, renal blood flow, active secretion, urine pH,
and forced diuresis would alter renal clearance of drug.
Alkalinization of urine with citrates and bicarbonates
promote excretion of acidic drugs.
18. viii) DISEASE STATE :
– Greatly cause the elimination of drugs those are
primarily excreted by kidney.
– Some of the causes of renal failure are hypertention,
Diabetes, hypovolemiya(low blood supply to kidney),
– Characterized by Impaired GF , accumulation of fluids
& protein metabolites(NH3),resulting in drug
accumulation and increased toxicity.
19. Drug Clearance :
• ‘Clearance is defined as the hypothetical volume of body
fluids containing drug from which the drug is removed or
cleared completely in a specific period of time.’
• Clearance [CL]=Elimination rate/plasma drug conc.
• The sum of individual clearance by all eliminating organ
(kidney, liver, lungs, biliary systems) called as ‘Total
Renal Clearance ;
• ‘The volume of plasma which is completely cleared of
the unchanged drug by the kidney per unit time’
20. • If the renal clearance is less than 120 ml/min
then we can assume that at least two
processes are in operation, glomerular
filtration and tubular re-absorption.
• If the renal clearance is greater than 120
ml/min then tubular secretion must be
contributing to the elimination process.
• It is also possible that all three processes are
21. Renal clearance values can range from 0 ml/min ( glucose) to a value equal to the
renal plasma flow of about 650 ml/min (for compounds like p-aminohippuric acid).
We can calculate renal clearance using the pharmacokinetic parameters kel and
CLrenal = kel * Vd.
22. RC = UV/P
RC = renal clearance rate
U = drug concentration in urine
V = flow rate of urine (ml/min)
P = plasma drug concentration
• Renal clearance tests are used to:
– Determine the GFR
– Detect glomerular damage
– Follow the progress of diagnosed renal disease
RC = rf+rs-rr/P
rf = rate of filtration
rs = rate of secretion
rr = rate
NON-RENAL ROUTE OF DRUG EXCRETION
Various routes are ;
1) Biliary Excretion
2) Pulmonary Excretion
3) Salivary Excretion
4) Mammary Excretion
5) Skin/dermal Excretion
6) Gastrointestinal Excretion
7) Genital Excretion
24. 1 )1 ) BILIARY EXCRETION ::
Bile juice is secreted by hepatic cells of the liver.
Its important in the digestion and absorption of fats.
90% of bile acid is reabsorbed from intestine(illium) and
transported back to the liver for resecretion.
The metabolites are more excreted in bile than parent drugs
due to increased polarity.
Ex. of drugs excreted in the bile are chloromphenicol, morphine
The reabsorbed drugs are again carried to the liver for
resecretion via bile into the intestine.
Several factor influence secretion of drug in bile are;
1) Molecular weight.2)Polarity.3)Other factor like
sex,spices, disease state, drug interation.
25. Enterohapatic circulation
26. This phenomenon of drug cycling between the intestine & the
liver is called Enterohepatic circulation
Enterohepatic Circulation is important in conservation of
vitamins, folic acid and hormones.
This process results in prolongation of half lives of drugs like
DDT, oral contraceptives.
2 ) PULMONARY EXCRETION :
Gaseous and volatile substances such as general anesthetics
(Halothane) are absorbed through lungs by simple diffusion.
Pulmonary blood flow, rate of respiration and solubility of
substance effect pulmonary excretion.
Intact gaseous drugs are excreted but not metabolites.
Alcohol which has high solubility in blood and tissues are
excreted slowly by lungs.
27. 3 ) SALIVARY EXCRETION :
The pH of saliva varies from 5.8 to 8.4. Unionized lipid
soluble drugs are excreted passively.
The bitter taste in the mouth of a patient is indication of drug
excreted. Some basic drugs inhibit saliva secretion and are
responsible for mouth dryness. Compounds excreted in saliva
are Caffeine, Phenytoin, Theophylline.mettalic taste in mouth
after taking flagyl(metronidazole) is other example
4 ) MAMMARY EXCRETION :
Milk consists of lactic secretions which is rich in fats and
proteins. 0.5 to one litre of milk is secreted per day in lactating
Excretion of drug in milk is important as it gains entry in
breast feeding infants.
28. Highly plasma bound drug like Diazepam is less secreted in
Since milk contains proteins. Drugs excreted can bind to it.
Amount of drug excreted in milk is less than 1% and fraction
consumed by infant is too less to produce toxic effects. Some
potent drugs like barbiturates and morphine may induce toxicity.
ADVERSE EFFECTS :
Discoloration of teeth with tetracycline and jaundice due to
interaction of bilirubin with sulfonamides.
Nicotine is secreted in the milk of mothers who smoke.
29. 5 ) SKIN EXCRETION ::
Drugs excreted through skin via sweat follows pH partition
Excretion of drugs through skin may lead to urticaria and dermatitis.
Compounds like benzoic acid, salicylic acid, alcohol and heavy
metals are excreted in sweat.
6 ) GASTROINTESTINAL EXCRETION :GASTROINTESTINAL EXCRETION :
Excretion of drugs through GIT usually occurs after parenteral
Water soluble and ionized form of weakly acidic and basic drugs are
excreted in GIT.
Example are nicotine and quinine are excreted in stomach.
Drugs excreted in GIT are reabsorbed into systemic circulation &
30. EXCRETION PATHWAYS, TRANSPORT
MECHANISMS & DRUG EXCRETED.
Mechanism Drug Excreted
Urine GF/ ATS/ ATR, PTR Free, hydrophilic, unchanged drugs/
metabolites of MW< 300
Bile Active secretion Hydrophilic, unchanged drugs/
metabolites/ conjugates of MW >500
Lung Passive diffusion Gaseous &volatile, blood & tissue
saliva Passive diffusion
Free, unionized, lipophilic drugs. Some
Milk Passive diffusion Free, unionized, lipophilic drugs (basic)
Sweat/ Passive diffusion Free, unionized lipophilic drugs
Intestine Passive diffusion Water soluble. Ionized drugs