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Absorption of drugs
Prepared By:
Mr. Ashwin Kumar Saxena
Assistant Professor,
School of Pharmaceutical Sciences,
IFTM University, Moradabad
Overview
Definition
Mechanism of drug
absorption
Factors affecting drug
absorption &
bioavailability
Pharmacokinetics Process
3
Pharmacokinetics Process
Administration
Absorption
Distribution
Metabolism
Excretion
Removal
oral
Unchanged
Oral- rapid
meta
reabsorbed
I V
I V
4
Definition
 Movement of unchanged drug from site of
administration to systemic circulation
Absorption /bioavailability from common
routes of drug administration
• Buccal / sublingual
• Oral
• Rectal
Enteral
• Intravenous
• Intramuscular
• Subcutaneous
• Inhalation
Parenteral
• Transdermal
• Mucous membrane
• Ocular
Topical
Absorption from GIT
 Cell membrane : structure and physiology
Mechanism of drug absorption
 Transcellular / Intracellular transport
Passage across GI epithelium
1. Passive transport process
2. Active transport process
 Paracellular / Intercellular transport
Transport through junctions between GI
epithelium
 Vesicular / Corpuscular transport
Transport of substances within vesicles into
cells
1. Pinocytosis
2. Phagocytosis
Passive diffusion
 Non – Ionic diffusion
 Major process for absorption of 90% of drugs
 Driving force- Concentration or electrochemical
gradient
 It follows Fick’s first law of diffusion
Drug molecules diffuse from region of
higher concentration to one lower concentration
until equilibrium is attained and that the rate of
diffusion is directly proportional to concentration
gradient across membrane
dQ/dT=k [Cgit – C ]
Pore transport
 Convective transport , bulk flow or filtration
 Responsible for transport of molecules into
cells
 Driving force- hydrostatic force or osmotic
differences across membrane
 Important in absorption of low molecular
weight {<100}, low molecular size , chain like
linear compounds molecular weight up to 400
daltons
Ion-pair transport
 Penetration of membrane by forming
reversible neutral complexes with
endogenous ions of GIT ( mucin )
 Example propranolol with oleic acid
Carrier mediated transport
 Carrier (component of membrane) binds
reversibly or non covalently with solute
molecules and complex traverses to other
side of membrane
1. Carriers – Unidirectional
2. Structure specific
3. Capacity limited
Specialized transport- carrier transport
Facilitated diffusion
 Carrier mediated
transport operates
down the concentration
gradient (downhill
transport)
 Driving force –
Concentration gradient
 No energy expenditure
 Example vitamin B12
Active transport
 Requires energy in the form of ATP
Primary active transport
Requires direct energy
Types
1} Ion transporters
Transporting ion in or outside the
cell
Example ATP driven ion pump is
proton pump
2} ABC [ATP binding cassette]
transporters
Responsible for transporting small
foreign molecules out of the cells (
exsorption )
Example
P – glycoprotien multidrug
resistance protein
ABC transporters in brain
capillaries
Secondary active transport
No direct energy requirement
1] Symport ( co – transport)
Transport of both molecules
in same direction
Example H+ coupled peptide
transporter (PEPT1)
implicated in intestinal
transport of beta lactam
antibiotics
2] Antiport (counter –
transport)
Movement of molecules in
opposite direction
Example expulsion H+ using
Na+ gradient in kidneys
Endocytosis
Minor transport mechanism involving engulfing
extracellular materials within segment of cell
membrane to form a saccule or vesicle then
pinched of intracellularly
Drug or compound not required to be aqueous
solution to get absorbed
Example cellular uptake of macromolecular nutrients
like fats ,starch, oil soluble vitamins A,D,E and K
1] Phagocytosis (cell eating)
2] Pinocytosis (cell drinking)
Combined absorption mechanism
Example
 Cardiac glycosides
Absorbed by both passive & active
transport
 Vitamin b12
Absorbed by passive diffusion, facilitated
diffusion as well as endocytosis
Phases of drug transfer from GI absorption
site(GI epithelium)into systemic circulation
 Preuptake phase
Dissolution of drug in GI fluids
Metabolism of drug in GI lumen
 Uptake phase
Delivery to absorption site in GIT
Metabolism in GI epithelium
Passage through GI epithelium
 Post-uptake phase
Metabolism in liver
Enterohepatic circulation of drug
Transfer into systemic circulation
Factors influencing drug absorption and
bioavailabilty
Pharmaceutical factors
Physicochemical properties
1. Drug solubility and
dissolution rate
2. Particle size and effective
surface area
3. Polymorphism and amorphism
4. Pseudopolymorphism
5. Salt form of drug
6. Lipophilicity of drugs
7. pKa of drug and GI pH
8. Drug stability
9. Stereochemical nature
Dosage form and
pharmaceutical ingredients
1. Disintegration time
2. Dissolution time
3. Manufacturing variables
4. Pharmaceutical ingredients
5. Nature and type of dosage
form
6. Product age and storage
conditions
Patient related factors
1. Age
2. Gastric emptying time
3. Intestinal transit time
4. Gastrointestinal pH
5. Blood flow through GIT
6. Gastrointestinal contents
7. Presystemic metabolism
• Luminal enzymes
• Gut wall enzymes
• Bacterial enzymes
• Hepatic enzymes
Physicochemical factors
A] Drug solubility and dissolution rate
Disintegration/ Permeation
Deaggregation Dissolution across the
membrane
Rate determinig step Rate determining step
for lipophilic drugs for hydrophilic drugs
Solid
dosage
form
Fine
drug
particles
Drug in
solution at
absorption
site
Drug
in the
body
Dissolution rate : Amount of solid substance
that goes into solution per unit time under
standard conditions of temperature , pH
and solvent composition and constant solid
surface area
Class Solubility Permeability Absorption
pattern
Rate
limiting
step in
absorption
Examples
1 High High Well
absorbed
Gastric
emptying
Diltiazem
2 Low High Variable Dissolution Nifedipine
3 High Low Variable Permeability Insulin
4 Low Low Poorly
absorbed
Case to case Paclitaxel
B] Particle size and effective surface area
of drug
Surface area ↑ with ↓ particle size
Micronisation will result in higher dissolution rate
Example griseofulvin , chloramphenicol and several
salts of tetracycline
D] Hydrates / Solvates ( polymorphism)
Hydrate ( drug in association with water)
Anhydrous ( drug not in association with water)
greater aqueous solubility
Example anhydrous theophylline and ampicillin
higher aqueous solubility
E] Salt form of drug
Salts of weakly acidic drugs are highly water
soluble
Example tolbutamide and phenytoin sodium
have better bioavailability than there parent
compounds
F] Drug pKa and lipophilicity
For drug compound molecular weight > 100 primarily transported
by passive diffusion the process of absorption is governed by
1.Dissociation constant of drug pKa of drug
2.Lipid solubility of drug (function of Ko/wp)
3.pH at absorption site
The relation ship between PH , pka and the extent of ionization
is given by HANDERSON-HESSELBACH equation.
For weak acids
PH = pka + log( ionized drug/un ionized drug)
For weak bases
PH = pka + log(un ionized drug/ ionized drug)
Acidic drugs are unionized at acidic PH ,and absorption starts
from stomach .
31
Very weak acids Unionized at all pH
values absorbed along
the entire length of
G.I.T.
Phenobarbital&
Phenytion
Moderately weak acids Unionized at gastric PH,
ionized at intestinal PH
and better from
stomach.
Cloxacillin,Aspirin ,
ibuprofen.
Stronger acids Ionized at all PH . Poorly
absorbed from G.I.T
Di sodium
cromoglycolate
Very week bases Unionized at all pH
values absorbed along
the entire length of
G.I.T
Theophyllin, caffeine,
diazepam
Moderately weak bases ionized at gastric PH,
unionized at intestinal
PH and better from
intestine.
Reserpine, codeine.
Stronger bases Ionized at all PH . Poorly
absorbed from G.I.T
Guanethidine
32
 In stomach
 In intestine
Type of drug Non-ionized
Lipid soluble
Ionized
Water
soluble
Absorption
Weak acidic
e.g. aspirin
More amt Less amt More
Weak basic Less amt More amt Less
Type of drug Non-ionized
Lipid soluble
Ionized
Water
soluble
Absorption
Weak acidic Less amt More amt Less
Weak basic
e.g.
chloroquine
More amt Less amt More
G] Drug stability
stability problems resulting in poor bioavailability
1. Degradation into inactive form
2. Drug interaction with one or more different
components of dosage form or those present in
GIT
H] Stereochemical nature
60% of drugs in current use are chiral
Optical isomers differ in potency of pharmacological
effect
Dosage form (Pharmaco-technical) factors
A] Disintegration time
 Important for tablets and capsules
 Coated tablets: long Disintegration time
 Disintegration time is proportional to
Amount of binder.
 Hard tablet with high binder: long
Disintegration time.
B] Manufacturing / Processing variables
 Excipients – non active contents
 Manufacturing processes-
 Solid dosage form
 Method of granulation
Wet granulation: faster dissolution
APOC : agglomerative phase of communition
 Compression force
Direct compression: faster dissolution
 Intensity of packing of capsule contents
 Intensity of packing of capsule contents
 Can inhibit or promote dissolution.
 Diffusion of GI fluids in to tightly packed
capsules creates high pressure within
capsule resulting in rapid burst &
dissolution of contents.
 Capsule with finer particles & intense
packing have poor release & low dissolution
rate due to low pore size & poor
penetrability by GI fluids.
C] Pharmaceutical ingredients / Excipients
(formulation factors)
 Excipients are added to ensure
1. Acceptability
2. Physicochemical stability during shelf life
3. Uniformity of composition and dosage
4. Optimum bioavailability and functionality
of drug product
 Commonly used excipients in various dosage
forms
1. Vehicle- major component of liquid, oral and
parenteral dosage form
2. Diluents – commonly added to tablet and
capsule formulations to produce the
necessary bulk
3. Binders and granulating agents – used to
hold powders together to form granules or
promote cohesive compact for directly
compressible materials and to ensure that
tablet remains intact after compression
4. Disintegrants – agent overcome the
cohesive strength of the tablet (mostly
hydrophillic)
5. Lubricants – added to tablet formulation
to aid flow of granules
6. Coatings – Deleterious effects of various
coatings on drug dissolution
Enteric coat> sugar coat> non enteric coat
7. Suspending agents – Primarily stabilize
solid drug particles by reducing their rate
of settling through an increasing viscosity
of medium
8. Surfactants – As wetting agents,
solubilisers, emulsifiers, etc..
9. Buffers – Creating right atmosphere for
drug dissolution
10. Complexing agents – To alter the
physicochemical & biopharmaceutical
properties of a drug
11. Colourants – Inhibitory effect on
dissolution rate of several crystalline
drugs
D] Nature & type of dosage form
The more complex a dosage form,
greater the number of rate limiting steps
and greater the potential for
bioavailability problems
ABSORPTION
RATE Tablet
Capsule
Powders
Suspension
Emulsion
Solution
Granules
Fine
partials
Dissolution
Drug in sol
In blood
Slowest
Fastest
deaggregation
Dissolution
Disintegration
absorption
43
Patient related factors
A ] Age
Infants Adults Elderly
Gastric pH High Normal[2 -
3]
High
Intestinal
surface
area
Low More Low
Blood flow
to GIT
Low Normal Low
Absorption Altered
pattern
Normal Impaired
B ] Gastric emptying
Passage of drug after dissolution from stomach to
small intestine
Rapid gastric emptying is advisable
1.Rapid onset of action is desired – Sedatives
2.Dissolution of drug occurs in intestine- Enteric
coated tablets
3.Drugs not stable in gastric fluid – Penicillin G &
erythromycin
4. Drugs absorbed from distal part of intestine-
Vitamin B 12
Delay in gastric emptying is recomended
1.Food promotes drug dissolution & absorption –
Griseofulvin
2. Disintegration & dissolution of dosage form
is promoted by gastric fluids
3.Drugs dissolve slowly- Griseofulvin
4.Drugs irritate gastric mucosa- Aspirin ,
phenylbutazone & nitrofurantoin
5.Drugs absorbed from proximal part of small
intestine – Vitamin B & C
Factors influencing gastric emptying
1. Volume of meal – Larger bulk longer
gastric emtpying time
2. Composition of meal – Rate of gastric
emptying: Carbohydrates>Proteins > Fats
3. Physical state & viscosity – Liquid meals
(hour to empty) >solid meals (6 to 7 hrs)
4. Temperature of meal high or low
temperature of ingested (in comparison
with to body temperature) reduce gastric
emptying
5. Gastrointestinal pH- Less acidic pH of stomach
promotes gastric emptying while more acidic pH
retards
6. Electrolytes – Water isotonic solutions , solutions
empty stomach rapidly whereas a higher electrolyte
concentration decreases gastric emptying
7. Body posture –Gastric emptying favoured while
standing and lying on right side and vice versa
8. Emotional state – Stress & anxiety promotes while
depression retards it
9. Exercise -Vigorous physical activity retards
Retard gastric emptying Promote gastric emptying
10.Disease states  Gastroenteritis
 Gastric ulcer
 Pyloric stenosis
 Diabetes
 Hypothyroidism
 Partial or total
gastrectomy
 Duodenal ulcer
 Hyperthyroidism
11. Drugs  Poorly soluble antacids
 Anticholinergics
 Narcotic analgesics
 Tricyclic antidepressants
 Metoclopromide
 Domperidone
 Cisapride
50
C] Intestinal transit
 Small intestine is major site for drug
absorption :Long intestinal transit time is
desired for complete drug absorption.
 Residence time depends upon intestinal
motility or contraction.
 Peristaltic contraction promote drug
absorption by increasing the drug
intestinal membrane contact, by enhancing
drug dissolution.
51
Delayed intestinal transit is desirable for:
 Drugs that release slowly (sustained
release)
 When the ratio of dose to solubility is
high. (chlorthiazide)
 Drugs that dissolve only in intestine
(enteric coated)
 Drugs which are absorbed from specific
site in the intestine (Lithium carbonate,
Vitamin B)
 When drug penetrate the intestinal
mucosa very slowly (e.g. acyclovir)
 When absorption of drug from colon is
minimal.
C ] GI pH influence in several ways:
• Disintegrating of some dosage forms is pH
sensitive, enteric coated tabs dissolve only in
alkaline pH.
1.Disintegration:
• A large no. of drugs either weak acids or weak bases, their
solubility is greatly affected by GI pH.
• -weakly acidic drugs dissolve rapidly in alkaline pH.
• -basic drugs soluble in acidic pH..
2.Dissolution:
• Depending upon drug pKa whether its an acidic or
basic drug the GI pH influences drug absorption.
3.Absorption:
• GI pH influence the stability of drug. Eg;
erythromycin
4.Stability of
drug:
52
53
D] Blood flow to GIT
GIT is extensively supplied by blood
capillary, about 28% of cardiac output is
supplied to GIT portion, most drug reach
the systemic circulation via blood only.
Any factor which affects blood flow to GIT
may also affect absorption.
54
D] Disease state
Several disease state may influence the rate
and extent of drug absorption.
Three major classes of disease may influence
bioavailability of drug.
 GI diseases
 CVS disease
 Hepatic disease
55
 Achlorhydria : Decreased gastric
emptying and absorption of acidic drugs
like aspirin
 Malabsorption syndrome and celiac disease
:
decreased absorption
 Infections like shigellosis, cholera, food
poisoning : Absorption
 Gastrectomy may cause drug dumping in
intestine, osmotic diarrhea and reduce
intestinal transit time.
56
 In CVS diseases blood flow to GIT
decrease, causes decreased drug
absorption.
 Disorders like hepatic cirrhosis
influences bioavailability of drugs which
under goes first pass metabolism.
 E.g. propranalol
57
E] Gastro intestinal contents
1.Food- drug interaction: In general
presence of food either delay, reduce,
increase or may not affect absorption.
Delayed Decreased Increased Unaffected
Aspirin Penicillin Griesiofulvin Methyldopa
Paracetamol Erythromycin Nitrofurantoin Propylthiouracil
Diclofenac Ethanol Diazepam sulphasomidine
Nitrofurontoin tetracycline Actively
absorbed water
soluble vit.
Digoxin Levodopa
Iron
58
2. Fluid volume : high vol  better absorption e.g.
erythromycin
3. Interaction of drug with normal GI contents:
bile salts : increases :lipid soluble drugs e.g.
gresiofulvin
decreased : neomycin, kanamycin
4. Drug-Drug interaction in the GIT:
(A) Physico chemical drug- drug interaction:
Adsorption: Eg; anti diarrheal preparations contains
adsorbents like kaolin, prevents a absorption of
many drugs co-administered with them.
Complexation: Eg; calcium, aluminium salts decreases
tetracycline
pH changes: Basic drugs changes gastric pH
E.g.; tetracycline with antacids
59
(B) Physiological interaction :
Decreased GI transit : Anticholinergics like
propanthelin decrease GI transit and
increased absorption of ranitidine and
digoxin
Increase GI emptying : Metoclopramide
increases GI motility and increased GI
absorption of tetracycline , levodopa etc.
Altered GI metabolism : Antibiotics
decrease bacterial metabolism of drug e.g.
erythromycin increases efficacy of digoxin
60
F] First pass metabolism
 “ The loss of drug as it passes through GIT
membrane, liver for the first time during the
absorption process ”
 Four primary systems which affect pre
systemic metabolism of a drugs.
1. Luminal enzymes.
2.Gut wall enzymes or mucosal enzymes.
3. Bacterial enzymes.
4. Hepatic enzymes.
61
 Luminal enzymes: These are enzymes present in
gut fluids and include enzymes from intestinal and
pancreatic secretions. E.g. hydrolases
 Gut wall enzymes: Also called mucosal enzymes
they are present in gut and intestine, colon. E.g.
alcohol dehydrogenase
 Bacterial enzymes: GI microflora scantily present
in stomach and small intestine and is rich in colon.
e.g. sulphasalazine  sulphapyridine + 5 ASA
 Hepatic enzyme: several drug undergo first-
pass hepatic metabolism, highly extracted ones
being isoprenaline, nitroglycerin, morphine etc.
Summary
 Absorption is very important aspect of
pharmacokinetic study of drug
 Knowledge of absorption helps us to decide
route of administration
 Knowledge of absorption gives us idea about
bioavailability of drug which in turn helps us
in deciding dose
 Pharmaceutical industry utilises knowledge of
absorption to prepare different formulation
ABSORPTION OF DRUGS FROM
NON PER OS EXTRAVASCULAR
ROUTES
Absorption
CENTRAL COMPARTMENT
Unwanted site of
action
Free ↔ bound
Biotransformation Site of action
Free ↔ bound
TISSUE
RESERVOIR
Free ↔ bound
FREE DRUG
Excretion
Metabolites
Protein
bound
2
Buccal/sublingual administration
Buccal
Sublingu
al
3
Sublingual
• Drug is placed under
tongue & is allowed to
dissolve
• Passive diffusion
Buccal
• Medicament is placed
between cheek & gum
• Passive diffusion
Advantages
• Useful for administration of antianginal drugs
Rapid absorption higher blood levels
No first –pass hepatic metabolism
Saliva facilitates drug dissolution & subsequent
permeation as it keeps oral mucosa moist
Factors important in oral mucosal drug delivery
1) Lipophilicity - High lipid solubility required
2) Salivary secretion – Drug should be soluble in
aqueous buccal fluids [biphasic solubility is
necessary]
3) pH of saliva – Around 6, weakly acidic drugs are
unionised at this pH and are easily absorbed
4) Binding to oral mucosa – Drugs that bind to oral
mucosa bioavailability is poor
5) Thickness of oral epithelium - Sublingual
absorption is faster than buccal since sublingual
epithelium is thinner & immersed in larger volume of
saliva
Q – drugs secreted in saliva ??
Ans-
1. Phenytoin
2. Lithium
3. Metronidazole
4. Rifampicin
Factors limit drug administration by this
route
1. Limited mucosal surface
2.Taste of medicament
3.Discomfort [highly innervated area]
4.Irritant drugs can’t be given
5.Drugs with high molecular weight
Examples
Antianginal → Nitrites & Nitrates
Antihypertensives → Nifedipine
Analgesics→ Buprenorphine
Steroids like oestradiol & peptides like
desaminooxytocin
Rectal administration
11
Rectal administration
• Important route for children & geriatric patients
• Drugs administered as solution [micro enemas] and
suppositories
• Absorption is rapid from solutions compared to
suppositories
• Highly vascularised but slower absorption due to
limited surface area
Advantages Disadvantages
Useful in patients having nausea &
vomiting
Chances of rectal inflammation
50 % of drug bypasses 1st pass
effect
Irritating suppositories promote
defecation & drug loss
Useful for gastric irritant drugs Limited surface area – slower
absorption
Cyp 3A4 is present in lesser
amount in lower intestine
Faecal matter retards absorption
Inconvenient & embarrassing to
patient
Rectal administration
• Examples – Bisacodyl suppositories , diazepam
prefilled syringes , glycerol ↓ to intracranial
tension
• Q – differences between evacaunt & retention enema ??
• Ans
Evacuant enema Retention enema
To remove fecal matter &
flatus
For local action
E.G soap water enema E.g prednisolone enema for
ulcerative colitis
Volume – 600ml Volume – 100 -120ml
Topical Administration
16
Skin
• Largest organ of body
• Weight 2kg & area 2 m2
• 1/3rd of total blood circulating through body
• Skin is made up 3 distinct layers
1. Epidermis- Non vascular
2. Dermis- Highly vascular
3. Subcutaneous fat tissue
 Three pathways postulated
for diffusion of solutes
through skin
A. Transcellular/
Intracellular – passive
diffusion
B. Intercellular – Paracellular
C. Transappendageal – Drug
diffusion through
• Hair follicles
• Sweat glands
• Sebaceous glands
• Principal barrier to entry of xenobiotics is stratum corneum
• Factors that influence passive percutaneous absorption of
drugs are
I. Skin conditions
II. Composition of topical vehicle
III.Application procedures or application conditions
A] Skin conditions
• Thickness of stratum corneum : Very slow from
foot & palm (thickened stratum corneum)
• Presence of hair follicles : Rapid from Scalp
(numerous hair follicles)
• Trauma : Destruction of stratum corneum promote
absorption e.g. Cuts, rashses ,inflammation, mild
burns
• Hydration of skin : Soaking of skin in water or
occluding (using emollients, plastic film or dressing
)promote hydration of skin and ↑drug absorption
• Age : Infants - Systemic toxicity is of particular
concern
Elderly - More prone allergic & irritant
effects
• Skin pH : Normal 4-6
B] Composition of topical vehicle
• Vehicle or base :
In which drug is dissolved than dispersed promotes
absorption
• Permeation enhancers :
Incorporation of chemicals like propylene glycol ,
azone promote absorption
C] Application conditions
• Rubbing : ↑ blood circulation to area of application
and thus ↑ drug permeation
• Occlusion : Trapped moisture endogenous or
exogenous → hydrates stratum corneum →
promotes drug permeation
• Loss of vehicle : Loss of vehicle ↓ transdermal
permeation
Examples
• Remain superficial - Sunscreen , insect repellants , cosmetics
• Delivery to appendages – Anti- infective , antiacne ,
antiperspirants /hair removers
• Delivery to local tissues – Antimitotics , anti-inflammatories
, antihistamines , anaesthetics
• Systemic delivery – Clonidine , scopolamine, nicotine ,
fentanyl , oestradiol
Q – Where is transdermal patch applied ??
Ans –
1. Chest
2. Upper abdomen
3. Mastoid region
Transdermal drug delivery
Ionic drugs are not absorbed
transdermally
Iontophoresis
Delivery of ionic drug into body
by means of electric current
Examples cortisol ,
methacholine , lidocaine ,
salicylates , peptides
delivered in this way
Transdermal drug delivery
Phonophoresiss
Movement of drug molecules
through skin under influence
of ultrasound
 Inunction
Certain drugs when rubbed into skin (inunction) get
absorbed & produce systemic effects e.g.
nitroglycerine ointment in angina pectoris
 Jet injection ( dermojet)
Transcutaneous introduction of drug by means of
high velocity jet produced through microfine orifice
Essentially painless
 Pellets &
biodegradable implants
Solid pellet or packed in
biodegradable tubes
Implanted under skin
Example – Testosterone
& contraceptive implants
Intramuscular injection
• Absorption from IM sites is rapid but slower in
comparison to IV
• Factors that determine rate of absorption from im
sites
A.Vascularity of injection site – Arm (deltoid)
>Thigh ( vastus lateralis ) > Buttocks (gluteus
maximus)
B. Lipid solubility & ionisation of drug - Highly
lipophilic drug rapidly absorbed by passive
diffusion & hydrophilic and ionised drug slowly
through capillary pores
C. Molecular size – Small molecules & ions gain
direct access to capillary & macromolecules taken up
by lymphatic system
D. Volume of injection & drug concentration-
Concentrated & large volume absorbed faster
E. Viscosity of injection vehicle
Viscous vehicles ( vegetable oil ) → Slow
absorption (Depot injection)
Limitations – 1. Irritant drugs can’t be given
2. Large volume can’t be given
(max 5 ml can be given)
3. Chances of abscess formation
4. Chances of nerve damage
• Q – In children where should IM injections be
given ??
• Ans – on lateral aspect of thigh until child starts
walking
• - when child starts walking gluteal muscle mass is
very well developed after which IM injections can
be given in buttocks
Subcutaneous injection
36
Subcutaneous
• Absorption - Slower than IM sites due to poor
perfusion
• Used – 1. When slow response is desired
2. Drug degrade when taken orally
Limitations – 1. Irritant drugs can’t be given
2. Large volume can’t be given(max -1ml)
Example - Insulin & low molecular weight heparin
• Q – Why vaccines are administered by
subcutaneous route??
• Ans – Active protein reaches directly to lymphatic
tissue without getting destroyed elsewhere in the
body
Pulmonary administration
39
• Extremely rapid absorption due to
• Large surface area of alveoli
• High permeability of alveoli
• Rich perfusion
• Depends upon
• pH of pulmonary fluid
• Particle size > 10 µ - NOT reach pulmonary
tree
• Example – Oxygen, general anesthetics,
salbutamol, beclomethasone, cromolyn sodium
40
Advantages Disadvantages
Faster absorption hence quick
onset of action
Bronchial irritation may lead to ↑
bronchial & salivary secretions
Avoidance of 1st pass effect
Rate drug delivery can be
controlled
Self administration is possible
Intranasal application
42
INTRANASAL
• Used for the systemic delivery of some peptides &
protein drugs
• Used for treatment of local symptoms like nasal
congestion , allergic rhinitis etc
• Rapid absorption due to rich vasculature and high
permeability
43
• Faster rate –Drug high lipophilicity
• Factors - pH of nasal secretion, viscosity, and
pathological conditions like common cold and
rhinitis
Examples
 Desmopressin
 Oxytocin
 GnRH analogues
 Calcitonin
 Nasal decongestants
Intraocular administration
46
Intraocular administration
• Mainly for local effects such as mydriasis, miosis,
anesthesia and glaucoma.
• Sterile aqueous solution of drug
• Cornea – Major barrier - both hydrophilic and lipophilic
characters.
• Thus for optimum intra ocular permeation drug should
posses biphasic solubility.
47
Examples
• Drugs used in glaucoma
1. Miotics – Pilocarpine
2. Non selective ẞ blocker - Timolol
3. PGF2α - Latanoprost
Q – Why latanoprost has become drug of choice in
glaucoma??
Ans –
1. Latanoprost is non irritant
2. ↑ Uveo scleral outflow
Occuserts
• Elliptical micro units
(drug reservoir )
• Drug -delivered slowly
at steady rate
• Example – pilocarpine
occuserts
Vaginal administration
51
VAGINAL ADMINISTRATION
• Intended to act locally e.g. Infection,
contraception
• Factors affecting drug absorption are
-pH of the lumen fluid 4-5.
-Vaginal secretions.
-Microbes at vaginal lumen
• Examples - Pessaries of sulfa drugs , antifungal &
metronidazole
52
Intraarterial administration
INTRARTERIAL ADMINISTRATION
• Localized drug effect
• Used in treatment liver tumors , head and neck
cancers
• Diagnostic purpose- coronary angiography &
cerebral angiography ( radiopaque contrast media)
Intrathecal administration
Intrathecal administration
• Local rapid effects of drugs on meninges and
cerebro spinal axis
• Limitation – strict aseptic condition & great
expertise is required
• Examples . Spinal anesthesia, acute CNS infections
(amphotericin –B), brain tumor,
Intraarticular administration
Intraarticular administration
 Drugs are administered in joint space
 To attain high local concentration
 For treatment of local conditions like rheumatoid arthritis
 Limitation
1) Expertise required
2) Strict aseptic precaution required
3) Repeated administration might further damage joint
Example – Hydrocortisone or gold chloride
Conclusion
• The knowledge of pharmacokinetics of a drug helps
us to understand which route should be preferred
for a particular drug
A. To achieve better bioavailability
B. To achieve better efficacy
C. To avoid adverse effects
References
• Goodman & gilman’s 12th edition, the pharmacological
basis of therapeutics
• Pharmacology & pharmacotherapeutics 23rd edition by
R.S. Satoskar, S.D. Bhandarkar & Nirmala N Rege
• Biopharmaceutics and pharmacokinetics a treatise 2nd
edition by D. M. Brahmankar and Sunil B. Jaiswal
Oral osmotic drug delivery
Extent of
absorption
depend upon
……
Drug related
properties
Physical
properties
Physical state
Lipid or water solubility
Nature of
dosage
forms
Particle size
Disintegration and
dissolution rate
Formulations
Patient
related
properties
Physiological
factors
Ionization
pH of GI fluid.
GI transit time
Enterohepatic circulation
Area of absorbing surface
and local circulation
1st pass metabolism
Presence of other agents
Pathological
states
Pharmacogenetic
63
1. pH of lachrymal fluid : weak electrolytes like
pilocarpine
2. pH of fomulation :
• High pH - ↓ lacrimation -↑ absorption
• Low pH - ↑ lacrimation - ↓ absorption
3. Rate of blinking : ↑ lacrimation - ↓ absorption
4. Volume of instillation : optimal
5. Concentration of drug : ↑ concentration ↑
6. Viscosity : Better due to longer contact time
64
Q – Intramedullary administration
Ans –
• Injection into tibial or sternal bone marrow..
• Eg - bone marrow transplantation
Route Inhalational Topical Occular Intrarticular
Budesonide Clobetasol Fluoromethalon
e
Betamethasone
Beclomethasone Clocortolone Medrysone Methylprednis
olone
Fluticasone Amcinonide Triamcinolone
Mometasone Desonide
Triamcinolone Flucinolone
Alclometasone
Dexsoximetason
e
Steroid
• Both topical / inhalational steroids – fluticasone &
beclomethasone

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Absorption of drugs from oral & non per os extravascular routes.pdf

  • 1. Absorption of drugs Prepared By: Mr. Ashwin Kumar Saxena Assistant Professor, School of Pharmaceutical Sciences, IFTM University, Moradabad
  • 2. Overview Definition Mechanism of drug absorption Factors affecting drug absorption & bioavailability
  • 5. Definition  Movement of unchanged drug from site of administration to systemic circulation
  • 6. Absorption /bioavailability from common routes of drug administration • Buccal / sublingual • Oral • Rectal Enteral • Intravenous • Intramuscular • Subcutaneous • Inhalation Parenteral • Transdermal • Mucous membrane • Ocular Topical
  • 7. Absorption from GIT  Cell membrane : structure and physiology
  • 8. Mechanism of drug absorption
  • 9.  Transcellular / Intracellular transport Passage across GI epithelium 1. Passive transport process 2. Active transport process  Paracellular / Intercellular transport Transport through junctions between GI epithelium  Vesicular / Corpuscular transport Transport of substances within vesicles into cells 1. Pinocytosis 2. Phagocytosis
  • 10.
  • 11. Passive diffusion  Non – Ionic diffusion  Major process for absorption of 90% of drugs  Driving force- Concentration or electrochemical gradient  It follows Fick’s first law of diffusion Drug molecules diffuse from region of higher concentration to one lower concentration until equilibrium is attained and that the rate of diffusion is directly proportional to concentration gradient across membrane dQ/dT=k [Cgit – C ]
  • 12.
  • 13. Pore transport  Convective transport , bulk flow or filtration  Responsible for transport of molecules into cells  Driving force- hydrostatic force or osmotic differences across membrane  Important in absorption of low molecular weight {<100}, low molecular size , chain like linear compounds molecular weight up to 400 daltons
  • 14. Ion-pair transport  Penetration of membrane by forming reversible neutral complexes with endogenous ions of GIT ( mucin )  Example propranolol with oleic acid
  • 15. Carrier mediated transport  Carrier (component of membrane) binds reversibly or non covalently with solute molecules and complex traverses to other side of membrane 1. Carriers – Unidirectional 2. Structure specific 3. Capacity limited
  • 17. Facilitated diffusion  Carrier mediated transport operates down the concentration gradient (downhill transport)  Driving force – Concentration gradient  No energy expenditure  Example vitamin B12
  • 18. Active transport  Requires energy in the form of ATP Primary active transport Requires direct energy Types 1} Ion transporters Transporting ion in or outside the cell Example ATP driven ion pump is proton pump 2} ABC [ATP binding cassette] transporters Responsible for transporting small foreign molecules out of the cells ( exsorption ) Example P – glycoprotien multidrug resistance protein ABC transporters in brain capillaries
  • 19. Secondary active transport No direct energy requirement 1] Symport ( co – transport) Transport of both molecules in same direction Example H+ coupled peptide transporter (PEPT1) implicated in intestinal transport of beta lactam antibiotics 2] Antiport (counter – transport) Movement of molecules in opposite direction Example expulsion H+ using Na+ gradient in kidneys
  • 20. Endocytosis Minor transport mechanism involving engulfing extracellular materials within segment of cell membrane to form a saccule or vesicle then pinched of intracellularly Drug or compound not required to be aqueous solution to get absorbed Example cellular uptake of macromolecular nutrients like fats ,starch, oil soluble vitamins A,D,E and K 1] Phagocytosis (cell eating) 2] Pinocytosis (cell drinking)
  • 21. Combined absorption mechanism Example  Cardiac glycosides Absorbed by both passive & active transport  Vitamin b12 Absorbed by passive diffusion, facilitated diffusion as well as endocytosis
  • 22. Phases of drug transfer from GI absorption site(GI epithelium)into systemic circulation  Preuptake phase Dissolution of drug in GI fluids Metabolism of drug in GI lumen  Uptake phase Delivery to absorption site in GIT Metabolism in GI epithelium Passage through GI epithelium  Post-uptake phase Metabolism in liver Enterohepatic circulation of drug Transfer into systemic circulation
  • 23. Factors influencing drug absorption and bioavailabilty Pharmaceutical factors Physicochemical properties 1. Drug solubility and dissolution rate 2. Particle size and effective surface area 3. Polymorphism and amorphism 4. Pseudopolymorphism 5. Salt form of drug 6. Lipophilicity of drugs 7. pKa of drug and GI pH 8. Drug stability 9. Stereochemical nature Dosage form and pharmaceutical ingredients 1. Disintegration time 2. Dissolution time 3. Manufacturing variables 4. Pharmaceutical ingredients 5. Nature and type of dosage form 6. Product age and storage conditions
  • 24. Patient related factors 1. Age 2. Gastric emptying time 3. Intestinal transit time 4. Gastrointestinal pH 5. Blood flow through GIT 6. Gastrointestinal contents 7. Presystemic metabolism • Luminal enzymes • Gut wall enzymes • Bacterial enzymes • Hepatic enzymes
  • 25. Physicochemical factors A] Drug solubility and dissolution rate Disintegration/ Permeation Deaggregation Dissolution across the membrane Rate determinig step Rate determining step for lipophilic drugs for hydrophilic drugs Solid dosage form Fine drug particles Drug in solution at absorption site Drug in the body
  • 26. Dissolution rate : Amount of solid substance that goes into solution per unit time under standard conditions of temperature , pH and solvent composition and constant solid surface area
  • 27. Class Solubility Permeability Absorption pattern Rate limiting step in absorption Examples 1 High High Well absorbed Gastric emptying Diltiazem 2 Low High Variable Dissolution Nifedipine 3 High Low Variable Permeability Insulin 4 Low Low Poorly absorbed Case to case Paclitaxel
  • 28. B] Particle size and effective surface area of drug Surface area ↑ with ↓ particle size Micronisation will result in higher dissolution rate Example griseofulvin , chloramphenicol and several salts of tetracycline
  • 29. D] Hydrates / Solvates ( polymorphism) Hydrate ( drug in association with water) Anhydrous ( drug not in association with water) greater aqueous solubility Example anhydrous theophylline and ampicillin higher aqueous solubility E] Salt form of drug Salts of weakly acidic drugs are highly water soluble Example tolbutamide and phenytoin sodium have better bioavailability than there parent compounds
  • 30. F] Drug pKa and lipophilicity For drug compound molecular weight > 100 primarily transported by passive diffusion the process of absorption is governed by 1.Dissociation constant of drug pKa of drug 2.Lipid solubility of drug (function of Ko/wp) 3.pH at absorption site The relation ship between PH , pka and the extent of ionization is given by HANDERSON-HESSELBACH equation. For weak acids PH = pka + log( ionized drug/un ionized drug) For weak bases PH = pka + log(un ionized drug/ ionized drug) Acidic drugs are unionized at acidic PH ,and absorption starts from stomach .
  • 31. 31 Very weak acids Unionized at all pH values absorbed along the entire length of G.I.T. Phenobarbital& Phenytion Moderately weak acids Unionized at gastric PH, ionized at intestinal PH and better from stomach. Cloxacillin,Aspirin , ibuprofen. Stronger acids Ionized at all PH . Poorly absorbed from G.I.T Di sodium cromoglycolate Very week bases Unionized at all pH values absorbed along the entire length of G.I.T Theophyllin, caffeine, diazepam Moderately weak bases ionized at gastric PH, unionized at intestinal PH and better from intestine. Reserpine, codeine. Stronger bases Ionized at all PH . Poorly absorbed from G.I.T Guanethidine
  • 32. 32  In stomach  In intestine Type of drug Non-ionized Lipid soluble Ionized Water soluble Absorption Weak acidic e.g. aspirin More amt Less amt More Weak basic Less amt More amt Less Type of drug Non-ionized Lipid soluble Ionized Water soluble Absorption Weak acidic Less amt More amt Less Weak basic e.g. chloroquine More amt Less amt More
  • 33. G] Drug stability stability problems resulting in poor bioavailability 1. Degradation into inactive form 2. Drug interaction with one or more different components of dosage form or those present in GIT H] Stereochemical nature 60% of drugs in current use are chiral Optical isomers differ in potency of pharmacological effect
  • 34. Dosage form (Pharmaco-technical) factors A] Disintegration time  Important for tablets and capsules  Coated tablets: long Disintegration time  Disintegration time is proportional to Amount of binder.  Hard tablet with high binder: long Disintegration time.
  • 35. B] Manufacturing / Processing variables  Excipients – non active contents  Manufacturing processes-  Solid dosage form  Method of granulation Wet granulation: faster dissolution APOC : agglomerative phase of communition  Compression force Direct compression: faster dissolution  Intensity of packing of capsule contents
  • 36.  Intensity of packing of capsule contents  Can inhibit or promote dissolution.  Diffusion of GI fluids in to tightly packed capsules creates high pressure within capsule resulting in rapid burst & dissolution of contents.  Capsule with finer particles & intense packing have poor release & low dissolution rate due to low pore size & poor penetrability by GI fluids.
  • 37. C] Pharmaceutical ingredients / Excipients (formulation factors)  Excipients are added to ensure 1. Acceptability 2. Physicochemical stability during shelf life 3. Uniformity of composition and dosage 4. Optimum bioavailability and functionality of drug product
  • 38.  Commonly used excipients in various dosage forms 1. Vehicle- major component of liquid, oral and parenteral dosage form 2. Diluents – commonly added to tablet and capsule formulations to produce the necessary bulk 3. Binders and granulating agents – used to hold powders together to form granules or promote cohesive compact for directly compressible materials and to ensure that tablet remains intact after compression
  • 39. 4. Disintegrants – agent overcome the cohesive strength of the tablet (mostly hydrophillic) 5. Lubricants – added to tablet formulation to aid flow of granules
  • 40. 6. Coatings – Deleterious effects of various coatings on drug dissolution Enteric coat> sugar coat> non enteric coat 7. Suspending agents – Primarily stabilize solid drug particles by reducing their rate of settling through an increasing viscosity of medium 8. Surfactants – As wetting agents, solubilisers, emulsifiers, etc..
  • 41. 9. Buffers – Creating right atmosphere for drug dissolution 10. Complexing agents – To alter the physicochemical & biopharmaceutical properties of a drug 11. Colourants – Inhibitory effect on dissolution rate of several crystalline drugs
  • 42. D] Nature & type of dosage form The more complex a dosage form, greater the number of rate limiting steps and greater the potential for bioavailability problems
  • 43. ABSORPTION RATE Tablet Capsule Powders Suspension Emulsion Solution Granules Fine partials Dissolution Drug in sol In blood Slowest Fastest deaggregation Dissolution Disintegration absorption 43
  • 44. Patient related factors A ] Age Infants Adults Elderly Gastric pH High Normal[2 - 3] High Intestinal surface area Low More Low Blood flow to GIT Low Normal Low Absorption Altered pattern Normal Impaired
  • 45. B ] Gastric emptying Passage of drug after dissolution from stomach to small intestine Rapid gastric emptying is advisable 1.Rapid onset of action is desired – Sedatives 2.Dissolution of drug occurs in intestine- Enteric coated tablets 3.Drugs not stable in gastric fluid – Penicillin G & erythromycin 4. Drugs absorbed from distal part of intestine- Vitamin B 12
  • 46. Delay in gastric emptying is recomended 1.Food promotes drug dissolution & absorption – Griseofulvin 2. Disintegration & dissolution of dosage form is promoted by gastric fluids 3.Drugs dissolve slowly- Griseofulvin 4.Drugs irritate gastric mucosa- Aspirin , phenylbutazone & nitrofurantoin 5.Drugs absorbed from proximal part of small intestine – Vitamin B & C
  • 47. Factors influencing gastric emptying 1. Volume of meal – Larger bulk longer gastric emtpying time 2. Composition of meal – Rate of gastric emptying: Carbohydrates>Proteins > Fats 3. Physical state & viscosity – Liquid meals (hour to empty) >solid meals (6 to 7 hrs) 4. Temperature of meal high or low temperature of ingested (in comparison with to body temperature) reduce gastric emptying
  • 48. 5. Gastrointestinal pH- Less acidic pH of stomach promotes gastric emptying while more acidic pH retards 6. Electrolytes – Water isotonic solutions , solutions empty stomach rapidly whereas a higher electrolyte concentration decreases gastric emptying 7. Body posture –Gastric emptying favoured while standing and lying on right side and vice versa 8. Emotional state – Stress & anxiety promotes while depression retards it 9. Exercise -Vigorous physical activity retards
  • 49. Retard gastric emptying Promote gastric emptying 10.Disease states  Gastroenteritis  Gastric ulcer  Pyloric stenosis  Diabetes  Hypothyroidism  Partial or total gastrectomy  Duodenal ulcer  Hyperthyroidism 11. Drugs  Poorly soluble antacids  Anticholinergics  Narcotic analgesics  Tricyclic antidepressants  Metoclopromide  Domperidone  Cisapride
  • 50. 50 C] Intestinal transit  Small intestine is major site for drug absorption :Long intestinal transit time is desired for complete drug absorption.  Residence time depends upon intestinal motility or contraction.  Peristaltic contraction promote drug absorption by increasing the drug intestinal membrane contact, by enhancing drug dissolution.
  • 51. 51 Delayed intestinal transit is desirable for:  Drugs that release slowly (sustained release)  When the ratio of dose to solubility is high. (chlorthiazide)  Drugs that dissolve only in intestine (enteric coated)  Drugs which are absorbed from specific site in the intestine (Lithium carbonate, Vitamin B)  When drug penetrate the intestinal mucosa very slowly (e.g. acyclovir)  When absorption of drug from colon is minimal.
  • 52. C ] GI pH influence in several ways: • Disintegrating of some dosage forms is pH sensitive, enteric coated tabs dissolve only in alkaline pH. 1.Disintegration: • A large no. of drugs either weak acids or weak bases, their solubility is greatly affected by GI pH. • -weakly acidic drugs dissolve rapidly in alkaline pH. • -basic drugs soluble in acidic pH.. 2.Dissolution: • Depending upon drug pKa whether its an acidic or basic drug the GI pH influences drug absorption. 3.Absorption: • GI pH influence the stability of drug. Eg; erythromycin 4.Stability of drug: 52
  • 53. 53 D] Blood flow to GIT GIT is extensively supplied by blood capillary, about 28% of cardiac output is supplied to GIT portion, most drug reach the systemic circulation via blood only. Any factor which affects blood flow to GIT may also affect absorption.
  • 54. 54 D] Disease state Several disease state may influence the rate and extent of drug absorption. Three major classes of disease may influence bioavailability of drug.  GI diseases  CVS disease  Hepatic disease
  • 55. 55  Achlorhydria : Decreased gastric emptying and absorption of acidic drugs like aspirin  Malabsorption syndrome and celiac disease : decreased absorption  Infections like shigellosis, cholera, food poisoning : Absorption  Gastrectomy may cause drug dumping in intestine, osmotic diarrhea and reduce intestinal transit time.
  • 56. 56  In CVS diseases blood flow to GIT decrease, causes decreased drug absorption.  Disorders like hepatic cirrhosis influences bioavailability of drugs which under goes first pass metabolism.  E.g. propranalol
  • 57. 57 E] Gastro intestinal contents 1.Food- drug interaction: In general presence of food either delay, reduce, increase or may not affect absorption. Delayed Decreased Increased Unaffected Aspirin Penicillin Griesiofulvin Methyldopa Paracetamol Erythromycin Nitrofurantoin Propylthiouracil Diclofenac Ethanol Diazepam sulphasomidine Nitrofurontoin tetracycline Actively absorbed water soluble vit. Digoxin Levodopa Iron
  • 58. 58 2. Fluid volume : high vol  better absorption e.g. erythromycin 3. Interaction of drug with normal GI contents: bile salts : increases :lipid soluble drugs e.g. gresiofulvin decreased : neomycin, kanamycin 4. Drug-Drug interaction in the GIT: (A) Physico chemical drug- drug interaction: Adsorption: Eg; anti diarrheal preparations contains adsorbents like kaolin, prevents a absorption of many drugs co-administered with them. Complexation: Eg; calcium, aluminium salts decreases tetracycline pH changes: Basic drugs changes gastric pH E.g.; tetracycline with antacids
  • 59. 59 (B) Physiological interaction : Decreased GI transit : Anticholinergics like propanthelin decrease GI transit and increased absorption of ranitidine and digoxin Increase GI emptying : Metoclopramide increases GI motility and increased GI absorption of tetracycline , levodopa etc. Altered GI metabolism : Antibiotics decrease bacterial metabolism of drug e.g. erythromycin increases efficacy of digoxin
  • 60. 60 F] First pass metabolism  “ The loss of drug as it passes through GIT membrane, liver for the first time during the absorption process ”  Four primary systems which affect pre systemic metabolism of a drugs. 1. Luminal enzymes. 2.Gut wall enzymes or mucosal enzymes. 3. Bacterial enzymes. 4. Hepatic enzymes.
  • 61. 61  Luminal enzymes: These are enzymes present in gut fluids and include enzymes from intestinal and pancreatic secretions. E.g. hydrolases  Gut wall enzymes: Also called mucosal enzymes they are present in gut and intestine, colon. E.g. alcohol dehydrogenase  Bacterial enzymes: GI microflora scantily present in stomach and small intestine and is rich in colon. e.g. sulphasalazine  sulphapyridine + 5 ASA  Hepatic enzyme: several drug undergo first- pass hepatic metabolism, highly extracted ones being isoprenaline, nitroglycerin, morphine etc.
  • 62. Summary  Absorption is very important aspect of pharmacokinetic study of drug  Knowledge of absorption helps us to decide route of administration  Knowledge of absorption gives us idea about bioavailability of drug which in turn helps us in deciding dose  Pharmaceutical industry utilises knowledge of absorption to prepare different formulation
  • 63. ABSORPTION OF DRUGS FROM NON PER OS EXTRAVASCULAR ROUTES
  • 64. Absorption CENTRAL COMPARTMENT Unwanted site of action Free ↔ bound Biotransformation Site of action Free ↔ bound TISSUE RESERVOIR Free ↔ bound FREE DRUG Excretion Metabolites Protein bound 2
  • 66. Sublingual • Drug is placed under tongue & is allowed to dissolve • Passive diffusion Buccal • Medicament is placed between cheek & gum • Passive diffusion
  • 67. Advantages • Useful for administration of antianginal drugs Rapid absorption higher blood levels No first –pass hepatic metabolism Saliva facilitates drug dissolution & subsequent permeation as it keeps oral mucosa moist
  • 68. Factors important in oral mucosal drug delivery 1) Lipophilicity - High lipid solubility required 2) Salivary secretion – Drug should be soluble in aqueous buccal fluids [biphasic solubility is necessary] 3) pH of saliva – Around 6, weakly acidic drugs are unionised at this pH and are easily absorbed
  • 69. 4) Binding to oral mucosa – Drugs that bind to oral mucosa bioavailability is poor 5) Thickness of oral epithelium - Sublingual absorption is faster than buccal since sublingual epithelium is thinner & immersed in larger volume of saliva
  • 70. Q – drugs secreted in saliva ?? Ans- 1. Phenytoin 2. Lithium 3. Metronidazole 4. Rifampicin
  • 71. Factors limit drug administration by this route 1. Limited mucosal surface 2.Taste of medicament 3.Discomfort [highly innervated area] 4.Irritant drugs can’t be given 5.Drugs with high molecular weight
  • 72. Examples Antianginal → Nitrites & Nitrates Antihypertensives → Nifedipine Analgesics→ Buprenorphine Steroids like oestradiol & peptides like desaminooxytocin
  • 74. Rectal administration • Important route for children & geriatric patients • Drugs administered as solution [micro enemas] and suppositories • Absorption is rapid from solutions compared to suppositories • Highly vascularised but slower absorption due to limited surface area
  • 75. Advantages Disadvantages Useful in patients having nausea & vomiting Chances of rectal inflammation 50 % of drug bypasses 1st pass effect Irritating suppositories promote defecation & drug loss Useful for gastric irritant drugs Limited surface area – slower absorption Cyp 3A4 is present in lesser amount in lower intestine Faecal matter retards absorption Inconvenient & embarrassing to patient Rectal administration
  • 76. • Examples – Bisacodyl suppositories , diazepam prefilled syringes , glycerol ↓ to intracranial tension
  • 77. • Q – differences between evacaunt & retention enema ?? • Ans Evacuant enema Retention enema To remove fecal matter & flatus For local action E.G soap water enema E.g prednisolone enema for ulcerative colitis Volume – 600ml Volume – 100 -120ml
  • 79. Skin • Largest organ of body • Weight 2kg & area 2 m2 • 1/3rd of total blood circulating through body • Skin is made up 3 distinct layers 1. Epidermis- Non vascular 2. Dermis- Highly vascular 3. Subcutaneous fat tissue
  • 80.  Three pathways postulated for diffusion of solutes through skin A. Transcellular/ Intracellular – passive diffusion B. Intercellular – Paracellular C. Transappendageal – Drug diffusion through • Hair follicles • Sweat glands • Sebaceous glands
  • 81. • Principal barrier to entry of xenobiotics is stratum corneum • Factors that influence passive percutaneous absorption of drugs are I. Skin conditions II. Composition of topical vehicle III.Application procedures or application conditions
  • 82. A] Skin conditions • Thickness of stratum corneum : Very slow from foot & palm (thickened stratum corneum) • Presence of hair follicles : Rapid from Scalp (numerous hair follicles) • Trauma : Destruction of stratum corneum promote absorption e.g. Cuts, rashses ,inflammation, mild burns
  • 83. • Hydration of skin : Soaking of skin in water or occluding (using emollients, plastic film or dressing )promote hydration of skin and ↑drug absorption • Age : Infants - Systemic toxicity is of particular concern Elderly - More prone allergic & irritant effects • Skin pH : Normal 4-6
  • 84. B] Composition of topical vehicle • Vehicle or base : In which drug is dissolved than dispersed promotes absorption • Permeation enhancers : Incorporation of chemicals like propylene glycol , azone promote absorption
  • 85. C] Application conditions • Rubbing : ↑ blood circulation to area of application and thus ↑ drug permeation • Occlusion : Trapped moisture endogenous or exogenous → hydrates stratum corneum → promotes drug permeation • Loss of vehicle : Loss of vehicle ↓ transdermal permeation
  • 86. Examples • Remain superficial - Sunscreen , insect repellants , cosmetics • Delivery to appendages – Anti- infective , antiacne , antiperspirants /hair removers • Delivery to local tissues – Antimitotics , anti-inflammatories , antihistamines , anaesthetics • Systemic delivery – Clonidine , scopolamine, nicotine , fentanyl , oestradiol
  • 87.
  • 88. Q – Where is transdermal patch applied ?? Ans – 1. Chest 2. Upper abdomen 3. Mastoid region
  • 89. Transdermal drug delivery Ionic drugs are not absorbed transdermally Iontophoresis Delivery of ionic drug into body by means of electric current Examples cortisol , methacholine , lidocaine , salicylates , peptides delivered in this way
  • 90. Transdermal drug delivery Phonophoresiss Movement of drug molecules through skin under influence of ultrasound
  • 91.  Inunction Certain drugs when rubbed into skin (inunction) get absorbed & produce systemic effects e.g. nitroglycerine ointment in angina pectoris  Jet injection ( dermojet) Transcutaneous introduction of drug by means of high velocity jet produced through microfine orifice Essentially painless
  • 92.  Pellets & biodegradable implants Solid pellet or packed in biodegradable tubes Implanted under skin Example – Testosterone & contraceptive implants
  • 94. • Absorption from IM sites is rapid but slower in comparison to IV • Factors that determine rate of absorption from im sites A.Vascularity of injection site – Arm (deltoid) >Thigh ( vastus lateralis ) > Buttocks (gluteus maximus) B. Lipid solubility & ionisation of drug - Highly lipophilic drug rapidly absorbed by passive diffusion & hydrophilic and ionised drug slowly through capillary pores
  • 95. C. Molecular size – Small molecules & ions gain direct access to capillary & macromolecules taken up by lymphatic system D. Volume of injection & drug concentration- Concentrated & large volume absorbed faster
  • 96. E. Viscosity of injection vehicle Viscous vehicles ( vegetable oil ) → Slow absorption (Depot injection) Limitations – 1. Irritant drugs can’t be given 2. Large volume can’t be given (max 5 ml can be given) 3. Chances of abscess formation 4. Chances of nerve damage
  • 97. • Q – In children where should IM injections be given ?? • Ans – on lateral aspect of thigh until child starts walking • - when child starts walking gluteal muscle mass is very well developed after which IM injections can be given in buttocks
  • 99. Subcutaneous • Absorption - Slower than IM sites due to poor perfusion • Used – 1. When slow response is desired 2. Drug degrade when taken orally Limitations – 1. Irritant drugs can’t be given 2. Large volume can’t be given(max -1ml) Example - Insulin & low molecular weight heparin
  • 100. • Q – Why vaccines are administered by subcutaneous route?? • Ans – Active protein reaches directly to lymphatic tissue without getting destroyed elsewhere in the body
  • 102. • Extremely rapid absorption due to • Large surface area of alveoli • High permeability of alveoli • Rich perfusion • Depends upon • pH of pulmonary fluid • Particle size > 10 µ - NOT reach pulmonary tree • Example – Oxygen, general anesthetics, salbutamol, beclomethasone, cromolyn sodium 40
  • 103. Advantages Disadvantages Faster absorption hence quick onset of action Bronchial irritation may lead to ↑ bronchial & salivary secretions Avoidance of 1st pass effect Rate drug delivery can be controlled Self administration is possible
  • 105. INTRANASAL • Used for the systemic delivery of some peptides & protein drugs • Used for treatment of local symptoms like nasal congestion , allergic rhinitis etc • Rapid absorption due to rich vasculature and high permeability 43
  • 106. • Faster rate –Drug high lipophilicity • Factors - pH of nasal secretion, viscosity, and pathological conditions like common cold and rhinitis
  • 107. Examples  Desmopressin  Oxytocin  GnRH analogues  Calcitonin  Nasal decongestants
  • 109. Intraocular administration • Mainly for local effects such as mydriasis, miosis, anesthesia and glaucoma. • Sterile aqueous solution of drug • Cornea – Major barrier - both hydrophilic and lipophilic characters. • Thus for optimum intra ocular permeation drug should posses biphasic solubility. 47
  • 110. Examples • Drugs used in glaucoma 1. Miotics – Pilocarpine 2. Non selective ẞ blocker - Timolol 3. PGF2α - Latanoprost
  • 111. Q – Why latanoprost has become drug of choice in glaucoma?? Ans – 1. Latanoprost is non irritant 2. ↑ Uveo scleral outflow
  • 112. Occuserts • Elliptical micro units (drug reservoir ) • Drug -delivered slowly at steady rate • Example – pilocarpine occuserts
  • 114. VAGINAL ADMINISTRATION • Intended to act locally e.g. Infection, contraception • Factors affecting drug absorption are -pH of the lumen fluid 4-5. -Vaginal secretions. -Microbes at vaginal lumen • Examples - Pessaries of sulfa drugs , antifungal & metronidazole 52
  • 116. INTRARTERIAL ADMINISTRATION • Localized drug effect • Used in treatment liver tumors , head and neck cancers • Diagnostic purpose- coronary angiography & cerebral angiography ( radiopaque contrast media)
  • 118. Intrathecal administration • Local rapid effects of drugs on meninges and cerebro spinal axis • Limitation – strict aseptic condition & great expertise is required • Examples . Spinal anesthesia, acute CNS infections (amphotericin –B), brain tumor,
  • 120. Intraarticular administration  Drugs are administered in joint space  To attain high local concentration  For treatment of local conditions like rheumatoid arthritis  Limitation 1) Expertise required 2) Strict aseptic precaution required 3) Repeated administration might further damage joint Example – Hydrocortisone or gold chloride
  • 121. Conclusion • The knowledge of pharmacokinetics of a drug helps us to understand which route should be preferred for a particular drug A. To achieve better bioavailability B. To achieve better efficacy C. To avoid adverse effects
  • 122. References • Goodman & gilman’s 12th edition, the pharmacological basis of therapeutics • Pharmacology & pharmacotherapeutics 23rd edition by R.S. Satoskar, S.D. Bhandarkar & Nirmala N Rege • Biopharmaceutics and pharmacokinetics a treatise 2nd edition by D. M. Brahmankar and Sunil B. Jaiswal
  • 123.
  • 124. Oral osmotic drug delivery
  • 125. Extent of absorption depend upon …… Drug related properties Physical properties Physical state Lipid or water solubility Nature of dosage forms Particle size Disintegration and dissolution rate Formulations Patient related properties Physiological factors Ionization pH of GI fluid. GI transit time Enterohepatic circulation Area of absorbing surface and local circulation 1st pass metabolism Presence of other agents Pathological states Pharmacogenetic 63
  • 126. 1. pH of lachrymal fluid : weak electrolytes like pilocarpine 2. pH of fomulation : • High pH - ↓ lacrimation -↑ absorption • Low pH - ↑ lacrimation - ↓ absorption 3. Rate of blinking : ↑ lacrimation - ↓ absorption 4. Volume of instillation : optimal 5. Concentration of drug : ↑ concentration ↑ 6. Viscosity : Better due to longer contact time 64
  • 127. Q – Intramedullary administration Ans – • Injection into tibial or sternal bone marrow.. • Eg - bone marrow transplantation
  • 128. Route Inhalational Topical Occular Intrarticular Budesonide Clobetasol Fluoromethalon e Betamethasone Beclomethasone Clocortolone Medrysone Methylprednis olone Fluticasone Amcinonide Triamcinolone Mometasone Desonide Triamcinolone Flucinolone Alclometasone Dexsoximetason e Steroid
  • 129. • Both topical / inhalational steroids – fluticasone & beclomethasone