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EXCRETION OF DRUGS
Sarita Sharma
Assistant professor
Department of pharmacology
Mumbai
• Excretion is a process whereby drugs/metabolites are
irreversibly transferred from the internal to the
external environment. OR
• Excretion is the passage out of systemically absorbed
drug.
• Principal organs involved
– Kidneys,
– Lungs,
– Biliary system
– Intestines
– Saliva
– Milk.
Types of excretion:
RENAL excretion NON-RENAL excretion
1. Biliary excretion
2. Pulmonary excretion
3. Salivary excretion
4. Mammary excretion
5. Dermal excretion
RENAL EXCRETION
 Kidney is the primary organ of removal for most
drugs especially for those that are water soluble
and not volatile.
 The three principal processes that determine the
urinary excretion of a drug
1.glomerular filtration,
2. tubular secretion, and
3.tubular reabsorption (mostly passive back-
diffusion)
a) Glomerular Filtration
• The ultrastructure of the glomerular capillary wall
is such that it permits a high degree of fluid
filtration while restricting the passage of
compounds having relatively large molecular
weights.
• This selective filtration is important in that it
prevents the filtration of plasma proteins (e.g.,
albumin) that are important for maintaining the
plasma volume.
• Several factors, including molecular size, charge,
and shape, influence the glomerular filtration of
large molecules.
• As the ultrafiltrate is formed, any drug that is free in the
plasma water, that is, not bound to plasma proteins or the
formed elements in the blood (e.g., red blood cells), will be
filtered as a result of the driving force provided by cardiac
pumping.
• All unbound drugs will be filtered as long as their molecular
size, charge, and shape are not excessively large.
• Compounds with 20 Å to 42Å may undergo glomerular
filtration.
• GFR normally is 120ml/min.
• GFR declines progressively after the age of 50 and also low in
renal failure.
b) Active Tubular Secretion
• Many drugs which do not enter into GF but do so
by tubule secretion which maily occurs in proximal
tubules.
• It is carrier mediated process which require energy
for transportation of compounds against the conc.
Gradient.
• Mainly 2 secretion mechanism are identified:
• 1) system for secretion of organic acids/anions—
eg. Penicilline, salicylates etc.
• These active secretory systems are important in
drug excretion because charged anions and
cations are often strongly bound to plasma
proteins and therefore are not readily available
for excretion by filtration.
• Active secretory systems can rapidly and
efficiently remove many protein-bound drugs
from the blood and transport them into tubular
fluid.
• Any drug known to be largely excreted by the
kidney that has a body half-life of less than 2
hours is probably eliminated, at least in part, by
Organic Anion Transport Organic Cation Transport
Acetazolamide Acetylcholine
Bile salts Atropine
Hydrochlorothiazide Cimetidine
Furosemide Dopamine
Indomethacin Epinephrine
Penicillin G Morphine
Prostaglandins Neostigmine
Salicylate Quinine
c) Active Tubular Reabsorption
• Some substances filtered at the glomerulus are
reabsorbed by passive diffusion and depends on
the lipid solubility and ionization of drug at the
existing urinary pH.
• So lipid soluble drugs filtered from GF but 99%
of the drug is reabsorbed but non-lipid soluble
and highly ionized drugs are unable to do so.
• Active reabsorption is particularly important for
endogenous substances, such as ions, glucose,
and amino acids, although a small number of
drugs also may be actively reabsorbed.
Clinical Implications of Renal Excretion
• The rate of urinary drug excretion will
depend on the drug’s volume of distribution,
its degree of protein binding, and the
following renal factors:
1. Glomerular filtration rate
2. Extent of active tubular secretion of the
compound
5. Possibly, extent of active tubular
reabsorption
1)Biliary Excretion/Faeces:
• Bile juice is secreted by the hepatic cells of the
liver(steady flow—0.5 to 1 ml/min) is important
for the digestion and absorption of fats.
• Greater the polarity better the excretion so
metabolites are more excreted than parent
compound.
• Generally larger molecules (MW>300) are
eliminated by bile.
• Some drugs which are excreted as glucuronides
are hydrolysed by intestinal/bacterial enzymes to
the parent drug which are
reabsorbed(enterohepatic cycling) and ultimate
Drugs that Undergo Enterohepatic Recirculation
Adriamycin Methadone
Amphetamine Metronidazole
Chlordecone Morphine
1,25-Dihydroxyvitamin D3 Phenytoin
Estradiol Polar Glucuronic Acid Conjugates
Indomethacin Polar Sulfate Conjugates
Mestranol Sulindac
• Extensive enterohepatic cycling may be
partly responsible for a drug’s long
persistence in the body.
• Orally administered activated charcoal
and/or anion exchange resins have been
used clinically to interrupt enterohepatic
cycling and trap drugs in the
gastrointestinal tract.
PULMONARY EXCRETION
• Gases and other volatile substances are eliminated
by lungs, irrespective to their lipid solubility.
• Alveolar transfer of the gas/vapour depends on its
partial pressure in the blood.
• Eg: Alcohol, general anaesthetics
EXCRETION IN OTHER BODY FLUIDS
Sweat and Saliva
• Minor importance for most drugs.
• Saliva:
• un-ionized lipid-soluble form of the drugs are
excreted passively.
• Thus, the bitter after taste in the mouth of a patient
is an indication of drug excretion.
• Substances excreted into saliva are usually
swallowed, and therefore their fate is the same as
that of orally administered.
• Eg:caffeine, metronidazole, alcohol etc.
• Sweat:
• Drugs or their metabolites that are excreted into
Milk:
• Milk consists of lactic secretions which is rich in fats and
proteins with pH 7.0
• 0.5 to 1 litre of the milk is secreted in lactating mothers.
• Low-molecular weight un-ionized water-soluble drugs
will diffuse passively across the mammary epithelium
and transfer into milk
• However, the total amount of the drug reaching to the
infant through breast feeding is generally small and
majority of the drugs can be given to lactating mother
without ill effects on infant
• but some are contraindicated that should be avoided.
Clearance(CL)
• It’s a theoritical volume of plasma from which
the drug is completely removed in unit time.
• CL = rate of elimination/ C
• C = plasma concentration
• Eg: creatinine Clearance
THANK YOU

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Drug excretion

  • 1. EXCRETION OF DRUGS Sarita Sharma Assistant professor Department of pharmacology Mumbai
  • 2. • Excretion is a process whereby drugs/metabolites are irreversibly transferred from the internal to the external environment. OR • Excretion is the passage out of systemically absorbed drug. • Principal organs involved – Kidneys, – Lungs, – Biliary system – Intestines – Saliva – Milk.
  • 3. Types of excretion: RENAL excretion NON-RENAL excretion 1. Biliary excretion 2. Pulmonary excretion 3. Salivary excretion 4. Mammary excretion 5. Dermal excretion
  • 4. RENAL EXCRETION  Kidney is the primary organ of removal for most drugs especially for those that are water soluble and not volatile.  The three principal processes that determine the urinary excretion of a drug 1.glomerular filtration, 2. tubular secretion, and 3.tubular reabsorption (mostly passive back- diffusion)
  • 5. a) Glomerular Filtration • The ultrastructure of the glomerular capillary wall is such that it permits a high degree of fluid filtration while restricting the passage of compounds having relatively large molecular weights. • This selective filtration is important in that it prevents the filtration of plasma proteins (e.g., albumin) that are important for maintaining the plasma volume. • Several factors, including molecular size, charge, and shape, influence the glomerular filtration of large molecules.
  • 6. • As the ultrafiltrate is formed, any drug that is free in the plasma water, that is, not bound to plasma proteins or the formed elements in the blood (e.g., red blood cells), will be filtered as a result of the driving force provided by cardiac pumping. • All unbound drugs will be filtered as long as their molecular size, charge, and shape are not excessively large. • Compounds with 20 Å to 42Å may undergo glomerular filtration. • GFR normally is 120ml/min. • GFR declines progressively after the age of 50 and also low in renal failure.
  • 7. b) Active Tubular Secretion • Many drugs which do not enter into GF but do so by tubule secretion which maily occurs in proximal tubules. • It is carrier mediated process which require energy for transportation of compounds against the conc. Gradient. • Mainly 2 secretion mechanism are identified: • 1) system for secretion of organic acids/anions— eg. Penicilline, salicylates etc.
  • 8. • These active secretory systems are important in drug excretion because charged anions and cations are often strongly bound to plasma proteins and therefore are not readily available for excretion by filtration. • Active secretory systems can rapidly and efficiently remove many protein-bound drugs from the blood and transport them into tubular fluid. • Any drug known to be largely excreted by the kidney that has a body half-life of less than 2 hours is probably eliminated, at least in part, by
  • 9. Organic Anion Transport Organic Cation Transport Acetazolamide Acetylcholine Bile salts Atropine Hydrochlorothiazide Cimetidine Furosemide Dopamine Indomethacin Epinephrine Penicillin G Morphine Prostaglandins Neostigmine Salicylate Quinine
  • 10. c) Active Tubular Reabsorption • Some substances filtered at the glomerulus are reabsorbed by passive diffusion and depends on the lipid solubility and ionization of drug at the existing urinary pH. • So lipid soluble drugs filtered from GF but 99% of the drug is reabsorbed but non-lipid soluble and highly ionized drugs are unable to do so. • Active reabsorption is particularly important for endogenous substances, such as ions, glucose, and amino acids, although a small number of drugs also may be actively reabsorbed.
  • 11. Clinical Implications of Renal Excretion • The rate of urinary drug excretion will depend on the drug’s volume of distribution, its degree of protein binding, and the following renal factors: 1. Glomerular filtration rate 2. Extent of active tubular secretion of the compound 5. Possibly, extent of active tubular reabsorption
  • 12. 1)Biliary Excretion/Faeces: • Bile juice is secreted by the hepatic cells of the liver(steady flow—0.5 to 1 ml/min) is important for the digestion and absorption of fats. • Greater the polarity better the excretion so metabolites are more excreted than parent compound. • Generally larger molecules (MW>300) are eliminated by bile. • Some drugs which are excreted as glucuronides are hydrolysed by intestinal/bacterial enzymes to the parent drug which are reabsorbed(enterohepatic cycling) and ultimate
  • 13.
  • 14. Drugs that Undergo Enterohepatic Recirculation Adriamycin Methadone Amphetamine Metronidazole Chlordecone Morphine 1,25-Dihydroxyvitamin D3 Phenytoin Estradiol Polar Glucuronic Acid Conjugates Indomethacin Polar Sulfate Conjugates Mestranol Sulindac
  • 15. • Extensive enterohepatic cycling may be partly responsible for a drug’s long persistence in the body. • Orally administered activated charcoal and/or anion exchange resins have been used clinically to interrupt enterohepatic cycling and trap drugs in the gastrointestinal tract.
  • 16. PULMONARY EXCRETION • Gases and other volatile substances are eliminated by lungs, irrespective to their lipid solubility. • Alveolar transfer of the gas/vapour depends on its partial pressure in the blood. • Eg: Alcohol, general anaesthetics
  • 17. EXCRETION IN OTHER BODY FLUIDS Sweat and Saliva • Minor importance for most drugs. • Saliva: • un-ionized lipid-soluble form of the drugs are excreted passively. • Thus, the bitter after taste in the mouth of a patient is an indication of drug excretion. • Substances excreted into saliva are usually swallowed, and therefore their fate is the same as that of orally administered. • Eg:caffeine, metronidazole, alcohol etc. • Sweat: • Drugs or their metabolites that are excreted into
  • 18. Milk: • Milk consists of lactic secretions which is rich in fats and proteins with pH 7.0 • 0.5 to 1 litre of the milk is secreted in lactating mothers. • Low-molecular weight un-ionized water-soluble drugs will diffuse passively across the mammary epithelium and transfer into milk • However, the total amount of the drug reaching to the infant through breast feeding is generally small and majority of the drugs can be given to lactating mother without ill effects on infant • but some are contraindicated that should be avoided.
  • 19. Clearance(CL) • It’s a theoritical volume of plasma from which the drug is completely removed in unit time. • CL = rate of elimination/ C • C = plasma concentration • Eg: creatinine Clearance