Your Feedback will be highly appreciated regarding "Protein Binding by Dr. Sanaullah Aslam". In this presentation protein binding of drugs is discussed in such a way that it could be easily understood by students of healthcare system.
Introduction
Mechanisms of protein drug binding
Kinetics of protein drug binding
Classes of protein drug binding.
1. Binding of drug to blood components.
(a) Plasma proteins
(b) Blood cells
2. Binding of drug to extravascular tissue protein
Determination of Protein-drug Binding
Factors affecting protein drug binding
Significance of protein/tissue binding of drug
The phenomenon of complex formation of drug with protein is called as Protein drug binding. The proteins are particularly responsible for such an interaction. A drug can interact with several tissue components.
-a broad-spectrum antibiotics.
-It is commonly used to treat acne, infection, and other infections caused by bacteria.
-The first of these compounds was chlortetracycline followed by oxytetracycline and tetracycline.
Tetracycline is a broad-spectrum polyketide antibiotic produced by the Streptomyces genus of Actinobacteria, indicated for use against many bacterial infections. It is a protein synthesis inhibitor. It is commonly used to treat acne today, and, more recently, rosacea, and is historically important in reducing the number of deaths from cholera. Tetracycline is marketed under the brand names Sumycin, Tetracyn, and Panmycin, among others. Actisite is a thread-like fiber formulation used in dental applications. It is also used to produce several semisynthetic derivatives, which together are known as the tetracycline antibiotics. The term "tetracycline" is also used to denote the four-ring system of this compound; "tetracyclines" are related substances that contain the same four-ring system.
Introduction
Mechanisms of protein drug binding
Kinetics of protein drug binding
Classes of protein drug binding.
1. Binding of drug to blood components.
(a) Plasma proteins
(b) Blood cells
2. Binding of drug to extravascular tissue protein
Determination of Protein-drug Binding
Factors affecting protein drug binding
Significance of protein/tissue binding of drug
The phenomenon of complex formation of drug with protein is called as Protein drug binding. The proteins are particularly responsible for such an interaction. A drug can interact with several tissue components.
-a broad-spectrum antibiotics.
-It is commonly used to treat acne, infection, and other infections caused by bacteria.
-The first of these compounds was chlortetracycline followed by oxytetracycline and tetracycline.
Tetracycline is a broad-spectrum polyketide antibiotic produced by the Streptomyces genus of Actinobacteria, indicated for use against many bacterial infections. It is a protein synthesis inhibitor. It is commonly used to treat acne today, and, more recently, rosacea, and is historically important in reducing the number of deaths from cholera. Tetracycline is marketed under the brand names Sumycin, Tetracyn, and Panmycin, among others. Actisite is a thread-like fiber formulation used in dental applications. It is also used to produce several semisynthetic derivatives, which together are known as the tetracycline antibiotics. The term "tetracycline" is also used to denote the four-ring system of this compound; "tetracyclines" are related substances that contain the same four-ring system.
A detailed study on every aspects of parenteral :- introduction, preformulation factors, essential requirements, vehicles and additives, isotonicity, production procedure, facilities, and controls, container and closure selection and finally the quality control evaluation of parenterals.
Methods of enhancing Dissolution and bioavailability of poorly soluble drugsRam Kanth
Greetings!
Good Day to all...
Topic: Methods of Enhancing Bioavailability
Several approaches discussed are
1. Micrnoization
2. Use of Surrfactants
3. Use of Salt forms
4. Alteration of pH of microenvironment
5. Use of metastable polymorphs
6. Solute-Solvent Complexation
7. Solvent Deposition
8. Selective Adsorption on Insoluble Carriers
9. Solid Solutions
10. Eutectic Mixtures
11. Solid Dispersions
12. Molecular Encapsulation with Cyclodextrins
Please do clarify for doubts if any....
Thank you all for watching this presentation.
PHARMACOKINETIC MODELS
Drug movement within the body is a complex process. The major objective is therefore to develop a generalized and simple approach to describe, analyse and interpret the data obtained during in vivo drug disposition studies.
The two major approaches in the quantitative study of various kinetic processes of drug disposition in the body are
Model approach, and
Model-independent approach (also called as non-compartmental analysis).
A detailed study on every aspects of parenteral :- introduction, preformulation factors, essential requirements, vehicles and additives, isotonicity, production procedure, facilities, and controls, container and closure selection and finally the quality control evaluation of parenterals.
Methods of enhancing Dissolution and bioavailability of poorly soluble drugsRam Kanth
Greetings!
Good Day to all...
Topic: Methods of Enhancing Bioavailability
Several approaches discussed are
1. Micrnoization
2. Use of Surrfactants
3. Use of Salt forms
4. Alteration of pH of microenvironment
5. Use of metastable polymorphs
6. Solute-Solvent Complexation
7. Solvent Deposition
8. Selective Adsorption on Insoluble Carriers
9. Solid Solutions
10. Eutectic Mixtures
11. Solid Dispersions
12. Molecular Encapsulation with Cyclodextrins
Please do clarify for doubts if any....
Thank you all for watching this presentation.
PHARMACOKINETIC MODELS
Drug movement within the body is a complex process. The major objective is therefore to develop a generalized and simple approach to describe, analyse and interpret the data obtained during in vivo drug disposition studies.
The two major approaches in the quantitative study of various kinetic processes of drug disposition in the body are
Model approach, and
Model-independent approach (also called as non-compartmental analysis).
factors affecting protein drug binding
significance of protein binding
drug related factors
protein related factors
drug interactions
patient related factors
To have complete understanding kindly use my other presentations on distribution
To enjoy the presentation kindly download it.
For Original view, download "Poetsen One" font style from dafont website.
Here I have discussed distribution of drug through BBB, Placenta and Plasma Protein Binding, and redistribution
Examination Fever. How to handle it..... (Prepared by Sanaullah Aslam)Sanaullah Aslam
Your Feedback will be highly appreciated. This presentation was made for students of different institutes to help them understand the exam fever and how to cope up with pressure. This presentation is made so that you can present it in a same session, without any change.
Digoxin & Nitroglycerin by Dr. Sanaullah Aslam (Complete)Sanaullah Aslam
Your Feedback will be highly appreciated. This presentation was made for students at pharmacy institute in a project of clinical pharmacy and use of digoxin and nitroglycerin. This presentation is made so that you can present it in a same session, without any change.
Presentation on Prospecting was made in order to train and guide the field force (specially of pharmaceutical sector). Your feedback is highly appreciated.
Precautions in handling, storage and manufacture of pharmaceutical products c...Sanaullah Aslam
Your Feedback will be highly appreciated regarding "Precautions in handling, storage and manufacture of pharmaceutical products containing antibiotics by Dr. Sanaullah Aslam". Presentation covers the basics, needs and legislation regarding precaution in handling, storage and manufacture of pharmaceutical products containing antibiotics. This presentation is made by keeping laws and health issues in countries where some basic knowledge about aforesaid topic is needed the most.
Digoxin & Nitroglycerin by Dr. Sanaullah AslamSanaullah Aslam
Your Feedback will be highly appreciated. This presentation was made for students at pharmacy institute in a project of clinical pharmacy and use of digoxin and nitroglycerin. This presentation is made so that you can present it in a same session, without any change.
Pharmaceutical Attire by Sanaullah Aslam (Product Manager)Sanaullah Aslam
Your Feedback will be highly appreciated regarding "Pharmaceutical attire from Product Manager". It may not cover all aspects but tried to make a comprehensive presentation. It was designed to cover a specific organization. You may change it according to your circumstances and organizational approach. Please give your feedback.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
2. Many drugs interact with
plasma or tissue proteins
or
with other macromolecules
to form a drug– macromolecule complex,
process is known as “protein binding” or more
specifically “Drug Protein Binding”.
Presented by: Dr. Sanaullah Aslam
3. Many drugs interact with plasma or tissue proteins or
with other macromolecules,
such as melanin and DNA,
to form a drug– macromolecule complex.
The formation of a drug protein complex is often
named
drug–protein binding
Presented by: Dr. Sanaullah Aslam
4. The protein binding process is defined as
a phenomenon of
complex formation
following the interaction of
drug moiety and the protein molecule.
Presented by: Dr. Sanaullah Aslam
5. The bound drug is kept in the blood stream
while
the unbound component may be metabolized or
excreted,
making it the active part.
Presented by: Dr. Sanaullah Aslam
6. So, if a drug is 95% bound,
5% is free,
means that
5% is active in the system and causing pharmacological
effects.
Presented by: Dr. Sanaullah Aslam
7. Bound Drug is Pharmacodynamicaly inert.
Binding: Half life of drug.
Presented by: Dr. Sanaullah Aslam
8. Bonding : Hydrogen bond, Hydrophilic bond, ionic bond,
Vander Walls bond, covalent bond.
Drug–protein binding may be
a reversible or
an irreversible process.
Presented by: Dr. Sanaullah Aslam
9. Irreversible drug–protein binding is usually a result
of chemical activation of the drug,
which then attaches strongly to the protein or
macromolecule
by covalent chemical bonding.
Presented by: Dr. Sanaullah Aslam
10. Irreversible drug binding accounts for certain types of drug
toxicity that may occur over a long time period
For example, the hepatotoxicity of
high doses of acetaminophen
is due to
the formation of reactive metabolite intermediates
that interact with liver proteins.
Presented by: Dr. Sanaullah Aslam
11. Reversible drug–protein binding implies that the
drug binds the protein
with weaker chemical bonds,
such as
hydrogen bonds
or vander Waals forces.
Presented by: Dr. Sanaullah Aslam
12. If the protein binding is reversible,
then a chemical equilibrium will exist
between the bound and unbound states,
such that:
Protein + drug ⇌ Protein-drug complex
Presented by: Dr. Sanaullah Aslam
13. At low drug concentrations, most of the drug may be bound
to the protein,
whereas at high drug concentrations, the protein-binding
sites may become saturated, with a consequent rapid increase
in the free drug concentrations
Presented by: Dr. Sanaullah Aslam
16. The human serum albumin
also abbreviated as HSA,
is a plasma protein with a
molecular weight of 650,000 and
comprises of 59% of total plasma protein content present in the
blood.
It is most abundantly present in plasma with a very high
potential of binding drugs.
Presented by: Dr. Sanaullah Aslam
17. Almost all types of drugs whether acidic, basic or neutral
drugs undergo significant HSA binding.
The sequence of protein-drug binding is:
Albumin> Glycoprotein > Lipoproteins> Globulins.
Presented by: Dr. Sanaullah Aslam
19. Studies also reveal that a very large population of drugs
no matter acidic, basic or neutral undergoes reversible
binding to tissues as well.
The order of binding to extravascular tissues is given as:
Liver> Kidney> Lung> skin> eyes>bones.
Presented by: Dr. Sanaullah Aslam
20. TISSUE EFFECT
LIVER
Irreversible binding of drugs like
paracetamol and their epoxide-metabolites to
liver tissues results in hepatotoxicity
LUNGS
drugs like imipramine, desipramine or other
drugs in lungs eventually leads to congestion
in heart or may even produce severe lungs
cancer
KIDNEYS
the protein called as METALLOTHION
binds with heavy metals such as lead,
mercury and cadmium resulting in major
renal failures or renal toxicity.
Presented by: Dr. Sanaullah Aslam
21. SKIN
Many drugs accumulate in skin with reaction
with melanin. E.g. chloroquine.
EYES
Retinal pigments of the eye contain melanin.
Drugs like chloroquine are responsible for
retinopathy.
BONES
bones : calcium
e.g. Tetracycline
Presented by: Dr. Sanaullah Aslam
22. The binding of drug to plasma (and tissue)
proteins is a major
determinant of drug disposition.
Binding has a very important effect on drug
dynamics since only the free (unbound) drug
interacts with receptors
Presented by: Dr. Sanaullah Aslam
23. The bound drug is kept in the blood stream
while the unbound component may be
metabolized or excreted,
making it the active part.
• So, if a drug is 95% bound to a binding protein
and 5% is free, that means that
5% is active in the system and
causing pharmacological effects.
Presented by: Dr. Sanaullah Aslam
24. Highly bound Drugs : reduced overall drug clearance.
For a drug that is metabolized mainly by the liver,
binding to plasma proteins
prevents the drug from entering the hepatocytes,
resulting in
reduced drug metabolism by the liver.
Presented by: Dr. Sanaullah Aslam
25. The fraction unbound can be altered by a number of
variables, such as
the concentration of drug in the body,
the amount and quality of plasma protein, and
other drugs that bind to plasma proteins.
Presented by: Dr. Sanaullah Aslam
26. Higher drug concentrations would lead to a
higher fraction unbound,
because the plasma protein would be saturated with drug
and
any excess drug would be unbound.
At low concentrations,
most drugs may be bound to proteins.
Presented by: Dr. Sanaullah Aslam
27. Figure : Fraction of drug bound versus drug
concentration at constant protein concentration
Presented by: Dr. Sanaullah Aslam
28. If the amount of plasma protein is decreased
(in catabolism, malnutrition, liver disease, renal disease),
there would also be a
higher fraction unbound.
Additionally, the quality of the plasma protein may
affect how many drug-binding sites there are on the
protein.
Presented by: Dr. Sanaullah Aslam
29. Using 2 drugs at the same time may affect each other's
fraction unbound.
For example, Drug A and Drug B are both protein-
bound drugs.
If Drug A is given, it will bind to the plasma proteins in
the blood.
If Drug B is also given, it can displace Drug A from the
protein,
thereby increasing Drug A's fraction unbound.
Presented by: Dr. Sanaullah Aslam
30. This may increase the effects of Drug A,
since only the unbound fraction may exhibit activity.
This effect of protein binding is most significant with
drugs that are
highly protein-bound (>95%) and
have a low therapeutic index
Presented by: Dr. Sanaullah Aslam
31. 1. Factors relating to the drug
2. Factors relating to the protein and other
binding component
3. Drug interactions
4. Patient related factors
Presented by: Dr. Sanaullah Aslam
32. Physicochemical Characteristics of the Drug
Increase in lipophilicity increases the extent of
binding.
Acidic/anionic drugs bind to HSA;
basic/cationic drugs to AAG;
neutral/unionized drugs to lipoproteins.
Presented by: Dr. Sanaullah Aslam
33. Drug-Protein/Tissue Affinity
Lidocaine has greater affinity for AAG than for
HSA.
Digoxin has more affinity for proteins of cardiac
muscles than those of skeletal muscles or
plasma.
Presented by: Dr. Sanaullah Aslam
34. Physicochemical Properties of Protein/Binding
Component
Lipophilicitylipoproteins bind with lipophilic
drugs.
Albumindepend on physiological pH.
Concentration of Protein/Binding Components
Disease states affect the concentration of proteins
in blood.
Presented by: Dr. Sanaullah Aslam
35. Number of Binding Sites on the Protein
Albumin has a large number of binding sites as
compared to other proteins.
Indomethacin binds to 3 sites on albumin.
AAG is a protein with limited binding capacity
due to low concentration & molecular size.
Presented by: Dr. Sanaullah Aslam
41. ABSORPTON
SYSTEMIC SOLUBILITY OF DRUGS
DISTRIBUTION
ELIMINATION
Presented by: Dr. Sanaullah Aslam
42. The absorption equilibrium is attained by
transfer of free drug from the site of administration into the
systemic circulation and
when the concentration in these two compartments become
equal.
However, binding of the absorbed drug to plasma proteins
decreases free drug concentration and disturbs such an
equilibrium .
Presented by: Dr. Sanaullah Aslam
43. Water insoluble drugs, neutral endogenous
macromolecules such as
Heparin, Oil soluble vitamins are circulated and
distributed to tissues
by binding especially to lipoproteins which act as
a vehicle for such hydrophobic compounds.
Presented by: Dr. Sanaullah Aslam
44. Plasma protein binding restricts the entry of drugs.
This prevents accumulation of large fraction of drugs
in such tissues and thus subsequent toxic reactions.
A protein bound drug in particular does not cross the
BBB ,the placental barrier and the glomerulus.
Presented by: Dr. Sanaullah Aslam
45. Only the unbound drug is capable of being eliminated.
This is because
the drug protein complex
cannot penetrate into the liver .
The large molecular size of the complex also prevents
it from getting filtered through the glomerulus .
Presented by: Dr. Sanaullah Aslam
46. Thus, drugs which are more than 95% bound are
eliminated slowely i.e they have long eliminaton half
lives:
e.g. tertacycline ,which is only 65% bound ,has an
elimination half life of 8.5 hours
in comparision to 15.1 hours of doxycycline which is 93%
bound to plasma proteins .
Presented by: Dr. Sanaullah Aslam
47. All pharmacokintic parameters can be influenced by protein
binding.
Bound drug cannot penetrate through blood capillaries, so
that the bound drug pharmacologically inert.
Plasma –protein bound drug have longer elimination half
lives compare to the free drug.
Protein bound drug doesn’t cross BBB and placental barrier .
Presented by: Dr. Sanaullah Aslam
48. Leon Shargel, Applied Biopharmaceutics and Pharmacokinetics, 5th edition,Chapter:
Physiologic Drug Distribution and Protein Binding.
P.L.Madan, Biopharmaceutics and Pharmacokinetics, 1st editoin, p 82-85.
D.M.Brahmankar, Biopharmaceutics and Pharmacokinetics—A Treatise, 1st edition, p 97-
102.
G.R.Chatwal, Biopharmaceutics and Pharmacokinetics, 1st edition, p 55-58.
Milo Gibaldi, Biopharmaceutics and Clinical Pharmacokinetics, 4th edition, p 195-200.
Javed Ali, A Textbook of Biopharmaceutics and Pharmacokinetics, 1st edition, p 51-53.
H.P Tripnis, Amritha Bajaj, Principles and Applications of Biopharmaceutics and
Pharmacokinetics, 1st edition, p 73-79.
V. Venkateswarlu, Fundamentals of Biopharmaceutics and Pharmacokinetics, 1st edition, p
68-71.
Shobha Rani, Textbook of Biopharmaceutics and Pharmacokinetics, 1st edition, p 142-143.
Presented by: Dr. Sanaullah Aslam
1. Factors relating to the drug
a. Physicochemical characteristics of the drug
b. Concentration of the drug in the body
c. Affinity of a drug for a particular binding component
2. Factors relating to the protein and other binding component
a. Physicochemical characteristics of the protein or binding agent
b. Concentration of protein or binding component
c. Number of binding sites on the binding agent
3. Drug interactions
a. Competition between drugs for the binding site (displacement interactions)
b. Competition between drugs and normal body constituents
c. Allosteric changes in protein molecule
4. Patient related factors
a. Age
b. Intersubject variations
c. Disease states
DRUG RELATED FACTORS
Physicochemical Characteristics of the Drug
Protein binding is directly related to the lipophilicity of the drug. An increase in lipophilicity increases the extend of binding; for example, the slow absorption of cloxacillin in comparison to ampicillin after i.m. injection is attributed to its higher lipophilicity and larger (95%) binding to proteins while the latter is less lipophilic and just 20% bound to proteins. Highly lipophilic drugs such as thiopental tend to localize in adipose tissues. Anionic or acidic drugs such as penicillins and sulphonamides bind more to HSA whereas cationic or basic drugs such as imipramine and alprenolol bind to AAG. Neutral, unionized drugs bind more to lipoproteins.
Drug-Protein/Tissue Affinity
Lidocaine has greater affinity for AAG than for HSA. Digoxin has more affinity for proteins of cardiac muscles than those of skeletal muscles or plasma. Iophenoxic acid, a radio opaque medium, has so great an affinity for plasma proteins that it has a half life of 2 ½ years.
PROTEIN/TISSUE RELATED FACTORS
Physicochemical Properties of Protein/Binding Component
Lipoproteins and adipose tissue tend to bind lipophilic drugs by dissolving them in their lipid core. The physiologic pH determines the presence of active anionic and cationic groups on the albumin molecules to bind to a variety of drugs.
Concentration of Protein/Binding Components
Among the plasma proteins, binding predominantly occurs with albumin as it is present in a higher concentration in comparison to other plasma proteins. The amount of several proteins and tissue components available for binding, changes during disease states. As the protein concentration increases, the percent of drug bound increases to a maximum. The shapes of the curves are determined by the association constant of the drug–protein complex and the drug concentration.
Number of Binding Sites on the Protein
Albumin has a large number of binding sites as compared to other proteins and is a high capacity binding component. Several drugs are capable of binding at more than one site on albumin, example flucocloxacillin, flurbiprofen, ketoprofen, tamoxifen and dicoumarol bind to both primary and secondary sites on albumin. Indomethacin is known to bind to 3 different sites. AAG is a protein with limited binding capacity because of its low concentration and low molecular size. Though pure AAG has only one binding site for lidocaine, in presence of HSA, two binding sites have been reported which was suggested to be due to direct interaction between HSA and AAG.
DRUG INTERACTIONS
Competition between Drugs for the Binding Sites (Displacement Interactions)
When two or more drugs can bind to the same site, competition between them for interaction with the binding site occurs. If one of the drugs (drug A) is bound to such a site, then administration of another drug (drug B) having affinity for the same site results in displacement of drug A from its binding site. Such a drug-drug interaction for the common binding site is called as displacement interaction.
The drug A is called the displaced drug and drug B is called displacer.
Example: Warfarin and phenyl butazone have same degree of affinity for HSA. Administration of phenyl butazone to a patient on warfarin therapy results in displacement of latter from its binding site. The free warfarin may cause adverse hemorrhagic reactions which may be lethal. Phenyl butazone is also known to displace sulphonamides from their HSA binding sites. Displacement interactions can result in unexpected rise in free concentration of the displaced drug which may enhance clinical response or toxicity. Even a drug metabolite can affect displacement interaction.
PATIENT RELATED FACTORS
Age:
Modification in protein-drug binding as influenced by age of the patient is mainly due to differences in the protein content in various age groups.
Neonates:
Albumin content is low in new born; as a result, the unbound concentration of drug that predominantly bind to albumin (e.g. phenytoin and diazepam) is increased.
Young infants:
An interesting example of differences in protein-drug binding in infants is that of digoxin. Infants suffering from congestive cardiac failure are given a digitalizing dose 4-6 times the adult dose on body weight basis. This is contrary to the general belief that infants should be given low doses considering their poorly developed eliminatory system. The reason attributed for use of a large digoxin dose is greater binding of the drug in infants (the other reason is abnormally large renal clearance of digoxin in infants).
Elderly:
In old age, the albumin content is lowered and free concentration of drugs that bind primarily to it is increased. Old age is also characterized by an increase in the levels of AAG and thus decreased free concentration is observed for drugs that bind to it. The situation is complex and difficult to generalize for drugs that bind to both HSA and AAG, e.g. lidocaine and propranolol
Intersubject Variations:
Intersubject variations in drug binding as studied with few drugs showed that the difference is small and no more than two fold. These differences have been attributed to genetic and environmental factors.
Disease States:
Several pathologic conditions are associated with alteration in protein content. Since albumin is the major drug binding protein, hypoalbuminemia can severely impair protein-drug binding. Hypoalbuminemia is caused by several conditions like aging, CCF, trauma, burns, inflammatory states, renal and hepatic disorders, pregnancy, surgery, cancer, etc. Almost every serious chronic illness is characterized by decreased albumin content. Some of the diseases that modify protein-drug binding are depicted in Table 4. Hyperlipoproteinemia caused by hypothyroidism, obstructive liver disease, alcoholism, etc. affects binding of lipophilic drugs.
Putting in a nutshell, all factors, especially drug interactions and patient related factors that affect protein or tissue binding of drugs, influence:
Pharmacokinetics of drugs: A decrease in plasma protein-drug binding i.e. an increase in unbound drug concentration, favours tissue redistribution and/or clearance of drugs from the body (enhanced biotransformation and excretion).
Pharmacodynamics of drugs: An increase in concentration of free or unbound drug results in increased intensity of action (therapeutic/toxic).