Drug metabolism and excretion ARLENE M. DIAZ M.D, F.P.S.C.E.P PHARMACOLOGY DEPT. S.W.U- MHAM
Biotransformation
is a process wherein a drug undergoes a chemical change due to its interaction with an endogenous enzyme system (due to a nonenzymatic reactions) resulting in an increase of polarity of the drug.
Why should a drug undergoes Biotransformation?
1. to convert a drug to a more excretable metabolite
2. to convert a pharmacologically active drugto inactive metabolite 3. to convert an active drug to an active metabolite 4. to convert an inactive drug to an active metabolite 5. to convert a drug into a more toxic metabolite
Organs responsible for Biotransformation
A. Liver –Major – DMMS
B. Kidney
Organs responsible for Biotransformation
C. Lung
D. GIT (intestines)
Classification of the Chemical reactions of enzymatic biotransformation Phase I Reaction – convert the parent drug to a more polar drug metabolite by: Oxidation Reduction Hydrolysis
Oxidation-is the addition of oxygen or the removal of hyrogen from the original compound
-Is
carried out by a group of monooxygenases (oxidative enzymes found in the hepatic endoplasmic reticulum). This monooxygeneses are usually a large family of isozymes called cytochrome P450 which activates molecular oxygen using reducing equivalents such as Nicotinamide adenine dinucleotide phospate (NADPH).
Oxidation NADP+
Reduced FLA-PRO
Oxidized Drug (ROH+)
+
Drug (RH) DrugFe3+
Fe3 Step 1
Cytochrome PStep 2 450
H2O
Step 4 e-
NADP
FLA-PRO
Oxidize d
Step 3
DrugFe2+
drug Fe2+ -O2
O2
2H+
5
Reduction- the removal of oxygen or the adding of hydrogen to the original compound. Enzymes responsible, are usually located in the cell cytoplasm.
Redox Recycling is a kind of reduction for – Quinone containing drugs wherein this quinone containing drug is reduced by a single electron and is converted to an unstable semiquinone which undergoes autooxidation or molecular oxygen, forming free radicals (superoxide which are toxic)
Redox recycling:
Quinone
O
O2
NADPH
FLAPRO NADP+
ō
1
O O
O
SemiQuinone
superoxide
2
O2 — Molecular oxygen
Phase I - Microsomal (enzymatic) Drug Biotransformation Reaction
A. Oxidation Reaction • Aliphatic hydroxylation -Pentobarbital; Phenylbutazone • Aromatic hydroxylation – Phenytoin • Epoxidation – Benzo(a) pyrene; aflatoxin • N-Dealkylation–Diazepam,Prazepam, Methadone • O – Dealkylation – Codeine • N – Hydroxylation – 2 Acetylaminofluorene
•
Sulfoxidation -chlorpromazine
• Desulfuration – Parathion • Dehalogenation – Halothane
B. Reduction Reactions • Nitro reduction – Chloramphenicol Clonazepam • Azo reduction – Prontosil • Reductive dehalogenation – Carbon tetrachloride, DDT • Redox recycling –Doxorubicin, Mitomycin,Bleomycin
C. Hydrolysis-
the original compound is broken into smaller parts. The enzyme resposible are located in the cytoplasm, the endoplasmic reticulum and circulating in the plasma
• Ester Hydrolysis - Acetycholine, Succinylcholine, Aspirin, Procaine
• Amide - Procainamide, Lidocaine, Indomethacin • Peptide - Pro-insulin
Phase II - Conjugation RXNS RXN Type a.Glucuronidation
Enzyme UDP-glucuronyl transferases
b. Sulfation
Sulfotransferases
c. Acetylation d. Methylation e. Glutathione
Example Bilirubin, Diazepam Chloramphenicol
Esterone, Andosterone Acetaminophen Acyl COA transferases Isoniazide Sulfonamide Mythyl transferases Norepinephrine Thiouracil GSH transferases Bromobenzene Enthacrynic acid
Induction of the Drug Metabolizing Microsomal System
How Does It Occur? • Induction of the Drug Metabolizing Microsomal System • The inducer binds to the specific- receptor molecule in the cytoplasm of the hepatocyte forming an inducer-receptor complex. • The receptor-inducer complex is the translocated into the nucleous and interact with DNA resulting to transcription of specific genes. • The MRNA transcribed from DNA Subsequently translated leading to synthesis and incorporation of new cytochrome P450 into the membrane of the endoplasmic reticulum.
Significance of DMMS Induction • Inactivation or diminishing effect of
the drug(development of tolerance)
• There is an increase metabolism
of other drugs taken simultaneously by the inducer.
• There is an increase metabolism of
drugs having the same biotransformation pathway of the inducer.
Example of Drugs that Enhance drug Metabolism in humans Inducer •Chlorcyclizine
Drug whose metabolism is enhanced
•Ethychlorvynol •Glutethimide •Griseofulvin
•Steroid hormones •Warfarin Antipyrine, glutethimide, warfarin •Warfarin
Example of Drugs that Enhance drug Metabolism in humans
• Inducer Phenobarbital and other barbiturates
Drug whose metabolism is enhanced Barbiturates Chloramphenicol Chlorpromazine Anticoagulants, Cortisol, coumarin Digitoxin, Desmethylimipramine
Example of Drugs that Enhance drug Metabolism in humans • Inducer
phenobarbital BARBITURATES
Drug whose metabolism is enhanced
Doxorubicin, estradiol Phenylbutazone Phenytoin theophylline Quinine Testosterone
Example of Drugs that Enhance drug Metabolism in humans
• Inducer
Phenybutazone Phenytoin Rifampicin
Drug whose metabolism is enhanced
Aminopyrine, cortisol, digitoxin cortisol, dexamethasone,digitoxin, theophylline
Coumarin, digitoxin, methadone, Oral contraceptives, prednisone,
propranolol, Quinidine
glucocorticoids, metoprolol
Drugs that inhibit metabolism of other drugs in human Inhibitor Allopurinol, Chloramphanicol, Isoniazid
Cimetidine Dicumarol Disulfiram
Drugs whose metabolism is inhibited Antipyrine, dicumarol probenecid, tolbutamide, Chlordiazepoxide, diazepam, warfarin Phenytoin Antipyrine, ethanol, phenytoin warfarin
Drugs that inhibit metabolism of other drugs in human Inhibitor Ketoconazole Phenylbutazone
Drugs whose metabolism is inhibited Cyclosporine,astemizole, terfenadine Phenytoin, tolbutamide
Erythromycin Grapefruit juice ETHANOL CHLORDIAZEPOXIDE
Amiodarone,digoxin, antipsychotics,theophylline
terfenadine, calcium blockers DIAZEPAM,
Drugs Exertion Drugs
Absorption Distribution
Excretion Kidney Main Organ Minor Routes of Excretion GIT – Biliary/Fecal Mamary – Milk Excretion Lungs Salivary - Saliva Sweat Glands Lacrimal - Tears Hair/ Nails/ Skin
Metabolism Biotransformation Liver –Main Organ Kidney GIT Lungs
3 Major Processes Involved in the Renal Handling of Drugs 1.Glomerular Filtration of a drug at the glomerulus depends on the molecular size of the drugs
2.Tubular Reabsorption
usually occurs in the proximal tabules and generally involves organic acids such as: Penicillin, aspirin and diuretics
3.Tubular Secretion occurs in Proximal and Distal part of the nephron
Factors That Will Promote Tubular Reabsorption Ionization Ph Of Drugs Lipid Solubility
• Half Life (t1/2) is the time it takes for
the plasma cone or the amount of drugs in the body to be reduced by 50%. • Volume of distribution – relates the
amount of drugs in the body to the concentration of drug in the blood or plasma
• Clearance – measure of the body’s
ability to eliminate a drug
• Half Life of a drug is inversely related
to its clearance and directly proportional to its volume of distribution
Clinical situations resulting in increased drug half life • Diminished renal plasma flow, for ex: in
cardiogenic shock, heart failure or hemorrhage • With addition of a second drug w/c displaces
the first drug from albumin, hence, increases the volume of distribution of the drug
• With decrease excretion – renal diseases • With decrease metabolism, for Ex. –
When another drug inhibits its biotransformation
Effect of urine Ph on renal clearance for drugs that undergo tubular reabsorption
Bases Cleared rapidly by making urine more acidic Amphetamine Chloroquine Levorphanol Imipramine
Acids
cleared rapidly by making urine alkaline Acetazolamide Nitrofurantoin Phenobarbital Probenecid
Mecamylamine
Salicylates
Quinine
Sulfathiazole