Absorption of drugsAbsorption is the transfer of a drug from its site

of administration to the blood stream without being chemically altered. or

The movement of a drug from its site of application into the blood or lymphatic system.

The rate and efficiency of absorption depend on the route of administration.

For intravenous delivery, absorption is complete, that is, the total dose of drug reaches the systemic circulation. Drug delivery by other routes may result in only partial absorption and thus lower bioavailability.

For example, the oral route requires that a drug dissolve in the gastrointestinal fluid and then penetrate the epithelial cells of the intestinal mucosa; disease states or the presence of food may affect this process.

The ability of a un-ionized drug to diffuse across membranes is frequently expressed in terms of its lipid–water partition coefficient rather than its lipid solubility.

This coefficient is defined as the ratio of the concentration of the drug in two immiscible phases:

● a nonpolar liquid or organic solvent (frequently octanol), representing the membrane; and

● an aqueous buffer, usually at pH 7.4, representing the plasma.

A. Transport of drug from the GI tract

Depending on the chemical properties, drugs may be absorbed from the GI tract by passive diffusion, active transport or pinocytosis process.

1. Passive diffusion:

The driving force for passive absorption of a drug is the concentration gradient across a membrane separating two body compartments, that is, the drug moves from a region of high concentration (e.g. GI fluids) to lower concentration (e.g. blood).

Passive diffusion does not involve a carrier, is not saturable, and shows a low structural specificity.

The vast majority of drugs gain access to the body by this mechanism. Lipid-soluble drugs readily move across most biological membranes, whereas water-soluble drugs penetrate the cell membrane through aqueous channels.

Figure: Schematic representation of drugs crossing cell membrane of epithelial cell of gastrointestinal tract.

Fig: Routes by which solutes can traverse cell membranes

2. Active transport:This mode of drug entry involves specific carrier

proteins that span the membrane. A few drugs that closely resemble the structure of naturally occurring metabolites are actively transported across cell membranes using these specific carrier proteins.

Active transport is energy-dependent and is driven by the hydrolysis of adenosine triphosphate (by the use of ATP).

It is capable of moving drugs against a concentration gradient, that is, from a region of low drug concentration to one of higher drug concentration. The process shows saturation kinetics for the carrier.

Characteristics of active transport (ref. cpr):- Drug moves against the concentration gradient.- The process requires energy.- The carrier may be selective for certain types of drugs that resemble natural substrate, or metabolites that the are normally actively transported.- The carrier system may be saturated at high drug concentration.- The process may be competitive (i.e. drugs with same structure may compete for the same career).

For example, levodopa and methyl dopa are actively absorbed from the gut by aromatic amino acid transport process.

3. Pinocytosis: Pinocytosis involves invagination of part of the

cell membrane and the trapping within the cell of a small vesicle containing extracellular constituents. The vesicle contents can then be released within the cell, or extruded from its other side.

This mechanism appears to be important for the transport of some macromolecules (e.g. insulin, which crosses the blood-brain barrier by this process), but not for small molecules.

Absorbed molecules

B. Effect of pH on drug absorption Most drugs are either weak acids or weak bases

that are present in solution as both the ionized and un-ionized form.

Acidic drugs (HA) release H+ & produce charged anion (A-). Weak bases (BH+) can also release H+; however, the protonated form of basic drugs is usually charged, and loss of a proton produces the uncharged base (B).

Acidic drug HA A- + H+

Basic drug BH+ B + H+

Passage of uncharged drug through a membrane:

A drug passes through membranes more readily if it is uncharged. Un-ionized molecules are usually lipid soluble and can diffuse across cell membranes.

For a weak acid, the uncharged HA can permeate through membranes, and A- cannot. For a weak base, the uncharged form, B, penetrates through the cell membrane, but BH+ does not.

The ratio between the two forms is, in turn, determined by the pH at the site of absorption and by the strength of the weak acid or base, which is represented by the pKa.

The use of only pKa values to describe the relative strengths of either weak bases or weak acids makes comparisons between drugs simpler.

The lower the pKa value (pKa6) of an acidic drug, the stronger the acid (i.e., the larger the proportion of ionized molecules).

The higher the pKa value (pKa8) of a basic drug, the stronger the base.

Fig. pKa values for some acidic and basic drugs.

Figure: A. Diffusion of un-ionized form of a weak acid through lipid membrane B. Diffusion of un-ionized form of a weak base through lipid membrane

Figure: The distribution of a drug between its ionized and un-ionized form depends on the ambient pH and pKa of the drug. For illustrative purposes, the drug has been assigned a pKa of 6.5.

Determination of how much drug will be found on either side of a membrane:

The relationship of pKa and the ratio of acid-base concentrations to pH is expressed by the Henderson-Hasselbalch equation:

Knowing the pH of the aqueous medium in which the drug is dissolved and the pKa of the drug, one can, using the Henderson-Hasselbach equation, calculate the relative proportions of ionized and un-ionized drug present in solution.

This equation is useful in determining how much drug will be found on either side of a membrane that separates two compartments that differ in pH, for example, stomach (pH 1.0 to 1.5) and blood plasma (pH 7.4).

Summary:Drug is weak acid:

AH A- + H+

Acidic environment: protonated, un-ionized, lipid-solubleBasic environment: un-protonated, ionized, water-soluble

Drug is weak base:BH+ B + H+

Acidic environment: protonated, ionized, water-solubleBasic environment: un-protonated, un-ionized, lipid-soluble

Physical factors influencing absorption

» Blood flow to the absorption site:

Blood flow to the intestine is much greater than the flow to the stomach; thus absorption from the intestine is favored over that from the stomach.

» Total surface area available for absorption:

Because the intestine has a surface rich in microvilli, it has a surface area about 1,000 times that of the stomach; thus absorption of the drug across the intestine is more efficient.

» Contact time at the absorption surface:

If a drug moves through the GI tract very quickly, as in severe diarrhea, it is not well absorbed. Conversely, anything that delays the transport of the drug from the stomach to the intestine delays the rate of absorption of the drug.