Absorption, distribution, metabolism nonlinear

Pharmacokinetic models describe the biological processes of absorption, distribution, metabolism, and excretion of exogenous compounds. With the exception of absorption into and across the skin, absorption, distribution, metabolism, and elimination are essential processes that also occur with nutrients and endogenous compounds. Many of these processes can become nonlinear with increasingly higher exposure concentrations. Pulmonary absorption can be limited by respiratory rates. Metabolism can often show Michaelis-Menten or saturable kinetics. Distribution can be limited by the affinity of the chemical for a specific tissue or by blood flow. 

As mentioned above, bioavailability is the degree to which a drug reaches the intended site of action. The amount of drug that reaches systemic circulation will depend on the processes of absorption, distribution, and biotransformation (when the route of administration exposes the drug to first-pass metabolism). Pharmacokinetics are often linear and when they are nonlinear it is often due to a saturation of protein binding, metabolism, or active renal transport. 

Absorption/Distribution - Propafenone is nearly completely absorbed after oral administration with peak plasma levels occurring approximately 3.5 hours after administration. It exhibits extensive first-pass metabolism resulting in a dose-dependent and dosage-form-dependent absolute bioavailability. Propafenone follows a nonlinear pharmacokinetic disposition presumably due to saturation of first-pass hepatic metabolism as the liver is exposed to higher concentrations of propafenone and shows a very high degree of interindividual variability. 

Factors analogous to those affecting gut absorption also can affect drug distribution and excretion. Any transporters or metabolizing enzymes can be taxed to capacity—which clearly would make the kinetic process nonlinear (see Linear versus Nonlinear Pharmacokinetics ). In order to have linear pharmacokinetics, all components (distribution, metabolism, filtration, active secretion, and active reabsorption) must be reasonably approximated by first-order kinetics for the valid design of controlled release delivery systems. 

Linear (or first-order) kinetics refers to the situation where the rate of some process is proportional to the amount or concentration of drug raised to the power of one (the first power, hence the name first-order kinetics). This is equivalent to stating that the rate is equal to the amount or concentration of drug multiplied by a constant (a linear function, hence linear kinetics). All the PK models described in this chapter have assumed linear elimination (metabolism and excretion) kinetics. All distribution processes have been taken to follow linear kinetics or to be instantaneous (completed quickly). Absorption processes have been taken to be instantaneous (completed quickly), follow linear first-order kinetics, or follow zero-order kinetics. Thus out of these processes, only zero-order absorption represents a nonlinear process that is not completed in too short of a time period to matter. This lone example of nonlinear kinetics in the standard PK models represents a special case since nonlinear absorption is relatively easy to handle mathematically. Inclusion of any other type of nonlinear kinetic process in a PK model makes it impossible to write the... 

The most, comprehensive review of quantitative structure-pharmacokinetics relationships [452] tabulates about 100 equations, including absorption, distribution, protein binding, elimination, and metabolism of drugs. Since many of these equations and those included in other reviews e.g. [472, 761]) have been derived before appropriate mathematical models for nonlinear lipophilicity-activity relationships (chapter 4.4) and for the correct consideration of the dissociation and ionization of acids and bases (chapter 4.5, especially eqs. 107—110) were available, some of the older results should be recalculated by using the theoretical models (chapters 4.4 and 4.5) instead of the empirical ones. 

Drug exposure was not proportional to dose, with ZT-1 and HA systemic availability increasing more than dose-proportionally in the 1- to 3-mg dose range, which suggests a nonlinearity at the level of absorption/first-pass metabolism or distribution. In addition, food delayed the peak concentrations of ZT-1 and HA and increased the systemic exposure to HA by 50-80%. 

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