Clearance saturable

Once the steady-state concentration is known, the rate of dmg clearance determines how frequendy the dmg must be adininistered. Because most dmg elimination systems do not achieve saturation under therapeutic dosing regimens, clearance is independent of plasma concentration of the dmg. This first-order elimination of many dmgs means that a constant fraction of dmg is eliminated per unit time. In the simplest case, clearance can be deterrnined by the dose and the area under the curve (AUC) describing dmg concentration as a function of total time ... 

A special case for reduced bioavailabilty results from first-pass extraction that sometimes might be subjected to saturable Michaelis-Menten absorption kinetics. The lower the hepatic drug clearance is (Clhep) in relation to liver blood flow (Ql), or the faster the drug absorption rate constant (Ka), and the higher the dose (D) are, the more bioavailable is the drug (F). 

Monitor for changes in pulmonary symptoms such as cough, sputum production, respiratory rate, and oxygen saturation. Symptoms of an acute exacerbation should improve with antibiotics and aggressive airway clearance therapy. Pulmonary function tests should be markedly increased after 1 week and trend back to pre-exacerbation levels after 2 weeks of therapy, ft improvement lags, 3 weeks of therapy may be needed. 

Only a subset of the parameter values in the O Flaherfy model require inputs from the user to simulate blood and tissue lead concentrations. Lead-related parameters for which values can be entered into the model include fractional absorption from the gastrointestinal tract partition coefficients for lead in nonbone tissues and in the surface region of bone maximum capacity and half-saturation concentration for capacity-limited binding in the erythrocyte elimination clearance fractional clearance of lead from plasma into forming bone and the restricted permeability coefficients for lead diffusion within bone, from plasma into bone, and from bone into plasma (O Flaherty 1991a). 

Excessive dietary intake of cholesterol and saturated fatty acids leads to decreased hepatic clearance of LDL and deposition of LDL and oxidized LDL in peripheral tissues. 

High-clearance drugs are those for which there is no saturation of the reaction that converts the drug, and therefore, the clearance rate approaches the blood-flow rate. For capacity-limited drugs, flow rate is irrelevant, and clearance is a simple product of the unbound fraction and the intrinsic clearance. 

Clearance is constant across drug concentrations because the mechanisms are normally not saturated. Under such normal conditions, a constant fraction of the drug is eliminated per unit time, whereas if there is... 

The clearance of a drug is usually defined as the rate of elimination of a compound in the urine relative to its concentration in the blood. In practice, the clearance value of a drug is usually determined for the kidney, liver, blood or any other tissue, and the total systemic clearance calculated from the sum of the clearance values for the individual tissues. For most drugs clearance is constant over the therapeutic range, so that the rate of drug elimination is directly proportional to the blood concentration. Some drugs, for example phenytoin, exhibit saturable or dose-dependent elimination so that the clearance will not be directly related to the plasma concentration in all cases. 

Figure 13.3. Model of Stella and Himmelstein, adapted from reference [5] (Section 13.3.1). The drug-carrier conjugate (DC) is administered at a rate i c(DC) into the central compartment of DC, which is characterized by a volume of distribution Fc(DC). DC is transported with an inter-compartmental clearance CLcr(DC) to and from the response (target) compartment with volume Fr(DC), and is eliminated from the central compartment with a clearance CZ.c(DC). The active drug (D) is released from DC in the central and response compartments via saturable processes obeying Michaelis-Menten kinetics defined by Fmax and Km values. D is distributed over the volumes Fc(D) and Fr(D) of the central and response compartment, respectively. D is transported with an inter-compartmental clearance CLcr(D) between the central compartment and response compartment, and is eliminated from the central compartment with a clearance CLc(D).

As a clearance route the renal route has attractive features for the design of drugs. For instance clearance rates, certainly for neutral compounds, are low. Moreover, the clearance process by filtration is not saturable and tubular secretion is only saturated at high doses with acidic and basic compounds. In a similar vein drug interactions... 

Saturable clearance mechanisms producing non-linear kinetics... 

Aspirin Aspirin is rapidly hydrolyzed in plasma to salicylic acid with a half-life of 20 minutes. Plasma levels of aspirin are essentially undetectable 2 to 2.5 hours after dosing, and peak salicylic acid concentration occurs 1 hour (range, 0.5 to 2 hours) after aspirin administration. Salicylic acid is primarily conjugated in the liver to form a number of minor metabolites. Salicylate metabolism is saturable and the total body clearance decreases at higher serum concentrations. 

Paroxetine at low concentration is dependent on CYP 2D6 for its clearance. However, this enzyme is almost completely saturated by paroxetine at low concentrations, which accounts for the nonlinear pharmacokinetics of paroxetine and why its half-life goes from 10 to 20 hours when the dose is advanced from 10 to 20 mg per day. At higher concentrations, paroxetine is most likely dependent on CYP 3A3/4 for its clearance. This dose-dependent change in the clearance of paroxetine probably accounts for the higher incidence of withdrawal reactions with this SSRI than might otherwise be expected for a drug with a half-life of 20 hours at steady-state on 20 mg per day (296, 297). 

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