Clearance systemic

NET (SLC6A2) Noradre-naline, dopamine 1 CNS noradrenergic neurons (emanate from locus coeruleus and lateral tegmental area), sympathetic nervous system Clearance of interstitial neuro-transmitter, reuptake into neurons... 

The area under the PCP concentration-time curve (AUC) from the time of antibody administration to the last measured concentration (Cn) was determined by the trapezoidal rule. The remaining area from Cn to time infinity was calculated by dividing Cn by the terminal elimination rate constant. By using dose, AUC, and the terminal elimination rate constant, we were able to calculate the terminal elimination half-life, systemic clearance, and the volume of distribution. Renal clearance was determined from the total amount of PCP appearing in the urine, divided by AUC. Unbound clearances were calculated based on unbound concentrations of PCP. The control values are from studies performed in our laboratory on dogs administered similar radioactive doses (i.e., 2.4 to 6.5 pg of PCP) (Woodworth et al., in press). Only one of the dogs (dog C) was used in both studies. 

CLi = organ clearance fi = fraction of dose eliminated by organ i CL = total systemic clearance... 

With disruption of this barrier, molecules such as albumin freely enter the brain and ions and water follow. Because the brain lacks a well-developed lymphatic system, clearance of plasma constituents is slow, edema occurs, and intracranial pressure rises. At lower levels of exposure, subtle dysfunction of the blood-brain barrier may contribute to neurobehavioral deficits in children (Bressler and Goldstein 1991 Goldstein 1993). The particular vulnerability of the fetus and infant to the neurotoxicity of lead may be due in part to immaturity of the blood-brain barrier and to the lack of the high-affinity leadbinding protein in astroglia, which is discussed later in this section. Results of measurements of transendothelial electrical resistance across the blood-brain barrier from mice of various ages showed that lead potentiates cytokines-induced increase in ion permeability of the blood-brain barrier (Dyatlov et al. 

Ketoconazole (a potent inhibitor of CYP3A4) has been shown to increase the oral bioavailability of cyclosporin from 22 to 56% [50]. This consisted of a 1.8-fold decrease in systemic clearance combined with a 4.9-fold decrease in oral clearance. The authors estimated that hepatic extraction was decreased only 1.15-fold, whereas the oral bioavailability increased 2.6-fold and the observation was attributed to decreased intestinal metabolism. Erythromycin was also shown to increase the oral bioavailability of cyclosporin A 1.7-fold, while pre-treatment with rifampin (an inducer of CYP3A4) decreased oral bioavailability of cyclosporin from 27% to 10% due to a 4.2-fold increase in oral clearance but only a 1.2-fold increase in systemic clearance. Floren et al. [51] have also shown that ketoconazole can double the oral bioavailability of tacrolimus in man by inhibiting gut wall CYP3A4. 

Oral bioavailability of a drug is primarily dependent upon its rate and extent of drug absorption and systemic clearance. Systemic clearance is primarily composed of hepatic, renal and biliary clearance. The PK properties are in turn directly impacted by the drug s physical properties, such as, log P, log D and pKa. The physical properties are in turn a function of the compound s structure, molecular weight, number of hydrogen bond donors and acceptors, and number of rotatable bonds. Oral bioavailability is the outcome from the dynamic interplay of these factors in the biological system. 

Mihaly et al. [128] identified the carboxylic acid derivative of primaquine as a major plasma metabolite. After oral administration of 45 mg of primaquine to healthy volunteers, absorption of the drug was rapid, with peak primaquine levels of 153.3 ng/mL at 3 h, followed by an elimination half-life of 7.1 h, systemic clearance of 21.1 L/h, volume of distribution of 205 L and cumulative urinary excretion of 1.3% of the dose. Primaquine was converted rapidly to the carboxylic acid metabolic, which achieved peak levels of 1427 ng/mL at 7 h. 

Knauf MJ, Bell DP, Hirtzer P, Luo ZP, Young JD, Katre NV (1988) Relationship of effective molecular size to systemic clearance in rats of recombinant interleukin-2 chemically modified with water-soluble polymers. J Biol Chem 263 15064—15070... 

After either oral or intravenous administration of ondansetron to laboratory animals the elimination of the drug is rapid. The short elimination half-lives t ji Table 7.7) reflect the high plasma clearance (CLp) in these species. Renal clearance (CLr) is below glomerular filtration rate, indicating that the major component of systemic clearance is metabolism. Ondansetron is rapidly absorbed after oral administration, peak concentrations in plasma being achieved within 40 min of dosing. However, the oral bioavailability is low. The similarity between concentrations of total drug-related material in plasma after oral and intravenous doses indicates that the low... 

Fleming, R.A., Milano, G., Thyss, A., et al. (1992) Correlation between dihydropyrimidine dehydrogenase activity in peripheral mononuclear cells and systemic clearance of fluorouracU in cancer patients. Cancer Res. 52, 2899-2902. 

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. 

The organs of extraction are generally the liver (hepatic clearance - metabolism and biliary excretion CIh) and the kidney (renal excretion, CIr) and the values can be summed together to give an overall value for systemic clearance (Cls) ... 

Cli and (Cli + Q) effectively cancel and Cl (or Cls) is equal to blood flow (Q). The implications of this on drugs cleared by metabolism is that the systemic clearance of low clearance drugs are sensitive to changes in metabolism rate whereas that of high clearance drugs are sensitive to changes in blood flow. 

The estimation of systemic clearance together with this value gives valuable information about the behaviour of a drug. High clearance drugs with values approaching hepatic blood flow will indicate hepatic extraction (metabolism) as a reason for low bioavailability. In contrast poor absorption will probably be the problem in low clearance drugs which show low bioavailabilities. 

This simplifies greatly the concepts of first-pass hepatic metabolism and systemic clearance referred to previously. Most importantly Cli is directly evolved from the enzyme kinetic parameters, V ax and K ... 

Lability can be used to advantage to create drugs that are designed for topical or intravenous infusion administration. For topical administration compounds may benefit from rapid systemic clearance to overcome possible side-effects. Thus the compound is stable at its topical site of action (skin, eye etc.) but rapidly degraded by the esterases present in blood, liver and kidneys to its inactive metabolites. This approach renders the compound selective. 

Fig. 9.2 Allometric relationship between body weight and systemic clearance of fluconazole.

The equation can be solved for intrinsic clearance (Clj) based upon systemic clearance (Clj) obtained after i.v. administration and hepatic blood flow (Q) in the test species. Intrinsic clearance in man can then be estimated based upon relative in vitro microsomal stabibty and the equation solved to provide an estimate for human systemic clearance. Hence this approach combines aUometry (by considering differences in organ blood flow) and species-specific differences in metabolic clearance. 

The systemic clearance of lepirudin is proportional to the glomerular filtration rate or creatinine clearance. Dose adjustment based on creatinine clearance is recommended (see Administration and Dosage). In patients with marked renal insufficiency (creatinine clearance less than 15 mL/min) and on hemodialysis, elimination half-lives are prolonged 2 days or less. 

Special populations The systemic clearance of lepirudin in women is about 25% lower than in men. In elderly patients, the systemic clearance of lepirudin is 20% lower than in younger patients. This may be explained by the lower creatinine clearance in elderly patients compared with younger patients. 

Excretion - After IV administration of 1 mg to healthy males, plasma concentrations declined biexponentially with a redistribution and a terminal elimination half-life of 41 34 minutes and 10.8 5.2 hours, respectively. The systemic clearance of nalmefene is 0.8 L/h/kg and the renal clearance is 0.08 L/h/kg. 

Mean systemic clearance in healthy adult volunteers following a single oral dose was... 

Excretion - The major route of elimination of valganciclovir is by renal excretion as ganciclovir through glomerular filtration and active tubular secretion. Systemic clearance of IV administered ganciclovir was about 3.07 mL/min (n = 68) while renal clearance was about 2.99 mL/min/kg (n = 16). 

Following IV administration, 66% of circulating radioactivity was attributed to unchanged drug and the remainder attributed to saquinavir metabolites, suggesting that saquinavir undergoes extensive first-pass metabolism. Systemic clearance of saquinavir was rapid, 1.14 L/h/kg after IV doses of 6, 36, and 72 mg. The mean residence time of saquinavir was 7 hours. 

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