The total body clearance is the volume of the plasma or blood which is completely cleared from the drug per unit time. It has units of volume/time.
The CLT for a drug is constant within a patient (dose and concentration independent) when the elimination processes follow first-order kinetics.
The total body clearance is a measure of the efficiency of all eliminating organs in eliminating the drug and it is the sum of all organ clearances (i.e. CLT is the sum of the renal clearance, hepatic clearance and all other organ clearances).
The elimination rate constant and the half life (the dependent pharmacokinetic parameters) are dependent on (is determined from) the total body clearance and the volume of distribution (the independent pharmacokinetic parameters).
CLT
Vd = k andCLT
Vd =0.693
t 1/2Drug molecules can be actively secreted in the proximal renal tubules. There are specific transport system for anions, cations, and quaternary amines in the renal tubules. These transport systems actively secrete the drug molecules from the plasma to the lumen of the nephron.
These transport systems are not specific, however they can transport compounds with similar characteristics. So, drugs can compete with each other for the transport system, and drugs with higher affinity for the transport system can inhibit the secretion of other drugs with lower affinity. (e.g. probenecid inhibits the active secretion of penicillins in the renal tubules).
Since most of the water filtered in the glomeruli is reabsorbed in the renal tubules, the drug concentration in the nephron lumen is always higher than the plasma drug concentration. So, the drug secretion in the renal tubule is against the concentration gradient.
The half life is the time required for the amount of the drug or the plasma concentration of the drug to decrease by 50%. The half life has units of time.
The half life and the first order elimination rate constant are dependent on the total body clearance and the volume of distribution.
CLT
Vd = k =0.693
t 1/2The half life of a drug is constant within a patient (dose and concentration independent) when the drug elimination process follows first-order kinetics. However different patients may have different half lives for the same drug.
The half life is a very important parameter, because it indicates how fast the drug is eliminated from the body. Drugs with shorter half lives are eliminated faster than those with longer half lives.