Metabolism
Renal excretion
Biliary excretion
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 1/2The volume of distribution is the apparent volume in which the drug can be distributed in. It is the factor that relates the amount of drug in the body to the concentration of the drug in the sampling site. It is not an actual volume, however it is a hypothetical volume determined by the drug distribution behavior.
The volume of distribution ranges from 3-5 liters to more than 25 L/kg. Drugs with higher affinity for tissues, have higher volume of distribution.
The first-order elimination rate constant is the rate constant for the elimination of the drug from the body. The elimination rate constant and the half life are dependent on the total body clearance and the volume of distribution of the drug.
CLT
Vd = k =0.693
t 1/2This rate constant represents drug elimination through all routes of drug elimination such as metabolism, renal excretion, and other routes.
The first-order elimination rate constant has units of time-1.
The first-order metabolic rate constant is the rate constant for the drug elimination by metabolism. The metabolic rate constant is dependent on the metabolic clearance and the volume of distribution.
CLm
Vd = kmThis rate constant represents drug elimination by metabolism. The metabolic rate constant cannot be bigger than the overall elimination rate constant (k). When the drug is excreted entirely by metabolism, the metabolic clearance will be equal to the CLT and the metabolic rate constant will be equal to the overall elimination rate constant.
The first-order metabolic rate constant has units of time-1.
The first-order renal excretion rate constant is the rate constant for the drug elimination by the kidney. The renal excretion rate constant is dependent on the renal clearance and the volume of distribution.
CLR
Vd = keThis rate constant represents drug elimination by the kidney in the urine. The renal excretion rate constant cannot be bigger than the overall elimination rate constant (k). When the drug is excreted entirely through the kidney, the renal clearance will be equal to the CLT and the renal excretion rate constant will be equal to the overall elimination rate constant.
The first-order renal excretion rate constant has units of time-1.
It is the volume of the plasma or the blood that is completely cleared from the drug per unit time by a specific organ. It has units of volume/time.
Any organ clearance cannot exceed the CLT. However the organ clearance can be equal to the CLT when the drug is excreted completely by that particular organ.
The CLT is the sum of the clearances of all organs.