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PLASMA HALF LIFE (t1/2) Minimum Effective Concentration (MEC): The plasma drug concentration below which a patient’s response is too small for clinical benefit. Peak Plasma & Trough Concentration : The maximum & minimum drug conc. achieved during repeated dosing cycles. Target Concentration : The plasma concentration required to produce desired therapeutic effect. Definition: The time required for the concentration of the drug in the plasma to decrease to one half of its initial value after the peak has been reached. It is designated as t ½. A useful parameter derived from Vd & CL. Important for rational drug therapy because it helps in designing & planning the dosage regimens Assimilation kinetics Elimination kinetics Plasma half life is a measure of the elimination kinetics Peak level- beyond which further assimilation cannot take place and elimination processes take over It can be calculated by following relationship: t ½ = 0.7 x Vd CL Plasma Concentration a 10000 Distribution and Elimination C0 1000 b Elimination only 100 10 Distribution equilibrium 1 0 1 2 3 4 Time 5 6 Decline in Plasma Concentration starting at any steady-state plasma concentration (100 %) of a drug , it will fall as follows: After 1 t ½ to 50 % After 2 t ½ to 25 % After 3 t ½ to 12.5 % After 4 t ½ to 6.25 % After 5 t ½ to 3.125 % t½ Plasma conc. (mg) 0 100 1 50 2 25 3 12.5 4 6.25 5 3.125 1. 2. 3. 4. 5. 6. 7. 8. 9. Volume of distribution Plasma protein binding Clearance Kinetics Pattern Presence of second drug Diseases Active metabolites Enterohepatic circulation Hepatic blood flow Large Vd = long t1/2 Albumin Globulin Free drug Bound drug Class I drugs Class II drugs Increased clearance = decreased t1/2 First order kinetics/Exponential kinetics/linear Uniform or fixed fraction of drug is eliminated in a unit time t1/2 independent of the drug concentration constant t ½ Zero order kinetics/Saturation kinetics/non-linear Michaelis Menten kinetics Fixed amount of drug is eliminated in a unit of time Increase dose = t ½ prolonged First order Plasma conc. is 100mg and fraction eliminated is 10%/hr So after 1 hr 10% is eliminated =10mg, leaving 90mg After 2nd hr again 10% is eliminated =9mg, leaving 81mg After 3rd hr 10% of 81mg is eliminated =8.1mg, leaving 72.9mg After 4th hr 10% of 72.9mg= 7.29mg, leaving 65.6mg Changing the dose t1/2 is not changed Time (hrs) 0 1 2 3 4 5 6 Plasma conc (mg) 100 90 81 72.9 65.6 59.04 53.14 Plasma conc (mg) 200 180 162 145.8 131.22 118.01 106.29 Zero order 100mg dose and amount eliminated is 10mg/hr So after 1hr 90mg remains After 2hrs 8omg remains After 3hrs = 70mg 4hrs =60mg 5hrs = 50mg Increasing dose will increase t1/2 as enzymes become saturated and elimination capacity decreases Time (hrs) 0 1 2 3 4 5 10 Plasma conc (mg) 100 90 80 70 60 50 - Plasma conc (mg) 200 190 180 170 160 150 100 Drugs following zero order kinetics Aspirin Phenytoin Alcohol Enzyme inducers ----- ↑ metabolism (↓ t½ ) Enzyme inhibitors ----- ↓ metabolism (↑t½) Diseases of organ of metabolism/excretion Hepatic & renal disease Change in Vd Change in plasma protein binding Biological half life (duration of action) longer than plasma half life ? Aspirin Omeprazole Aspirin – salicylate Morphine – morphine 6 glucoronide Drugs excreted in bile are reabsorbed from intestine and plasma half life is prolonged Rifampin Morphine Decreased hepatic blood flow e.g. in cardiogenic shock, cardiac failure, hemorrhage Prolonged t ½ of drugs with flow dependent CL/extensive hepatic first pass metabolism Rate of elimination Duration of action Dosing interval Designing a dosing regimen Time for steady state concentration Time for complete elimination t ½ indicates rate of elimination 97 % drug eliminated in 5 t ½ Increase t1/2 – elimination is slow Decrease t1/2 – elimination is fast t ½ indicates the duration of action of a drug longer t ½ -long duration of action shorter t ½ -short duration of action t ½ indicates the dosing interval longer t ½ -long dose interval shorter t ½ -short dose interval t ½ is important for designing a dosage regimen. It is a plan for drug administration over a period of time. The interval between doses should not be less than 4 t ½. Drugs with short half life --- More frequent dosing. Drugs with long half life --- Less frequent dosing. Loading dose for drugs with large Vd . Time for Steady State (SS) Rate of elimination equals the Rate of drug administration Time to reach SS is 4-5 t ½ Time to reach SS is not affected by dose of drug Time for complete elimination Important incase of certain adverse effects When constant dose of a drug is repeated before 5 t1/2. it would achieve higher peak concentration, because some remnant of the previous dose will be present in the body This continues with every dose until progressively increasing rate of elimination balances the amount administered over the dose interval Plasma concentration plateaus and fluctuates about an average steady state level Plasma Half Life of Some drugs: Esmolol 09 Min Aspirin 15 Min Morphine 1.9 Hours Propranolol 3.9 Hours Digoxin 50 Hours Digitoxin 161 Hours Thank you!