Department: Pharmacy

Class: BPharm

Semester: VI Sem

Subject: Biopharmaceutics & Pharmacokinetics (BP604T)

Topic: NON-LINEAR PHARMACOKINETICS

Disclaimer:

The presented matter is compilation of various online materials available on the topic with
modification and simplification. The content is presented here for student’s easy accessibility
as online study material and not for commercial purpose.
Unit-V

NON-LINEAR PHARMACOKINETICS

It is a Dose Dependent Pharmacokinetics. Nonlinear pharmacokinetic models imply that

some aspect of the pharmacokinetic behaviour of the drug is saturable.

CAUSES OF NON-LINEARITY

 Saturation of enzymes in process of drug

 Pathologic alteration in drug ADME

EXAMPLES

 Amino glycoside may cause renal nephrotoxicity thereby altering renal drug excretion
 Obstruction of the bile duct to the formation of gallstone will alter biliary drug
excretion

PROCESS SATURATED

 Absorption

Nonlinearity in drug absorption can arise from 5 important sources;

1. When absorption is solubility or dissolution rate-limited. e.g. griseofulvin

At higher doses, a saturated solution of the drug is formed in the GIT or at any other
extravascular site and the rate of absorption attains a constant value.

2. When absorption involves carrier-mediated transport systems

e.g. absorption of riboflavin, ascorbic acid, cyanocobalamin, etc.

Saturation of the transport system at higher doses of these vitamins results in nonlinearity.

3. When presystemic gut wall or hepatic metabolism attains satura-Tion

e.g. propranolol, hydralazine and verapamil.

Saturation of presystemic metabolism of these drugs at high doses leads to increased

bioavailability.

The parameters affected will be F, Ka, Cmax and AUC, A decrease in these parameters is
observed in the former two cases and an increase in the latter case. Other causes of
nonlinearity in drug absorption are changes in gastric emptying and GI blood flow and other
physiological factors. Nonlinearity in drug absorption is of little consequence unless
availability is drastically affected.
  Distribution

Nonlinearity in distribution of drugs administered at high doses may be due to-

1. Saturation of binding sites on plasma proteins e.g. phenylbutazone and naproxen. There is
a finite number of binding sites for a particular drug on plasma proteins and, theoretically, as
the concentration is raised, so too is the fraction unbound.

2. Saturation of tissue binding sites e.g. thiopental and fentanyl. With large single bolus doses
or multiple dosing, saturation of tissue storage sites can occur. In both cases, the free plasma
drug concentration increases but Vd increases only in the former case whereas it decreases in
the latter.

Clearance is also altered depending upon the extraction ratio of the drug. Clearance of a drug
with high ER is greatly increased due to saturation of binding sites. Unbound clearance of
drugs with low ER is unaffected and one can expect an increase in pharmacological response.

 Metabolism

The nonlinear kinetics of most clinical importance is capacity-limited metabolism since

small changes in dose administered can produce large variations in plasma concentration
at steady-state. It is major sources of large inter subject variability in pharmacological
response. Two important causes of nonlinearity in metabolism are;

1. Capacity-limited metabolism due to enzyme and/or cofactor satu- ration. Typical

examples include phenytoin, alcohol, theophylline, etc.
 2. Enzyme induction e.g. carbamazepine, where a decrease in peak plasma concentration
has been observed on repetitive adminis- tration over a period of time. Autoinduction
characterized in this case is also dose-dependent. Thus, enzyme induction is a common
cause of both dose- and time-dependent kinetics.

3. Saturation of enzyme results in decreased ClH and therefore in- creased Css Reverse is
true for enzyme induction. Other causes of nonlinearity in biotransformation include
saturation of binding sites, inhibitory effect of the metabolite on enzyme and pathological
situations such as hepatotoxicity and changes in hepatic blood flow.

 Excretion

The two active processes in renal excretion of a drug that are;

1. Active tubular secretion e.g. penicilin G. After saturation of the carrier-system, a decrease
in renal clearance occurs.

2. Active tubular reabsorption e.g. water-soluble vitamins and glucose. After saturation of the
carrier-system, an increase in renal clearance occurs. Other sources of nonlinearity in renal
excretion include forced diurebiliary secretion, which is also an active process.

A summary of outcome of saturation (nonlinearity) in various ADME is changes in urine pH,

nephrotoxicity and saturation of binding sites. e.g. tetracycline and indomethacin.
MICHAELIS MENTEN EQUATION

Michaelis–Menten
Menten kinetics is one of the best
best-known
known models of enzyme kinetics. It is named
after German biochemist Leonor Michaelis and Canadian physician Maud Menten. The
Michaelis-Menten equation is commonly used to describe the kinetics of in
in-vitro, in-situ as
well as certain in-vitro
vitro processes that are kknown
nown to be catalysed by enzymes.
enzymes The elimination
of drugs by a saturable enzymatic process is described by Michaelis-Menten
Menten Kinetics.

If C is the concentration of drugs in the plasma then Elimination rate

Where C is the plasma concentration

Vm is tthe maximum rate of process
Km iis the Michaelis-Menten constant

A typical p
plot of Michaelis-Menten equation
Case I: Km=c

The value for Km is equal to the concentration at which the rate of process is half (1/2) the
maximum rate Vm.

-dc/dt=Vmax/2

Case II where Km > C

At low concentration, where Km> C , Km + C is approximately equal to Km,

As Vm/Km is a constant term, the equation can be described as a first order equation with
Vm/Km as the first order kinetics is expected. Usually in most of the case of the cases Km is
larger than the plasma concentration that is achieved.

Case III:

In some cases at higher doses C > Km, then

Km+ C is approximately equal to C.

Summary:

Condition I When Km = C -dc/dt=Vmax/2

Condition II When Km>>C -dc/dt=Vmax.c/Km
Condition III When Km<<C -dc/dt=Vmax

 When given in the therapeutic doses, most drugs produce plasma drug concentration
well below the Km for all carrier mediated enzyme systems affecting the
pharmacokinetics of the drugs. Therefore, most drugs at normal therapeutic
concentration follow 1st order rate process
 A few drugs such as salicylate and phenytoin saturate the hepatic mixed function
oxidase at higher therapeutic doses.
 Later part of the graph describes here zero order kinetics. Thus at high plasma
concentration, first order kinetics are not seen.
 With these drugs, elimination kinetics are first order at low doses and mixed at high
doses and may approach zero-order at very high therapeutic doses
 Suggested References/Sources

1. https://www.slideshare.net/bharathpharmacist/non-linear-pharmacokinetics-
39686259?qid=ab58fcd5-fe1f-4203-b07a-111e806a20c7&v=&b=&from_search=6
2. Ritschel, Wolfgang A. "Handbook of basic pharmacokinetics." (1976).
3. Brahmankar, D. M., and Sunil B. Jaiswal. Biopharmaceutics and pharmacokinetics: A
treatise. Vallabh prakashan, 2005.
4. Shargel, Leon, Susanna Wu-Pong, and Andrew BC Yu. Applied biopharmaceutics &
pharmacokinetics. McGraw-Hill, 2007.
5. Gibaldi, Milo. Biopharmaceutics and clinical pharmacokinetics. Lea & Febiger,
1977.
6. Winter, Michael E. Basic clinical pharmacokinetics. Eds. Mary Anne Koda-Kimble,
and Lloyd Y. Young. Philadelphia: Lippincott Williams & Wilkins, 2004.
7. Welling, Peter G. Pharmacokinetics: processes, mathematics, and applications. Amer
Chemical Society, 1997.
Department: Pharmacy

Class: BPharm

Semester: VI Sem

Subject: Biopharmaceutics & Pharmacokinetics (BP604T)

Topic: Two compartment open model with first order elimination

kinetics, pharmacokinetics of single and multiple dose administration, as
applied to intravenous (rapid/bolus)

Disclaimer:

The content present here is part of the project which was submitted to www.cec.nic.in for e-
content development. Here, it is presented again for student’s easy accessibility as online
study material.
Various mathematical models can be devised to simulate the rate processes of drug
absorption, distribution, metabolism, and elimination. These mathematical models
are useful in the development of equations to describe drug concentration in the
body as a function of time. Pharmacokinetic models are divided into the:
1. Compartment models
2. Physiologic pharmacokinetic models
3. Non-compartmental pharmacokinetics
4. Non-linear pharmacokinetics
Compartment Model
In a pharmacokinetic analysis of the data, the living system is assumed to consist of
a number of interconnected compartments. A compartment is defined as a group of
tissues which behaves uniformly with respect to the drug movement. Each
compartment behaves differently regarding the drug concentration time course data.
As you know that one – compartment model describes pharmacokinetics of many
drugs. Instantaneous distribution equilibrium is assumed in such cases and decline
in the amount of drug in the body with time is expressed by an equation with a mono-
exponential term (i.e. elimination). However, instantaneous distribution is not truly
possible for an even larger number of drugs and drug disposition is not mono-
exponential but bi-or multi-exponential.
This is because the body is composed of a heterogeneous group of tissues each
with different degree of blood flow and affinity for drug and therefore different rate of
equilibration. Ideally, a true pharmacokinetic model should be the one with a rate
constant for each tissue undergoing equilibrium, which is difficult mathematically.
The best approach is therefore to pool together tissues on the basis of similarity in
their distribution characteristics.
As for one-compartment models, drug disposition in multi-compartment systems is
also assumed to occur by first-order. Multi-compartment characteristics of a drug are
best understood by giving it as i.v. bolus and observing the manner in which the
plasma concentration declines with time.
TWO COMPARTMENT OPEN MODEL

In a two compartment open model, the body tissues are broadly classified into two
categories.
1. Central Compartment or Compartment 1
It is comprised of blood and highly perfused tissues like liver, lungs, kidneys, etc.
that equilibrate with the drug rapidly. Elimination usually occurs from this
compartment.
2. Peripheral or Tissue Compartment or Compartment 2
It is comprised of poorly perfused and slow equilibrating tissues such as muscles,
skin, adipose, etc. and considered as a hybrid of several functional physiological
units.
Classification of particular tissue, for example brain, into central or peripheral
compartment depends upon the physicochemical properties of the drug. A highly
lipophilic drug can cross the BBB and brain would then be included in the central
compartment. In contrast, a polar drug cannot penetrate the BBB and brain in this
case will be a part of peripheral compartment despite the fact that it is a highly
perfused organ.
Following I.V. bolus, if a drug distributes to some tissue which are not highly
perfused with blood, the distribution of the drug to tissue may take a longer time to
establish equilibrium between the central compartment and the tissue compartment.
During this time the drug levels in the central compartment will fall because of two
reasons. 1. Distribution of the drug from the central compartment to peripheral
compartment. 2. Elimination of the drug levels from the central compartment by the
all possible pathways of elimination. It means the decrease in drug level in the
central compartment can be described by biexponential equation. This part of the
plasma level time curve is called distribution phase. Once equilibrium is established
between the amount of the drug present in the central compartment and that of the
peripheral compartment, a decline in the plasma level takes place mono
exponentially. This decline is only because of elimination of the drug from the body
and is called elimination phase.
The following points should be considered in developing the equation for a
two-compartment open model:
1. In this model, the drug distributes in two compartments, the central
compartment and the tissue compartment.
2. Drug transfer between the two compartments is assumed to take place by a
first-order process.
3. There are three possible types of two compartment systems. Depending upon
the compartment from which the drug is eliminated, the two-compartment
model can be categorized into 3 types:
I. Two –compartment model with elimination from central compartment.
II. Two–compartment model with elimination from peripheral compartment.
III. Two- compartment model with elimination from both the compartments.
In the absence of information, elimination is assumed to occur exclusively from
central compartment.
4. Elimination of the drug from the body is assumed to follow first order kinetics.
5. The concentration of the drug in a compartment is assumed to be uniform in
its volume of distribution.
Two compartment models assume that at t=0 there is no drug in the tissue
compartment. After an I.V. dose, drug levels in the tissue compartment will first
increase, reach maximum and then decline.

PHARMACOKINETICS OF I.V BOLUS SINGLE DOSE ADMINISTRATION

After the i.v. bolus of a drug that follows two-compartment kinetics, the decline in
plasma concentration is bi-exponential indicating the presence of two disposition
processes viz. distribution and elimination. These two processes are not evident to
the eyes in a regular arithmetic plot but when a semilog plot of C versus t is made,
they can be identified.
You can see figure 1. Initially, the concentration of drug in the central compartment
declines rapidly, this is due to the distribution of drug from the central compartment
to the peripheral compartment. The phase during which this occurs is therefore
called as the distributive phase.
After sometime, a pseudo
do distribution equilibrium is achieved between the two
compartments following which the subsequent loss of drug from the central
compartment is slow and mainly due to elimination. This second, slower rate process
is called as the post-distributive
distributive or elim
elimination
ination phase. In contrast to the central
compartment, the drug concentration in the peripheral compartment first increases
and reaches a maximum. This corresponds with the distribution phase. Following
peak, the drug concentration declines which correspo
corresponds
nds to the post-distributive
post
phase.

Figure 2: Changes in drug concentration in the central (plasma) and the

peripheral compartment after i.v. bolus of a drug that fits two
two-compartment
model

You can see figure 2 in which two compartment IV bolus model ha

hass been depicted
with elimination from the central compartment
 1 K12
Ka 2
Xo
Xc = Vc.C Xt = Vt.Ct
K21
K13

X3

Figure 1: Scheme for I.V. Bolus Two-Compartment Pharmacokinetic Model

Where:
X0 = I.V. dose given as bolus
Xc = Amount of the drug in the central compartment at any time (Compartment 1)
Xt = Amount of drug in the tissue compartment at any time (Compartment 2)
X3 = Amount of drug eliminated to time t.
Vc = Volume of distribution of drug in the central compartment.
Vt = Volume of distribution of the drug in the tissue compartment.
C = Concentration of the drug in the central compartment at any time.
Ct = Concentration of the drug in the tissue compartment at any time.

Calculation of pharmacokinetic parameters

Let K12 and K21 be the first-order distribution rate constants depicting drug transfer
between the central and the peripheral compartments and let subscript c and t define
central and peripheral compartment respectively. The constants K12 and K21 that
depict reversible transfer of drug between compartments are called as micro-
constants or transfer constants. Ke is the elimination rate constant.
Equation that describes the time course of drug concentration in the central
compartment and peripheral compartment following I.V. bolus can be developed as
described below.
According to mass balance equation,
X0 = Xc + Xt + X (1)
The rate of change in the amount of the drug in central compartment is the net
balance of rate of input (K21 Xt) and output (K12 Xc and K13 Xc)
dXc
= K X −K X − K X (2)
dt
The rate of change in drug concentration in the tissue compartment is given by
equation:

(3)
 dXt
= K X − K X
dt

The rate of elimination of drug from the central compartment is given by,

dX (4)
= K X
dt

Integrating the equation (4) and substituting the value of X3 in equation (1) it will yield
a biexponentail curve in the form of,
= + (5)

Where
0( − )
=
( − )
and
0( − )
=
( − )

Substituting the values of A’ and B’ in equation 5, we get

0( − ) 0( − ) (6)
= +
( − ) ( − )

A linear relationship exists between the drug concentration in plasma and the
amount of the drug in the central compartment.

Xc = Vc. C (7)
Where, Vc is the apparent volume of distribution of the drug in the central
compartment. This relationship enables the conversion of equation 6 from amount-
time to a concentration-time equation, which can be expressed as,
( ) ( )
C= e + e
( ) ( ) (8)
or in simpler form,
C=Ae +Be
(9)
( ) ( )
Where, A = ( )
and B = ( )
 Where Xo = i.v. bolus dose, α and β are hybrid first-order constants for the rapid
distribution phase and the slow elimination phase respectively which depends
entirely upon the first order rate constants K12, K21 and KE

Method of Residuals: The bi-exponential disposition curve obtained after i.v. bolus
of a drug that fits two compartment models can be resolved into its individual
exponents by the method of residuals.
C = A e-αt + B e-βt (9)
As apparent from the bi-exponential curve given in Fig. 3., the initial due to
distribution is more rapid than the terminal decline due to elimination i.e. the rate
constant α > >β and hence the term e-αt approaches zero much faster than does e-βt.
Thus, equation 9 reduces to:

C = Be (10)
In log form, the equation becomes:

log = log − .
(11)

Equations 10 and 11 describe the plasma drug-level time data during the elimination
phase.
A plot of the log plasma drug level versus time can be used to estimate various
pharmacokinetic parameters as shown in fig.3. An estimate of b can be made from
the slope of the terminal linear portion (slope = -βt/ 2.303) and the biological half-life
(t1/2) can be determined employing relationship t1/2 = 0.693/β.
Figure 3: Resolution off biexponential plasma concentration
concentration-time
time curve by the
method of residuals for a drug that follows two
two-compartment
compartment kinetics on i.v. bolus
administration

The zero time intercept obtained by extrapolation of the terminal linear phase
is log B. Application of the method of residual may be carried out by subtracting the
plasma drug level on the extended line at the same time point to obtain residual
concentration-time
time data. A plot of residual concentration versus time gives a residual
line with a slope = -α/
α/ 2.303 and an intercept = log A.
The constant A, B, a, and b may be obtained graphically as explained above.
Once these experimental constants are obtained, the pharmacokinetic par
parameters,
Vc, K12, K13 and K21 can be generated by considering the following relationship.
Module 4: ESTIMATION OF PHARMACOKINETIC PARAMETERS
All the parameters of equation 9 can be resolved by the method of residuals as
described above. Other parameters o
of the model viz. K12, K21, KE, etc. can now be
derived by proper substitution of these values.

1. Vc
=C
C0 = A + B (12)
Therefore,
. .
Vc = = = (13)

2. K21

K = (14)

3. K13
( )
K = ( )
(15)

4. K12 : By definition (α+β) = K12 + K13 + K21. Substituting K21 and K13 values
in the above equation and solving it for K12 we get
( )
K = ( )( )
(16)

It must be noted that for two-compartment model K13 is the rate constant for
elimination of drug from the central compartment and β is the rate constant for
elimination from the entire body. Overall elimination t1/2 should therefore be
calculated from β.
Drug level in tissue or peripheral compartment
The differential equation that describes the rate of change in the amount of the drug
in the tissue compartment is,
Xt = ( )
(e −e ) (17)

Equation 17 describes the time course of the amount of the drug in the peripheral
compartment following I.V. bolus. Thie equation may be useful in determining the
relationship between pharmacological action and the tissue level of the drug.
It is assumed that the drug in the tissue compartment distributes uniformly in its
volume of distribution, Vt, then equation 17 can be written in concentration terms.
Ct = ( )
(e −e ) (18)

Module 5: APPARENT VOLUME OF DISTRIBUTION

Even though the volume of distribution is fictive, it provides not only some insight into
distribution but also importantly relates to the rate of clearance of the drug from
plasma. In multiple compartments we may consider mathematically hypothetical
volumes, such as the volume of the central compartment and the volume of the
tissue or peripheral compartment.
In a two-compartment open model, the determination of the volume of
distribution, Vd is complicated by 1) The slow attainment of distribution equilibrium;
and, 2) The volume of distribution is changing continually during the distribution
phase. There are several volumes of distribution that may be considered for a drug
that follows a two-compartment open model.
Volume of distribution of central compartment (Vc)
The volume of distribution of the central compartment, Vc, is an important parameter
to understand distribution pattern of the drug in the body, to estimate drug clearance
and to describe the time course of plasma drug levels because the central
compartment is usually the sampling compartment.
At time zero, the total drug injected is in the central compartment. Hence Vc is
the ratio of I.V. dose and plasma drug concentration at t = 0 i.e., C0
Vc = I. V. Dose/C0 (19)
C0, can be estimated from equation
C = A e-αt + B e-βt, at t = 0
C0 = A + B
Vc = (20)

A and B are estimated from the plasma drug level – time graph by the method of
residuals.
Alternatively, the volume of the central compartment may be calculated from [ ]
in a manner similar to the calculation for the apparent Vd in the one-compartment
model.
Vc = [ ]
(21)

The apparent volume of distribution at steady-state

The apparent volume of distribution at steady-state Vd,ss is equal to the total drug in
the body at steady state divided by the plasma drug concentration at that time.

, =
Total drug in the body = amount of the drug in the central compartment (Xc) +
amount of drug in the tissue compartment (Xt). Therefore,
, = (22)

At steady state condition the rate of drug entry into the tissue compartment from the
central compartment is equal to the rate of drug exit from the tissue compartment
into the central compartment. This steady-state condition may be exist for a moment,
theoretically, following I.V. bolus. Hence, at steady state condition
Vd, ss = Vc + Vc (23)

Volume of distribution by area can be given as:

Vd, area = (24)

I.V. Bolus – Unchanged drug in Urine

It is possible to obtain pharmacokinetics of a drug from urinary excretion data that
follows a two-compartment open model following an I.V. bolus administration. The
elimination of the drug from the body in such cases is by the parallel renal and extra-
renal elimination processes.

1 K12
Ka 2
Xo
Xc = Vc.C Xt = Vt.Ct
K21
Ke Ky

Xu Xy

Figure 4: Scheme for I.V. Bolus Two-Compartment Pharmacokinetic Model

(Unchanged Drug in Urine)
Where:
Ke = Urinary excretion rate constant for unchanged drug.
Ky = Sum of all the rate constants of all the processes involved in the elimination of
drug other than renal excretion.
Xu = Cumulative amount of the unchanged drug excreted in urine.
Xy = Cumulative amount of drug eliminated by all other routes other than renal.
The overall elimination rate constant from the central compartment, K13 is the sum of
the individual rate constants which characterize the parallel elimination processes
(K13 = Ke + Ky).
The excretion rate of unchanged drug, dXu/dt can be expressed as

= A"e + B"e (25)

( ) ( )
Where A" = Ke X0 ( )
and B" = Ke X0 ( )

dXu/dt is the instantaneous rate of excretion of the drug, which cannot be

determined experimentally. Hence, instead of dXu/dt, the average excretion rate,
ΔXu/Δt, is used. ΔXu/Δt approximate dXu/dt if the sampling intervals are short.
Therefore,
= A"e + B"e ′ (26)

t’ = mid-point of urine collection period.

All pharmacokinetic parameters can be determined by applying method of residual.