Skip to main content
Log in

Classical absorption theory and the development of gastric mucosal damage associated with the non-steroidal anti-inflammatory drugs

  • Review
  • Published:
Archives of Toxicology Aims and scope Submit manuscript

Abstract

Evidence has accumulated during the last decade to support the view that the pharmacokinetic behaviour of non-steroidal anti-inflammatory drugs (NSAIDs) contributes not only decisively to their therapeutic effects but also to the type and incidence of their side effects. It has been shown that NSAIDs reach particularly high concentrations in those compartments in which they cause effects and side effects. Specifically, the data reviewed herein indicate that the accumulation of NSAID within gastric mucosal cells a priori is a principal factor associated with the intervention of intracellular biochemical events and resultant gastric mucosal damage. To a large extent this behaviour is according to the precepts of classical absorption theory; in this respect the limitations of such theory are examined. Our survey further indicates that the failure of certain NSAIDs to significantly reduce gastric mucosal levels of prostaglandins (PG) in vivo may reflect pharmacokinetic differences between NSAIDs rather than tissuespecific differences in their potency as inhibitors of cyclooxygenase.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Aehringhaus U, Weiler H, Peskar BA, Peskar BM (1984) Molecular mechanisms of the gastric toxicity of anti-rheumatic drugs. Arch Toxicol (Suppl) 7: 323–327

    Google Scholar 

  • Allen A, Bell A, Mantle M, Pearson JP (1982) The structure and physiology of gastrointestinal mucus. In: Chantler EN et al. (ed) Mucus in health and disease II, Plenum, New York and London, pp 3–28

    Google Scholar 

  • Bhattacherjee P, Eakins KE (1974) Inhibition of the prostaglandin synthetase systems in ocular tissues by indomethacin. Br J Pharmacol 50: 227–230

    PubMed  Google Scholar 

  • Brogden RN, Heel RC, Pakes GE, Speight TM, Avery GS (1980) Diflusinal: A review of its pharmacological properties and therapeutic use in pain and musculoskeletal strains and sprains and pain in osteoarthritis. Drugs 19: 84–106

    PubMed  Google Scholar 

  • Bronsted JN (1926) The acid-basic function of molecules and its dependence on the electric charge type. J Phys Chem 30: 777–790

    Google Scholar 

  • Brooks PM, Buchanan WW (1976) Azapropazone — its place in the management of rheumatoid conditions. Curr Med Res Opin 4 (1): 94–100

    PubMed  Google Scholar 

  • Brune K (1974) How aspirin might work: a pharmacokinetic approach. Agents Actions 4 (4): 230–232

    PubMed  Google Scholar 

  • Brune K (1977) Biodistribution of salicylates: a clue to the understanding of some effects and side effects. Agents Actions (Suppl) 2: 163–177

    Google Scholar 

  • Brune K (1978) Analgesics: pharmacologic properties as a basis for rational therapy. Schweiz Med Wochenschr 108 (17): 625–630

    PubMed  Google Scholar 

  • Brune K (1982) Prostaglandins, inflammation and anti-inflammatory drugs Eur J Rheumatol Inflam 5 (4): 335–349

    Google Scholar 

  • Brune K (1985a) Rationale and success of modifying the absorption of anti-inflammatory drugs to reduce the gastrointestinal side-effects. Adv Inflam Res 10: 391–394

    Google Scholar 

  • Brune K (1985b) Pharmacokinetic factors as causes of variability in response to non-steroidal anti-inflammatory drugs. Agents Actions (Suppl) 17: 59–63

    Google Scholar 

  • Brune K, Graf P (1978) Non-steroid anti-inflammatory drugs: influence of extra-cellular pH on biodistribution and pharmacological effects. Biochem Pharmacol 27 (4): 525–530

    PubMed  Google Scholar 

  • Brune K, Lanz R (1985) Pharmacokinetics of non-steroidal antiinflammatory drugs. In: Bonta IL et al. (ed) Handbook of inflammation, Volume 5: The pharmacology of inflammation. Elsevier Science Pub BV, pp 413–450

  • Brune K, Graf P, Rainsford KD (1977a) A pharmacokinetic approach to the understanding of therapeutic effects and side effects of salicylates. Agents Actions (Suppl) 1: 9–25

    Google Scholar 

  • Brune K, Schweitzer A, Eckert H (1977b) Parietal cells of the stomach trap salicylates during absorption. Biochem Pharmacol 26 (18): 1735–1740

    PubMed  Google Scholar 

  • Brune K, Gubler H, Schweitzer A (1979) Autoradiographic methods for the evaluation of ulcerogenic effects of anti-inflammatory drugs. Pharmacol Ther 5: 199–207

    Google Scholar 

  • Brune K, Rainsford KD, Wagner K, Peskar BA (1981) Inhibition by antiinflammatory drugs of prostaglandin production in cultured macrophages. Naunyn-Schmiedeberg's Arch Pharmacol 315: 269–276

    Google Scholar 

  • Brune K, Schweitzer A, Lanz R (1984) Importance of drug biodistribution and metabolism in the development of side-effects by anti-inflammatory/analgesic drugs. Adv Inflam Res 6: 9–15

    Google Scholar 

  • Calabrese EJ (1984) Absorption: Interspecies Differences in the gastrointestinal tract. Drug Metab Rev 15 (5/6): 1014–1032

    Google Scholar 

  • Cohen MM (1984) Prevention of aspirin-induced fecal blood loss with oral prostaglandin E: dose response studies in man. Prostaglandins (Suppl) 21: 155–160

    Google Scholar 

  • Colaizzi JL, Klink PR (1969) pH-Partition behaviour of tetracyclines. J Pharm Sci 58 (10): 1184–1189

    PubMed  Google Scholar 

  • Crouthamel WG, Tan GH, Dittert LW, Doluisio JT (1971) Drug absorption IV: Influence of pH on absorption kinetics of weakly acidic drugs. J Pharm Sci 60 (8): 1160–1162

    PubMed  Google Scholar 

  • Crouthamel WG, Abolin CR, Hsieh J, Kim JK (1975) Intestinal pH as a factor in selection of animal models for bioavailability testing. J Pharm Sci 64 (10): 1726–1727

    PubMed  Google Scholar 

  • Doluisio JT, Swintosky JV (1964) Drug partitioning II. In vitro model for drug absorption. J Pharm Sci 53 (6): 597–600

    PubMed  Google Scholar 

  • Fenner H, Mixich G (1973) NMR studies of the molecular structure of azapropazone and interpretation of its pharmacokinetics and biotransformation. Arzneim Forsch 23 (5): 667–669

    Google Scholar 

  • Ferreira SH, Vane JR (1974) New aspects of the mode of action of non-steroidal anti-inflammatory drugs. Ann Rev Pharmacol 14: 57–73

    Google Scholar 

  • Flower RJ, Vane JR (1974) Some pharmacologic and biochemical aspects of prostaglandin biosynthesis and its inhibition. In: Robinson HJ (ed) Prostaglandin synthesase inhibitors. Raven Press, New York, pp 9–18

    Google Scholar 

  • Gleeson MH (1982) A survey of peptic ulcers associated with NSAIDs. Eur J Rheumatol 5 (3): 308–312

    Google Scholar 

  • Graf P, Glatt M, Brune K (1975) Acidic non-steroid anti-inflammatory drugs accumulating in inflamed tissue. Experientia 31 (8): 951–953

    PubMed  Google Scholar 

  • Gubler HU, Baggliolini M (1978) Pharmacological properties of proquazone. Scand J Rheumatol 21: 8–11

    Google Scholar 

  • Heller CA, Ingelfinger JA, Goldman P (1985) Nonsteroidal antiinflammatory drugs and aspirin — analyzing the scores. Pharmacotherapy 5 (1): 30–38

    PubMed  Google Scholar 

  • Herzfeldt CD, Kummel R (1983) Dissociation constants, solubilities and dissolution rates of some selected non-steroidal antiinflammatories. Drug Dev Ind Pharm 9 (5): 767–793

    Google Scholar 

  • Hogben CAM, Schanker LS, Tocco DJ, Brodie BB (1957) Absorption of drugs from the stomach. II. The human. J Pharmacol 120: 540–545

    Google Scholar 

  • Hogben CAM, Tocco DJ, Brodie BB, Schanker LS (1959) On the mechanism of intestinal absorption of drugs. J Pharmacol 125: 275–282

    Google Scholar 

  • Hollander D, Dadufalza VD, Fairchild PA (1981) Intestinal absorption of aspirin — influence of pH, taurocholate, ascorbate, and ethanol. J Lab Clin Med 98: 591–598

    PubMed  Google Scholar 

  • Jacob BP (1972) Unpublished data

  • Jahn V, Reller J, Schatz F (1973) Pharmacokinetic experiments with azapropazone in animals. Arzneim Forsch 13 (5): 660–666

    Google Scholar 

  • Klatt L, Koss FW (1973) Pharmacokientic studies with azapropazone dihydrate, labelled with carbon-14, in the rat. Arzneim Forsch 23 (7): 913–919

    Google Scholar 

  • Krebs HA, Speakman JC (1945) The effect of pH on the solubility of sulphonamides. Biochem J 39: XL ii.

    Google Scholar 

  • Kuna S (1964) The pH of gastric juice in the normal resting stomach Arch Int Pharmacodyn 152: 79–97

    PubMed  Google Scholar 

  • Leonards JR (1963) The influence of solubility on the rate of gastrointestinal absorption of aspirin. Clin Pharmacol Ther 4: 476–479

    PubMed  Google Scholar 

  • Lombardino JG, Otterness IG, Wiseman EH (1975) Acidic antiinflammatory agents — correlations of some physical, pharmacological and clinical data. Arzneim Forsch 25 (10): 1629–1635

    Google Scholar 

  • Luzzani F, Colombo G, Schiatti P, Selva D, Glasser A (1984) Inhibition of PG production by MDL 305, a new non-steroidal anti-inflammatory compound, in rat gastric mucosa and inflammatory exudate. Pharmacol Res Commun 16 (8): 755–763

    PubMed  Google Scholar 

  • Martin BK (1963) Accumulation of drug anions in gastric mucosal cells Nature 198 (4883): 896–897

    Google Scholar 

  • Mason WD, Winer N (1981) Kinetics of aspirin, salicylic acid, and salicyluric acid following oral administration of aspirin as a tablet and two buffered solutions. J Pharm Sci 70: 262–265

    PubMed  Google Scholar 

  • McCormack K (1987) Unpublished data

  • Meldrum SJ, Watson BW, Riddle HC (1972) pH profile of gut as measured by radiotelemetry capsule. Br Med J 2: 104–106

    PubMed  Google Scholar 

  • Mixich G (1968) The chemical behaviour of the antiphlogistic compound azapropazone (Mi 85) 3-dimethylamino-7-methyl-1,2-(propylamolonyl)-1, 2-dihydro-1,2,4-benzotriazine. Helv Chim Acta 51 (3): 532–538

    Google Scholar 

  • Orme M (1984) Drug absorption in the gut. Br J Anaesth 56: 59–67

    PubMed  Google Scholar 

  • Peskar BM, Weiler H, Peskar BA (1982) Effect of BW 755C on prostaglandin synthesis in the rat stomach. Biochem Pharmacol 31: 1652–1653

    PubMed  Google Scholar 

  • Peskar BM, Weiler H, Meyer Ch (1984) Inhbiition of prostaglandin production in the gastrointestinal tract by anti-inflammatory drugs. Adv Inflam Res 6: 39–50

    Google Scholar 

  • Pindell MH, Cull KM, Doran KM, Dickison HL (1959) Absorption and excretion studies on tetracycline. J Pharmacol Exp Ther 125: 287–294

    PubMed  Google Scholar 

  • Pong SS, Levine L (1976) Prostaglandin synthetase systems of rabbit tissues and their inhibition by non-steroidal anti-inflammatory drugs. J Pharmacol Exp Ther 196)1): 226–230

    PubMed  Google Scholar 

  • Rainsford KD (1977) Gastrointestinal and other side-effects from the use of aspirin and related drugs; biochemical studies on the mechanism sof gastrotoxicity. Agents actions (Suppl) 1: 59–75

    Google Scholar 

  • Rainsford KD (1978) Structure-activity relationships of non-steroid anti-inflammatory drugs. Gastric ulcerogenic activity, Agents Actions 8 (6): 587–605

    PubMed  Google Scholar 

  • Rainsford KD (1981) Comparison of the gastric ulcerogenic activity of new non-steroid anti-inflammatory drugs in stressed rats. Br J Pharmacol 73: 226P-227P

    Google Scholar 

  • Rainsford KD (1984a) Mechanisms of gastrointestinal ulceration by nonsteroidal anti-inflammatory/analgesic drugs. Adv Inflam Res 6: 51–64

    Google Scholar 

  • Rainsford KD (1984b) Side-effects of anti-inflammatory analgesic drugs: epidemiology and gastrointestinal tract. TIPS 5: 156–159

    Google Scholar 

  • Rainsford KD, Brune K (1978) Selective cytotoxic actions of aspirin on parietal cells: a principal factor in the early, stages of aspirin-induced gastric damage. Arch Toxicol 40 (2): 143–150

    PubMed  Google Scholar 

  • Rainsford KD, Whitehouse MW (1980) Biochemical gastroprotection from acute ulceration induced by aspirin and related drugs. Biochem Pharmacol 29: 1281–1289

    PubMed  Google Scholar 

  • Rainsford KD, Willis C (1982) Relationship of gastric mucosal damage induced in pigs by anti-inflammatory drugs to their effects on prostaglandin production. Dig Dis Sci 27 (7): 624–635

    PubMed  Google Scholar 

  • Rainsford KD, Fox SA, Osborne DJ (1984) Comparative effects of some non-steroidal anti-inflammatory drugs on the ultrastructural integrity and prostaglandin levels in the rat gastric mucosa: relationship to drug intake. Scand J Gastroenterol 19 (101): 55–68

    Google Scholar 

  • Robert A (1975) An intestinal disease produced experimentally by a prostaglandin deficiency. Gastroenterology 69: 1045–1047

    PubMed  Google Scholar 

  • Schachter H, Williams D (1982) Biosynthesis of mucus glycoproteins. In: Chantler EN et al. (ed) Mucus in health and disease II. Plenum, New York and London, pp 3–28

    Google Scholar 

  • Schanker LS (1959) Absorption of drugs from the rat colon. J Pharmacol 126: 81–88

    Google Scholar 

  • Schanker LS, Shore PA, Brodie BB, Hogben CAM (1957) Absorption of drugs form the stomach. The rat. J Pharmacol 123: 81–88

    Google Scholar 

  • Schanker LS, Tocco DJ, Brodie BB, Hogben CAM (1958) Absorption of drugs from the rat small intestine. J Pharmacol 123: 81–88

    Google Scholar 

  • Schror K, Saverland S, Kuhn A, Rosen R (1980) Different sensitivities of prostaglandin-cyclooxygenases in blood platelets and coronary arteries against non-steroidal anti-inflammatory drugs. Naunyn-Schmiedeberg's Arch Pharmacol 313: 69–76

    Google Scholar 

  • Schweitzer A, Brune K (1977) Salicylic acid and proquazone: the differences in absorption and biodistribution explain their different profile of side-effects. In: Willoughby DA et al (ed) Perspectives in inflammation. MTP Press, UK pp 353–360

    Google Scholar 

  • Shen TY (1981) Toward more selective anti-arthritic therapy. J Med Chem 24: 1–5

    PubMed  Google Scholar 

  • Shore PA, Brodie BB, Hogben CAM (1950) The gastric secretion of drugs. A pH partition hypothesis. J Pharmacol 119: 361–369

    Google Scholar 

  • Smith HW (1965) Observations on the flora of the alimentary tract of animals and factors affecting its composition. J Pathol Bacteriol 89: 95–122

    PubMed  Google Scholar 

  • Sugiyama H, Okazaki T, Adachi A (1970) Unpublished data

  • Takesue EI, Perrine JW, Trapold JH (1976) The anti-inflammatory profile of proquazone. Arch Int Pharmacodyn 221: 122–131

    PubMed  Google Scholar 

  • Vane JR (1971) Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nature (New Biol) 234: 231–238

    Google Scholar 

  • Verbeeck RK, Blackburn JL, Loewen GR (1983) Clinical pharmacokinetics of non-steroidal anti-inflammatory drugs. Clin Pharmacokinet 8: 297–331

    PubMed  Google Scholar 

  • Walker FS (1985) Azapropazone and related benzotriazines, In: Rainsford KD (ed), Anti-inflammatory and anti-rheumatic drugs. Volume II: Newer anti-inflammatory drugs. CRC Press Inc, Florida, pp 1–32

    Google Scholar 

  • Wheatley D (1984) Azapropazone in arthritis: a long-term treatment. Curr Med Res Opin 9 (2): 86–92

    PubMed  Google Scholar 

  • Whittle BRJ (1976) Relationship between the prevention of rat gastric erosions and the inhibition of acid secretion by prostaglandins. Eur J Pharmacol 40: 233–239

    PubMed  Google Scholar 

  • Whittle BJR, Higgs GA, Eakins KE, Moncada S, Vane JR (1980) Selective inhibition of prostaglandin production in inflammatory exudates and gastric mucosa. Nature 284: 271–273

    PubMed  Google Scholar 

  • Whittle BJR (1981) Arachidonic acid metabolites and the gastrointestinal toxicity of an anti-inflammatory agent. Prostaglandins (Suppl) 21: 113–124

    Google Scholar 

  • Yik KY, Dreidger AA, Watson WC (1982) Prostaglandin E2 tablets prevent aspirin-induced blood loss in man. Dig Dis Sci 27: 972–975

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

McCormack, K., Brune, K. Classical absorption theory and the development of gastric mucosal damage associated with the non-steroidal anti-inflammatory drugs. Arch Toxicol 60, 261–269 (1987). https://doi.org/10.1007/BF01234664

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01234664

Key words

Navigation