The process by which the drug and/or its metabolite(s) are transferred permanently from the internal to the external environment is called excretion of the drug. The major route of drug elimination is kidney, followed by the liver, lungs, skin, salivary glands, mammary glands, and semen constituting the nonrenal pathways for drug elimination. Size, solubility, polarity, and protein binding nature are the major determinants for the elimination of drugs by the organ. The kinetics of elimination defines the half-life of the drug and thereby determines the dosing frequency of the drug. The drug can undergo linear (first order) kinetics or nonlinear (zero order or saturation) kinetics. Elimination is one of the sites for “drug interaction” wherein two drugs can compete for excretion resulting in toxicity or failure of therapy. Elimination of drugs in breast milk is a major concern while prescribing the drug for lactating mother. In clinics, the knowledge about the drug elimination gains significance in multidrug therapy, in the presence of organ failure and other co-morbid conditions.
KeywordsRenal drug elimination Nonrenal drug elimination Clearance Half-life First-order kinetics Zero order kinetics
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