DRUG METABOLISM
DRUG METABOLISM
Drug metabolism or biotransformation are the
chemical reactions that are responsible for the
conversion of drugs into other products (metabolites)
within the body before and after they have reached
their sites of action.
It usually occurs by more than one route.
These routes normally consist of a series of enzyme
controlled reactions.
Consequences of metabolism
IMPLICATIONS OF DRUG METABOLISM
Inactive products
Active metabolites
Metabolites which are similar in activity to the
parent drug
It may change the usual activity of the substrate
Toxic metabolites.
Products which are highly polar hence easily
eliminated from the body
Less toxic metabolites (detoxification)
Sites of metabolism
Liver- main site of drug metabolism
Gastro intestinal tract
Lungs
Plasma
Brain
Skin
kidney
First pass metabolism
Bioavailability and First Pass Metabolism (1).mp4
Drug metabolism
https://youtu.be/eOlh_oJehUg
DRUG METABOLISM and Excretion Animation!.mp4
metabolic enzymes
Metabolism is the activity of certain enzymes
which may be obtained from the liver.
If the liver is homogenized and centrifuged,
three metabolic fractions are isolated.
i. Microsomal fraction
ii. Mitochondrial fraction
iii. The soluble fraction
Enzymes : Microsomal fraction
Is the most significant
The microsomal drug metabolizing system is located
in the liver in the hepatic smooth endoplasmic
reticulum.
It consist of non-specific enzymes responsible for
most metabolic oxidative reactions.
The most significant of these enzymes are the mixed
function oxidases, (MFO) e.g. cytochrome p 450
system.
Lipid soluble substances such as drugs and hormones
are primarily acted upon by enzymes of this fraction.
Enzymes: Mitochondrial fraction
Consist of enzymes that metabolize more water
soluble drugs.
They include
Monoamine and diamine oxidases which catalyze
breakdown/degradation of biogenic or xenobiotic
amine.
Rhodanases which act on cyanide compounds by
converting them to thiocynides
Enzymes : The soluble fraction
Contains enzymes involved in hydrolysis and
conjugative reaction
Also phase two reactions except glucoronide
formation occur by enzymes of this fraction.
Enzymes in this fraction at are also present in other
body organs.
Factors affecting metabolism
The route and rate of metabolism of drugs varies
between species and between individuals and groups of
individuals (e.g. in different races).
The differences are due to a number of factors:
1. Genetic varieties
Variations in the genetic codes of individuals can
result in the absence of enzymes, low concentrations
of enzymes or the formation of enzymes with
reduced activity.
Factors affecting metabolism
1. Genetic varieties
These differences in enzyme concentration and
activity result in individuals exhibiting different
metabolic rates and in some cases different
pharmacological responses for the same drug.
An individual’s inability to metabolize a drug could
result in that drug accumulating in the body.
This could give rise to unwanted effects.
Factors affecting metabolism
2. Physiological factors
The metabolic differences found within a species are
believed to be due to variations in age, sex, nutritional
status and diet, and diseases
Age.
The ability to metabolize drugs is lower in the very
young (under 5) and the elderly (over 60).
However, it is emphasized that the quoted ages are
approximate and the actual changes will vary
according to the individual and their lifestyle.
Eg Chloramphenicol in infants-causes gray baby
syndrome
Factors affecting metabolism
2. Physiological factors
Sex.
The metabolic pathway followed by a drug is
normally the same for both males and females.
However, some sex related differences in the
metabolism of anxiolytics, hypnotics and a number
of other drugs have been observed.
Pregnant women will also exhibit changes in the rate
of metabolism of some drugs.
Factors affecting metabolism
2. Physiological factors
Disease states
Diseases that affect the liver will have a large effect
on drug metabolism.
Diseases of organs, such as the kidneys and lungs,
that are less important centers for metabolism will
also affect the excretion of metabolic products.
Factors affecting metabolism
3. Pharmacodynamics factors such as dose,
frequency and route of administration.
Environmental factors: Drinking, smoking and drug
abuse may all have an influence on the rate of
metabolism.
The use of over-the-counter self-medicaments may
also affect the rate of metabolism of an endogenous
ligand or a prescribed drug.
Metabolic reactions
Drug metabolism is divided into phase I and phase II
reactions.
Phase I reactions
convert drugs into more soluble products through
oxidation, hydrolysis or reduction.
The product obtained may have lesser activity.
Phase I reactions are functionalization reactions
i.e. there is a minor change on the functional groups.
New functional groups may be introduced or older
functional groups replaced or removed.
Metabolic reactions
Phase I reactions
This functionalization provide a site for phase II
reaction.
Certain drugs may be eliminated from the body at
this position without going to phase II
Metabolic reactions
Phase II reactions
Also referred to as synthetic or conjugation
reaction
In this phase the metabolites from phase I or a drug
that has by – passed phase I is coupled or conjugated
with a polar endogenous molecule to give a larger
(more water soluble) or polar and usually inactive
product.
Metabolic reactions
Assignment;
Is metabolism the same as detoxification? 5mks
NB: The mechanism of drug metabolism/
biotransformation are similar in all animals because
they use similar enzymes, however the rate at which the
enzymes act and the route involved in metabolism
would vary from compound to compound and from
species to species.
Metabolism Phases
Pharmacokinetics animation Phases Of Drug Metabolism.mp4
PHASE I REACTIONS
They involve;
Hydrolysis
Oxidation
Reduction
Minor or miscellaneous phase I reactions include
Hydration
Dethioacetylation
Isomerization.
Oxidative reactions
A.Oxidative reaction microsomal
Microsomal oxidative of many drugs and
steroid hormones are mediated by mixed
function oxidases/ mono oxidases e.g. CYP
450.
Oxidation is
Addition of oxygen
Removal of hydrogen
Loss of electrons
Oxidative reactions
Oxidation is the most important of metabolic
reactions.
The MFO particularly the CYP 450 catalyze a large
proportion of oxidative metabolism.
CYP 450 is a group of closely related heme
containing isoenzymes or isoforms that combine with
carbon dioxide to give a complex that absorbs U.V
radiation at 450nm.
There are about 100 iso-enzymes that have been
identified.
Oxidative reactions
A. Oxidative reaction microsomal
Most drugs are oxidized by four of this iso-enzymes
which are;
Cyp 3A4/5
Cyp 2D6
Cyp 2C8/9
Cyp 1A1/2
Oxidative reactions
Cyp 3A4/5 (the number 3 stands for the family, A for the
subfamily while 4 and 5 represent individual
isoenzymes).
This accounts for about 40% of all oxidations.
Drugs that inhibit or induce these isoforms are
candidates for drug-drug and drug – food interactions.
Cyp 2D6.
Oxidizes about 20% of drugs including tricyclic
antidepressants, neuroleptics, b-blockers and selective
serotonin re-uptake inhibitors.
Oxidative reactions
Cyp 2C8/9
Acts on warfarin and phenytoin which have narrow
safety margins.
Cyp 1A1/2
Responsible for activation of several procarcinogens.
Oxidative reactions
MFOs require the reduced form of nicotinamide
adenine dinucleotide phosphate (NADPH) and
molecular oxygen for activity.
The CYP 450 system consists of a heme protein CYP
450 that acts as the substrate and oxygen binding site,
and a flavoprotein (NADPH-CYP 450, CYP
reductase) that serves as an electron carrier.
Oxidative reactions
The rate of oxidation depends on the following factors;
I. The concentration of CYP 450 and its affinity for the
drug. The concentration of CYP 450 differs between
species and individuals and so does the affinity
II. The species, nutritional status or diet and age. With
aging, there is decline in no of hepatocyte and
enzyme activity.
III. The concentration of CYP 450 which differs from
species to species and individual to individual.
Oxidative reactions
Iv. The ease of dissociation or break down of the CYP
oxygen drug complex. This is the rate determining step.
At this juncture many other compounds may compete
with the drug for that complex formation e.g. carbon
monoxide which readily forms a complex with the drug
reduced CYP 450 and can displace O2 and the CYP 450
drug carbon monoxide is highly stable and does not
dissociate to release CYP 450.
v. Competing endogenous and exogenous substrates.
vi. Lipophilicity of the compound/drug
Oxidative reactions
Drug oxidation takes various forms;
I. Side chain aliphatic oxidation/ aliphatic
hydroxylation
An alkyl chain is hydroxylated at the carbon next to
the last carbon atom (most commonly) or at the last
carbon of the chain.
Where there is a methyl group attached to an
aromatic group, then it is the methyl group that is
oxidized.
Oxidative reactions: Side chain aliphatic
oxidation/ aliphatic hydroxylation
The products of this side chain oxidation are alcohols
which will later undergo further phase II reactions
ii. Aromatic ring hydroxylation
The product formed are phenols.
The reaction takes place at the least deactivated or
most activated of the molecule usually at the para
position of aromatic ring
Oxidative reactions
iii. N- dealkylation
It involves removal of an alkyl chain attached to the
N of an amide converting the amine from 30 to 20 to
10
The alkyl group leaves as aldehydes and the
remaining product maybe 20 or 10 amine
These products can undergo further phase I and II
reactions.
Oxidative reactions
iii. N- dealkylation
1 – RNH2
0
20 – R-NH-CH
3
Oxidative reactions
N- dealkylation occurs for 30 and 20,
10 amines do not undergo N- dealkylation.
30 amines undergo the reaction more readily than 2 0
amines
The reaction also occurs more readily when the
alkyl chain is short.
If the alkyl group is a methyl group, the reaction
may be termed as N- demethylation
N- dealkylation is one of the most important
oxidation reactions.
Oxidative reactions
iii. N- dealkylation
iii. N- dealkylation
Oxidative reactions: iv. Oxidative deamination
Primary and secondary amines undergo this reaction
Primary amines more readily undergo the reaction than
secondary amines.
Products are either ketones or aldehydes depending on
the carbon to which the N is attached i.e if the alpha
carbon is unsubstituted, the product is and aldehyde,
otherwise ketone will be produced.
The ketones or aldehydes formed then undergo further
phase I reactions or phase II reactions (rarely)
iv. Oxidative deamination
iv. Oxidative deamination
If the carbon is primary (unsubstituted) – we get aldehyde
Substituted or secondary carbon – we get a ketone
The ammonia is converted to urea and eliminated through
urine
Secondary and tertiary amines rarely undergoes this
reaction, but in most they preferably (30 and 20 ) undergo
N-dealkylation to secondary and tertiary amines. i.e. N
dealkylation has to be complete before deamination takes
place.
The two process i.e. deamination and N- dealkylation
occurs concurrently.
iv. Oxidative deamination
Amphetamine in some species e.g. dogs and rats
preferably undergo ring ring hydroxylation as the
principle metabolism where ring hydroxylation and
oxidative deamination takes place concurrently.
v. O – dealkylation
It occurs in aliphatic ethers but more common in
aromatic ethers.
Products formed are alcohols and an aldehyde which
may undergo further phase I and phase II reactions.
vi. S – dealkylation
It occurs in thioethers but more in aromatic
thioethers, but also takes place in aliphatic thioethers.
The products are aldehyde and thiols.
R is purine molecule.
vii. Sulfoxide formation/sulfoxidation
Also called sulfide oxidation. A sulfide is oxidized to
a sulfoxide which may itself be converted to a
sulfone.
Sulfoxidation is more catalyzed by flavin
monoxygenases which are not part of the cyp 450.
Oxidative desulfuration
The reaction substitutes an S atom with an O atom i.e.
thiol to alcohol and thioketone to ketone
The reaction is more common in insects than in man.
N- oxidation and N- Hydroxylation
Tertiary amines are converted to N oxides while
secondary amines are converted to hydroxy amines/
hydroxylamines.
NON MICROSOMAL OXIDATIVE REACTIONS.
This oxidation is catalyzed by enzymes of the
mitochondrial and soluble fraction of the liver.
Is not catalyzed by CYP 450.
1. Oxidative deamination non microsomal.
Is catalyzed by monoamine oxidases and diamine
oxidases in the liver mitochondria and other tissues.
This reaction involves deamination of primary and
secondary amines and is faster in the former i.e.
primary amines.
NON MICROSOMAL OXIDATIVE REACTIONS.
Secondary and tertiary amines preferably
undergo N- dealkylation to a primary amine by
oxidative deamination.
The enzymes metabolize primarily amines next
to a non substituted methylene group i.e -CH 2-
NON MICROSOMAL OXIDATIVE REACTIONS.
Endogenous catecholamines are metabolized
by this reaction
Catecholamines
adrenaline
noradrenaline
dopamine
NON MICROSOMAL OXIDATIVE
REACTIONS.
NON MICROSOMAL OXIDATIVE
REACTIONS
products of oxidative deaminations are aldehydes +
NH3 which may undergo to further phase I reactions
including reduction to alcohols or reduction/ oxidation
to COOH esp. aldehydes.
NON MICROSOMAL OXIDATIVE REACTIONS.
2. Alcohol and aldehyde oxidation / alcohol
dehydrogenation.
Oxidation of alcohols in the body is catalyzed by
liver alcohol dehydrogenase (LAD) which requires
NAD coenzyme.
Alcohol are oxidized to aldehydes (i.e. primary
alcohols) or ketones (secondary alcohols).
The aldehydes/ketones formed undergo further phase
I reactions.
NON MICROSOMAL OXIDATIVE REACTIONS.
2. Alcohol and aldehyde oxidation / alcohol
dehydrogenation.
Oxidation of primary alcohols is faster i.e. primary>
secondary> tertiary.
Tertiary alcohols lack an alpha hydrogen that is
involved in the reaction.
NON MICROSOMAL OXIDATIVE REACTIONS.
3.Purine Oxidation
Xanthine oxidase found in the liver cytosol
metabolizes endogenous and exogenous non
methylated or non-alkylated purine to uric acid.
The purines are oxidized from their hypoxanthine to
their xanthine derivatives and finally to uric acid.
The uric acid is eliminated through urine but
sometimes accumulates in joints causing gout.
Reaction can be blocked by xanthine oxidase inhibitors
eg allopurinol, febuxostat
NON MICROSOMAL OXIDATIVE REACTIONS.
NON MICROSOMAL OXIDATIVE REACTIONS.
4. Beta Oxidation
The alkyl chain of alkyl carboxylic acids is oxidized to
an alcohol at the beta position.
NON MICROSOMAL OXIDATIVE REACTIONS.
5. Aromatization reaction
Aliphatic cyclic compounds are converted to
aromatic derivatives. Reaction occurs only in pigs
NON MICROSOMAL OXIDATIVE REACTIONS.
6. Oxidative dehalogenation
It affects halogen containing compounds like
insecticides and anesthetics.
It is a slow reaction, not common in man but in
insects.
It involves removal of halogen from a compound.
The reaction is done by a group to compounds found
in the soluble fraction which are named according to
the halogen they eliminate e.g. those that eliminate
chlorine are called dechlorinases. The enzymes
require glutathione
NON MICROSOMAL OXIDATIVE REACTIONS.
The ease of halogenation depends on the halogen in
the question.
C-F is the strongest bond hence most difficult to
dehalogenate, followed by C- Cl > C-I
This information is used in drug design to produce
more potent drugs with long duration of action.
NON MICROSOMAL OXIDATIVE REACTIONS.
If R is Cl, the bond is hard to break hence the drug is
not easily metabolized hence it has a long duration of
action.
REDUCTION
REACTIONS
REDUCTION REACTIONS
They may be microsomal or non microsomal, majority
being microsomal.
I. MICROSOMAL REDUCTION REACTIONS
i. Nitro reductions
Occur thro’ stepwise reduction process
Reduce the nitro group on aromatic compounds
through the nitroso then hydroxyl amine intermediates
and finally to the corresponding amine (primary
amine)
1. MICROSOMAL REDUCTION
REACTIONS
i. Nitro reductions
The reaction does not occur in developed (especially
in man) unlike in less developed organisms like
bacteria.
The primary amine can undergo further phase I or II
reactions.
1. MICROSOMAL REDUCTION
REACTIONS
E.g. Chloramphenicol
1. MICROSOMAL REDUCTION REACTIONS
Examples of compounds that undergo this reactions are:
Nitrobenzene
Para-nitrosulfathiazole
The coenzymes required are NADPH
1. MICROSOMAL REDUCTION REACTIONS
2. Azo reduction
Azo reductases convert aromatic azo aromatic
compounds into two amines per compound.
The coenzyme is NADPH. Examples protonsil – is a
sulfanilamide, It undergoes reduction to produce a
sulfanilamide.
The reaction is slow in mammals but fast in bacteria.
1. MICROSOMAL REDUCTION REACTIONS
This reaction was the basis for discovery of
sulfanilamide.
1. MICROSOMAL REDUCTION
REACTIONS
3. Disulfide reduction
1. MICROSOMAL REDUCTION
REACTIONS
Sulphur – sulphur linkage/bonds undergo reactions
leading to the rapture of the S-S bonds and formation
of two sulfides.
It is a very slow reaction that less reaction in less
developed organisms e.g. bacteria.
2. NON MICROSOMAL REDUCTION
REACTIONS.
Aldehydes and ketones can be reduced to their
corresponding alcohols using liver alcohol
dehydrogenase.
HYDROLYSIS REACTIONS
Restricted to group of drugs containing the following
linkages.
Esters
Amides
Hydrazines
Carbamates
Involves esterases and amidases which are widely
spread in the body e.g. blood plasma, liver, skin, GIT.
Esterases are responsible for esters and carbamates
linkages while amides are responsible for amides and
hydrazine linkages.
HYDROLYSIS REACTIONS
For and ester → Carboxylic acid + alcohol
HYDROLYSIS REACTIONS
Amide → Carboxylic acid + amine
HYDROLYSIS REACTIONS
PHASE II
REACTIONS
PHASE II REACTIONS
They are conjugative or additional reactions.
Involve addition of a polar endogenous substances to
a drug or phase I metabolites hence increasing its
polarity and eventually its water solubility.
This makes the drug to be easily eliminated by renal
excretion.
The endogenous molecules include:
glucoronic acid
Sulphate
amino acids e.g. glycerin, acetyl COA, glutathione.
PHASE II REACTIONS
For conjugation to occur, the endogenous molecule
is synthesized in the body before being transferred to
the drug through enzyme catalyzed process.
Conjugation reaction occur in the liver enzyme
fractions whereby glucoronide conjugative reactions
occurs mainly in hepatic microsomes while other
conjugative reactions occur in other liver fractions.
The products of conjugation are usually biologically
inactive, non-toxic and readily eliminated from the
body since they are highly water soluble
PHASE II REACTIONS
1. GLUCORONIDE CONJUGATION
Takes place in microsomal fraction.
Enzymes involved are known as glucoronyl
transferase.
It occurs in the liver but also to a small extent in the
kidney, intestinal tract, skin and lung.
PHASE II REACTIONS
1. GLUCORONIDE CONJUGATION
Takes place in two stages:
a) Involves formation of the activated form of
glucoronic acid called uridine disphosphate
glucoronic acid (UDPGA) from D glucose – 1 –
phosphate.
b) The UDPGA combines with an active hydrogen from
an acid, OH, phenol, SH, NH2 in the presence of
UDP glycoronly transferase.
PHASE II REACTIONS : GLUCORONIDE
CONJUGATION
Compounds/ functional groups metabolized through
glucoronide conjugation include:
Phenols
OHs
NH2
Carboxylic acids
Amines especially aromatic amines.
PHASE II REACTIONS
PHASE II REACTIONS
PHASE II REACTIONS
O- glucuronides are acid stable while N and S are
labile
E.g.
PHASE II REACTIONS
Though glucuronide conjugation leads to inactive
products there is an exception with drugs are more
active biologically.
PHASE II REACTIONS
2. SULPHATE CONJUGATION
Enzymes involved are sulphate transferases/sulfokinases
found in the cytosol i.e. soluble fraction.
The drugs that can be conjugated through this process
include OHs, phenols and NH2. The activated
transferring molecule phosphoadenosine – 5 –
phosposulphate (PAPS) is synthesized from adenosine –
5 - phosphosulphate (APS).
PHASE II REACTIONS
2. SULPHATE CONJUGATION
PHASE II REACTIONS
3. ACETYLATION
The acetyl group from acetylation is derived from the
acetyl COA, the conjugation is catalyzed by acetyl
transferases found in the cytosol/soluble fraction.
Hydrozines and primary aromatic amines, OH and SH
may undergo acetylation. i.e
PHASE II REACTIONS: 3. ACETYLATION
PHASE II REACTIONS: 3. ACETYLATION
The amount of acetyl transferases available for
acetylation varies btn species and btn individuals.
The human population can be divided into fast and slow
acetylators.
The slow acetylators are prone to toxicity where drugs
that are metabolized primarily through acetylation
slow acetylators are more likely to have PN with
isoniazid use.
Acetylated form has low soluble and may accumulate in
urine causing crystauria.
PHASE II REACTIONS
4. AMINO ACIDS CONJUGATION
Also known as uric acid formation.
Glycine conjugation occurs with aromatic acids
while glutamine conjugates to aryl acetic acid.
ASA – is metabolized to uric acid.
PHASE II REACTIONS
PHASE II REACTIONS
5. GLUTATHIONE CONJUGATION /
MERCAPTOPURIC ACID FORMATION
Aromatic hydrocarbons and halogenated aromatic
hydrocarbons undergo glutathione conjugation.
Glutathione is a tri-peptide consisting of cysteine,
glutamic acid and glycine and conjugates with the
substrates via the mercapturic (-SH) function of cysteine.
The enzyme involved is glutathione S-transferase and the
products are mercaturic acid derivatives.
PHASE II REACTIONS
5. GLUTATHIONE CONJUGATION /
MERCAPTOPURIC ACID FORMATION
PHASE II REACTIONS
6. METHYLATION i.e. O, N, S methylation.
S-adenosylmethionine (SAM) acts as a donor
molecule for transfer of a methyl group to the N of
amines, O of phenols or S of thiols. An important
methylation reaction is O-methylation of biogenic
catecholamines by catechol-O-methyl transferase
(COMT).
PHASE II REACTIONS
NB: Some drugs act as enzyme inhibitors e.g.
cimetidine, macrolides (erythromycin), ketoconazole
and phenytoin. Propanol, warfarin, phenytoin and
theophylline should not be given/administered
together with ketoconazole.
Theophylline and ciprofloxacin should not be
administered together. Disulfurum inhibit the enzyme
alcohol dehydrogenase in treatment of alcoholism.
PRO-DRUGS
These are drugs whose metabolisable
functional groups have been blocked by larger
chemical groups to prevent the drug from
being metabolized prematurely hence
prolonging the duration of action.
They are drugs which exist in inactive form by
only becoming active after undergoing
metabolism i.e becomes active in vivo.
PRO-DRUGS: Importance of pro- drugs
i. To overcome formation of pharmacokinetic problems
associated with the parent drug e.g. instability.
ii. Prolonging the duration of action
iii. To enhance activity some drugs are less active and
may be converted into more active forms or active
form.
iv. To prevent the drug from undergoing the 1st pass
effect hence increasing its duration of action.
v. To increase its bioavailability.
PRO-DRUGS
E.g. bacamphillin, pivampicillin are pro-drugs of
amphicillin and are better absorbed than ampicillin. The
esters are hydrolysed to ampicillin in vivo.
General structure of penicillin
PRO-DRUGS
For ampicillin R1 – H
For Bacampicillin R1 –
For Pivampicilin R1
PRO-DRUGS
Anticancer drug cyclophosphamide is a pro drug which
is converted to the active form phosporamidate mustard
by CYP 450. The pro-drug is less reactive and more
chemically stable in the creative form. Giving the pro-
drug reduces the toxicity associated with the active
form also allows the drug to reach its site of action
before destruction.
PRO-DRUGS
1. Erythromycin is unstable in gastric acid. It may
therefore be prepared as the more acid stable estolase
of succinate ester drug. The esters are hydrolysed
after absorption.
2. Chloramphenicol and clindamycin may be
formulated as palmitates to improve the tastes of
liquid preparations. The sweet tasting palmic acid
moiety overcomes the impalatibility of the free drug.
The esters are then hydrolyzed to the parent
compound in vivo.
Characteristics of a pro-drug
a) It should be inactive.
b) Non toxic
c) Easily converted to the parent compound in vivo
d) Should be easily synthesized.
e) Once the pro-drug moiety is removed, the moiety
should be inactive i.e. it should be eliminated without
causing any effect. It thus should be inactive, non-
toxic and readily eliminated.
Aspirin Journey through the body - 3D Animation.mp4