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2. Chemical properties of the drug Certain drugs may stimulate or inhibit the metabolism
of the other drugs
3. Route of administration. The oral route, sublingual, intramuscular, intravenous, for
example, can result in extensive hepatic metabolism of some drugs. It results in minimal
drug delivery to the systemic circulation for certain drugs (e.g., propranolol, lidocaine).
4. Diet.
5. Dosage .Toxic doses deplete enzymes needed for detoxification reactions.
6. The liver cannot detoxify drugs, such as chioramphenicol, as well in neonates as it can
in adults. Neonates have reduced hepatic metabolism and renal excretion due to relative
organ immaturity.
7. Disease. Liver disease decreases the ability to metabolize drugs, while kidney disease
hampers the excretion of drugs.
8. Social factors. Tobacco smoking, and others.
Drug excretion is the process by which a drug or metabolite is eliminated from the body.
Routes of elimination:
1. The kidney is the most important organ for excretion of drugs. Excretion of drugs and
their metabolites into the urine involves three processes:
a) Glomerular filtration (water-soluble and polar compounds);
b) Active tubular secretion (organic acids, e.g. penicillin, bases, quinine, are transported
by these system);
c) Passive tubular reabsorption.
2. The biliary tract and the feces are important routes of excretion for some drugs that
are metabolized in the liver.
3. Other routes: air, sweat, saliva, tears and breast milk (lipid-soluble and non-ionized
compounds).