clinical pharmacology
Drug Absorption
Passive diffusion
Drugs diffuse across a cell membrane from a region of high concentration (eg, gastrointestinal fluids) to one of low concentration (eg, blood). Diffusion rate is directly proportional to the gradient but also depends on the molecule’s lipid solubility, size, degree of ionization, and the area of absorptive surface. Because the cell membrane is lipoid, lipid-soluble drugs diffuse most rapidly. Small molecules tend to penetrate membranes more rapidly than larger ones. Most drugs are weak organic acids or bases, existing in un-ionized and ionized forms in an aqueous environment. The un-ionized form is usually lipid soluble (lipophilic) and diffuses readily across cell membranes. The ionized form has low lipid solubility (but high water solubility—ie, hydrophilic) and high electrical resistance and thus cannot penetrate cell membranes easily. The proportion of the un-ionized form present (and thus the drug’s ability to cross a membrane) is determined by the environmental pH and the drug’s pKa (acid dissociation constant). The pKa is the pH at which concentrations of ionized and un-ionized forms are equal. When the pH is lower than the pKa, the un-ionized form of a weak acid predominates, but the ionized form of a weak base predominates. Thus, in plasma (pH 7.4), the ratio of un-ionized to ionized forms for a weak acid (eg, with a pKa of 4.4) is 1:1000; in gastric fluid (pH 1.4), the ratio is reversed (1000:1). Therefore, when a weak acid is given orally, most of the drug in the stomach is un-ionized, favoring diffusion through the gastric mucosa. For a weak base with a pKa of 4.4, the outcome is reversed; most of the drug in the stomach is ionized. ). However, whether a drug is acidic or basic, most absorption occurs in the small intestine because the surface area is larger and membranes are more permeable (see Oral Administration ). 