First-pass effect

First-pass effect

Once a drug is absorbed orally, it is transported to the general circulation via the liver. Thus drugs which are extensively metabolized will be metabolized in the liver during absorption, never reaching their full concentration in the systemic circulation. This is called first-pass metabolism and determines the fraction of the dose that will reach the systemic circulation. This is the reason the propranolol oral dose is somewhat higher than the IV, the same is true for morphine.

There are

also metabolic enzymes located in the gastrointestinal lumen. Thus, metabolism can also occur during absorption in the gut, before the drug even reaches the liver.

The second illustration shows an example with felodipine a drug which undergoes metabolism in the GI and liver.

See how first pass metabolism effects the oral availability of drugs by clicking hereand selecting the first pass metabolism (module 2).