Metabolism (biotransformation) changes medications into less active or inactive forms by the action of enzymes. This occurs primarily in the liver, but it also takes place in the kidneys, lungs, intestines, and blood.
FACTORS INFLUENCING THE RATE OF MEDICATION METABOLISM
● Age: Infants have a limited medication‑metabolizing capacity. The aging process also can influence medication metabolism, but varies with the individual. In general, hepatic medication metabolism tends to decline with age. Older adults require smaller doses of medications due to the possibility of accumulation in the body.
● Increase in some medication-metabolizing enzymes: This can metabolize a particular medication sooner, requiring an increase in dosage of that medication to maintain a therapeutic level. It can also cause an increase in the metabolism of other concurrent‑use medications.
● First‑pass effect: The liver inactivates some medications on their first pass through the liver, and thus they require a nonenteral route (sublingual, IV) because of their high first-pass effect.
● Similar metabolic pathways: When the same pathway metabolizes two medications, it can alter the metabolism of one or both of them. In this way, the rate of metabolism can decrease for one or both of the medications, leading to medication accumulation.
● Nutritional status: Clients who are malnourished can be deficient in the factors that are necessary to produce specific medication-metabolizing enzymes, thus impairing medication metabolism.
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