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First (1st) pass metabolism

Authoring team

First pass metabolism of drugs can occur in the gut and the liver. Examples include:

  • gut - benzylpenicillin, insulin
  • liver - propanolol, lignocaine, chloromethiasole, GTN

The first pass effect of the liver is much reduced if there is shunting; this is much more important than damage to the liver in that it only requires a relatively small amount of functional liver to achieve adequate first pass metabolism. However, cirrhotic patients are apparently more sensitive to some drugs, and this appears to be a systematic effect of the disturbed liver function.

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