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The glomerulus is adapted for the filtration of water and substances dissolved in it from plasma. Pressure in the capillaries of the glomerulus forces fluid and dissolved substances into the Bowmans capsule. Most drugs are small enough to be filtered, although if they are lipid soluble they are readily reabsorbed from other parts of the kidney tubule.

Such drugs are conjugated in the liver and passed into bile before they reach isotretinoin cost nz systemic circulation. Often bacteria in the large intestine digest the conjugate releasing free drug, which can then be reabsorbed and recycled by the process of enterohepatic shunting. Prolonged use of antibiotics can sterilize the large intestine and interrupt this cycle and increase drug elimination in faeces. Unexpected loss of a drug in this way can reduce its therapeutic action. Diarrhoea can have a similar effect.

The digestive tract can be imaged following ingestion of barium sulphate suspended in a gel. The preparation must be taken with plenty of water to avoid it causing intestinal obstruction. Barium sulphate is insoluble and not absorbed from the gastrointestinal tract and therefore it is not normally toxic. Severe and potentially fatal inflammation can occur if the gastrointestinal tract is perforated and the barium contrast agent escapes into the peritoneal cavity. Iodine contrast agents should be used with caution in patients with thyroid disorders.

Authored by Timothy Andrew Woodward, MD


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