Editing Volume of distribution

{{short description|Measuring the relative affinity of a drug between blood constituents and tissue constituents.}}
{{see|Distribution (pharmacology)}}

In [[pharmacology]], the '''volume of distribution''' (V<sub>D</sub>, also known as '''apparent volume of distribution''', literally, ''volume of dilution''<ref name="Ward_2012">{{cite book | vauthors = Ward RM, Kern SE, Lugo RA | title=Avery's Diseases of the Newborn | chapter=Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics | publisher=Elsevier | year=2012 | isbn=978-1-4377-0134-0 | doi=10.1016/b978-1-4377-0134-0.10034-4 | pages=417–428}}</ref>) is the theoretical [[volume]] that would be necessary to contain the total amount of an administered [[drug]] at the same concentration that it is observed in the [[blood plasma]].<ref>{{cite web|url=http://sepia.unil.ch/pharmacology/?id=61|title=Volume of distribution|website=sepia.unil.ch|access-date=19 April 2018}}</ref> In other words, it is the ratio of ''amount of drug in a body (dose)'' to ''concentration of the drug that is measured in blood, plasma, and un-bound in interstitial fluid''.<ref name="Davis_2011">{{cite book | vauthors = Davis PJ, Bosenberg A, Davidson A, Jimenez N, Kharasch E, Lynn AM, Tofovic SP, Woelfel S | title=Smith's Anesthesia for Infants and Children | chapter=Pharmacology of Pediatric Anesthesia | publisher=Elsevier | year=2011 | isbn=978-0-323-06612-9 | doi=10.1016/b978-0-323-06612-9.00007-9 | pages=179–261}}</ref><ref name="urlUntitled Document">{{cite web | vauthors = Wilcke JR |url=http://cpharm.vetmed.vt.edu/VM8314/VM8314PharmaModeling.htm | archive-url = https://web.archive.org/web/20110716153737/http://cpharm.vetmed.vt.edu/VM8314/VM8314PharmaModeling.htm | archive-date = 16 July 2011 | title = Pharmacokinetic Modeling |work = Virginia-Maryland Regional College of Veterinary Medicine }}</ref>

The V<sub>D</sub> of a drug represents the degree to which a drug is distributed in body tissue rather than the plasma. V<sub>D</sub> is directly proportional with the amount of drug distributed into tissue; a higher V<sub>D</sub> indicates a greater amount of tissue distribution. A V<sub>D</sub> greater than the total volume of body water (approximately 42 liters in humans<ref>{{cite web|url=http://www.anaesthesiamcq.com/FluidBook/fl2_1.php|title=Fluid Physiology: 2.1 Fluid Compartments|website=www.anaesthesiamcq.com|access-date=19 April 2018}}</ref>) is possible, and would indicate that the drug is highly distributed into tissue. In other words, the volume of distribution is smaller in the drug staying in the plasma than that of a drug that is widely distributed in tissues.<ref name="Ilowite_2011">{{cite book | vauthors = Ilowite NT, Laxer RM | title=Textbook of Pediatric Rheumatology | chapter= Pharmacology and Drug Therapy | publisher= Elsevier | year=2011 | isbn=978-1-4160-6581-4 | doi=10.1016/b978-1-4160-6581-4.10006-8 | pages=71–126}}</ref>

In rough terms, drugs with a high lipid solubility (non-polar drugs), low rates of ionization, or low plasma protein binding capabilities have higher volumes of distribution than drugs which are more polar, more highly ionized or exhibit high plasma protein binding in the body's environment. Volume of distribution may be increased by [[kidney failure]] (due to fluid retention) and [[liver failure]] (due to altered body fluid and [[plasma protein binding]]). Conversely it may be decreased in dehydration.

The [[initial volume of distribution]] describes blood concentrations prior to attaining the apparent volume of distribution and uses the same formula.

==Equations==
The volume of distribution is given by the following equation:

:::::::<math>{V_{D}} = \frac{\mathrm{total \ amount \ of \ drug \ in \ the \ body}}{\mathrm{drug \ blood \ plasma \ concentration}}</math>

Therefore, the dose required to give a certain plasma concentration can be determined if the V<sub>D</sub> for that drug is known. The V<sub>D</sub> is '''not''' a physiological value; it is more a reflection of how a drug will distribute throughout the body depending on several physicochemical properties, e.g. solubility, charge, size, etc.

The unit for Volume of Distribution is typically reported in  litres.  As body composition changes with age, V<sub>D</sub> decreases.

The V<sub>D</sub> may also be used to determine how readily a drug will displace into the body tissue compartments relative to the blood:

:::::::<math>{V_{D}} = {V_{P}} + {V_{T}} \left(\frac{fu}{fu_{t}}\right)</math>

Where:

* V<sub>P</sub> = plasma volume
* V<sub>T</sub> = apparent tissue volume
* fu = fraction [[plasma protein binding|unbound in plasma]]
* fu<sub>T</sub> = fraction unbound in tissue

==Examples==
{{main|Table of volume of distribution for drugs}}
{{See also|Pharmacokinetics#Metrics}}{{Tone|date=November 2024}}
If you administer a dose D of a drug intravenously in one go (IV-bolus), you would naturally expect it to have an immediate blood concentration <math>C_0</math> which directly corresponds to the amount of blood contained in the body <math>V_{blood}</math>. Mathematically this would be:

<math>C_0 = D/V_{blood}</math>

But this is generally not what happens. Instead you observe that the drug has distributed out into some other volume (read organs/tissue). So probably the first question you want to ask is: how much of the drug is no longer in the blood stream?
The volume of distribution <math>V_D</math> quantifies just that by specifying how big a volume you would need in order to observe the blood concentration actually measured.

An example for a simple case (mono-compartmental) would be to administer D=8&nbsp;mg/kg to a human. A human has a blood volume of around <math>V_{blood}=</math>0.08 L/kg 
.<ref name="alberts_table">{{Cite book | chapter-url=https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Search&db=books&doptcmdl=GenBookHL&rid=mboc4.table.4143| chapter = Leukocyte functions and percentage breakdown|access-date=2007-04-14|via=NCBI Bookshelf|year=2005| vauthors = Alberts B | title = Molecular Biology of the Cell}}</ref>
This gives a <math>C_0=</math>100&nbsp;μg/mL if the drug stays in the blood stream only, and thus its volume of distribution is the same as <math>V_{blood}</math> that is <math>V_D=</math> 0.08 L/kg. If the drug distributes into all body water the volume of distribution would increase to approximately <math>V_D=</math>0.57 L/kg
<ref name="Guyton_1976">{{cite book|title=Textbook of Medical Physiology| vauthors = Guyton AC |year=1976|edition=5th|publisher=W.B. Saunders|location=Philadelphia|page=[https://archive.org/details/textbookofmedica0005guyt/page/424 424]|isbn=0-7216-4393-0|url=https://archive.org/details/textbookofmedica0005guyt/page/424}}</ref>

If the drug readily diffuses into the body fat the volume of distribution may increase dramatically, an example is [[chloroquine]] which has a <math>V_D=</math>250-302 L/kg
<ref>{{cite journal | vauthors = Wetsteyn JC, De Vries PJ, Oosterhuis B, Van Boxtel CJ | title = The pharmacokinetics of three multiple dose regimens of chloroquine: implications for malaria chemoprophylaxis | journal = British Journal of Clinical Pharmacology | volume = 39 | issue = 6 | pages = 696–699 | date = June 1995 | pmid = 7654492 | pmc = 1365086 | doi = 10.1111/j.1365-2125.1995.tb05731.x }}</ref>

In the simple mono-compartmental case the volume of distribution is defined as: <math>V_D=D/C_0</math>, where the <math>C_0</math> in practice is an extrapolated concentration at time = 0 from the first early plasma concentrations after an IV-bolus administration (generally taken around 5 min - 30 min after giving the drug).

{| class="wikitable"
|+Compounds with different V<sub>D</sub> for a 70 kg man<ref>{{Cite web |url= https://www.cambridgemedchemconsulting.com/resources/ADME/distribution.html |title=Distribution and plasma protein binding| vauthors = Swain C |website=Cambridge MedChem Consulting |language=en |access-date=2020-04-02 }}</ref>
| '''Drug''' || '''V<sub>D</sub>''' || '''Comments''' 
 |- 
 | [[Warfarin]] || 8 L  || Reflects a high degree of plasma protein binding. 
 |- 
 | [[Theophylline]], [[Ethanol]]|| 30 L  || Represents distribution in total body water.
 |- 
 | [[Chloroquine]] || 15000 L || Shows highly [[lipophilic]] molecules which sequester into total [[body fat]].
 |-
 | [[NXY-059]] ||  8 L  || Highly charged [[hydrophilic]] molecule.
|}

== References ==
{{reflist|30em}}

== External links ==
* [http://www.nottingham.ac.uk/nmp/sonet/rlos/bioproc/vd/index.html Tutorial on volume of distribution]
* [http://www.icp.org.nz/html/volume_of_distribution.html Overview at icp.org.nz]
* [http://web.vet.cornell.edu/public/pharmacokinetics/pk/avd.html Overview at cornell.edu]
* [https://web.archive.org/web/20060917194220/http://mips.stanford.edu/public/classes/pharmacokinetics/2006/Lin_comp/VolofDis/VolDist1.html Overview at stanford.edu]
* [https://web.archive.org/web/20060715031004/http://www.boomer.org/c/p3/c05/c0507.html Overview at boomer.org]

{{Pharmacology|state=collapsed}}

[[Category:Pharmacokinetics]]