1 00:00:07,054 --> 00:00:10,208 Have you ever wondered what happens to a painkiller, like ibuprofen, 2 00:00:10,208 --> 00:00:11,964 after you swallow it? 3 00:00:11,964 --> 00:00:14,972 Medicine that slides down your throat can help treat a headache, 4 00:00:14,972 --> 00:00:16,054 a sore back, 5 00:00:16,054 --> 00:00:17,934 or a throbbing sprained ankle. 6 00:00:17,934 --> 00:00:20,833 But how does it get where it needs to go in the first place? 7 00:00:20,833 --> 00:00:24,715 The answer is that it hitches a ride in your circulatory blood stream, 8 00:00:24,715 --> 00:00:27,445 cycling through your body in a race to do its job 9 00:00:27,445 --> 00:00:31,145 before it's snared by organs and molecules designed to neutralize 10 00:00:31,145 --> 00:00:33,926 and expel foreign substances. 11 00:00:33,926 --> 00:00:36,605 This process starts in your digestive system. 12 00:00:36,605 --> 00:00:40,845 Say you swallow an ibuprofen tablet for a sore ankle. 13 00:00:40,845 --> 00:00:44,125 Within minutes, the tablet starts disintegrating in the acidic fluids 14 00:00:44,125 --> 00:00:45,736 of your stomach. 15 00:00:45,736 --> 00:00:48,552 The dissolved ibuprofen travels into the small intestine 16 00:00:48,552 --> 00:00:53,276 and then across the intestinal wall into a network of blood vessels. 17 00:00:53,276 --> 00:00:56,005 These blood vessels feed into a vein, 18 00:00:56,005 --> 00:00:59,845 which carries the blood, and anything in it, to the liver. 19 00:00:59,845 --> 00:01:02,526 The next step is to make it through the liver. 20 00:01:02,526 --> 00:01:07,775 As the blood and the drug molecules in it travel through liver blood vessels, 21 00:01:07,775 --> 00:01:11,195 enzymes attempt to react with the ibuprofen molecules 22 00:01:11,195 --> 00:01:13,305 to neutralize them. 23 00:01:13,305 --> 00:01:16,769 The damaged ibuprofen molecules, called metabolites, 24 00:01:16,769 --> 00:01:19,837 may no longer be effective as painkillers. 25 00:01:19,837 --> 00:01:24,396 At this stage, most of the ibuprofen makes it through the liver unscathed. 26 00:01:24,396 --> 00:01:26,527 It continues its journey out of the liver, 27 00:01:26,527 --> 00:01:27,766 through veins, 28 00:01:27,766 --> 00:01:30,206 into the body's circulatory system. 29 00:01:30,206 --> 00:01:32,176 Half an hour after you swallow the pill, 30 00:01:32,176 --> 00:01:36,987 some of the dose has already made it into the circulatory blood stream. 31 00:01:36,987 --> 00:01:39,698 This blood loop travels through every limb and organ, 32 00:01:39,698 --> 00:01:44,674 including the heart, brain, kidneys, and back through the liver. 33 00:01:44,674 --> 00:01:47,218 When ibuprofen molecules encounter a location 34 00:01:47,218 --> 00:01:50,084 where the body's pain response is in full swing, 35 00:01:50,084 --> 00:01:54,611 they bind to specific target molecules that are a part of that reaction. 36 00:01:54,611 --> 00:01:57,681 Painkillers, like ibuprofen, block the production of compounds 37 00:01:57,681 --> 00:02:00,859 that help the body transmit pain signals. 38 00:02:00,859 --> 00:02:02,758 As more drug molecules accumulate, 39 00:02:02,758 --> 00:02:05,388 the pain-cancelling affect increases, 40 00:02:05,388 --> 00:02:09,084 reaching a maximum within about one or two hours. 41 00:02:09,084 --> 00:02:11,948 Then the body starts efficiently eliminating ibuprofen, 42 00:02:11,948 --> 00:02:16,299 with the blood dose decreasing by half every two hours on average. 43 00:02:16,299 --> 00:02:19,238 When the ibuprofen molecules detach from their targets, 44 00:02:19,238 --> 00:02:22,828 the systemic blood stream carries them away again. 45 00:02:22,828 --> 00:02:26,412 Back in the liver, another small fraction of the total amount of the drug 46 00:02:26,412 --> 00:02:29,169 gets transformed into metabolites, 47 00:02:29,169 --> 00:02:32,728 which are eventually filtered out by the kidneys in the urine. 48 00:02:32,728 --> 00:02:35,530 The loop from liver to body to kidneys continues at a rate 49 00:02:35,530 --> 00:02:38,220 of about one blood cycle per minute, 50 00:02:38,220 --> 00:02:42,398 with a little more of the drug neutralized and filtered out in each cycle. 51 00:02:42,398 --> 00:02:45,570 These basic steps are the same for any drug that you take orally, 52 00:02:45,570 --> 00:02:47,119 but the speed of the process 53 00:02:47,119 --> 00:02:50,086 and the amount of medicine that makes it into your blood stream 54 00:02:50,086 --> 00:02:51,538 varies based on drug, 55 00:02:51,538 --> 00:02:52,456 person, 56 00:02:52,456 --> 00:02:54,709 and how it gets into the body. 57 00:02:54,709 --> 00:02:57,320 The dosing instructions on medicine labels can help, 58 00:02:57,320 --> 00:03:00,109 but they're averages based on a sample population 59 00:03:00,109 --> 00:03:02,933 that doesn't represent every consumer. 60 00:03:02,933 --> 00:03:05,201 And getting the dose right is important. 61 00:03:05,201 --> 00:03:07,989 If it's too low, the medicine won't do its job. 62 00:03:07,989 --> 00:03:12,210 If it's too high, the drug and its metabolites can be toxic. 63 00:03:12,210 --> 00:03:14,151 That's true of any drug. 64 00:03:14,151 --> 00:03:18,350 One of the hardest groups of patients to get the right dosage for are children. 65 00:03:18,350 --> 00:03:22,930 That's because how they process medicine changes quickly, as do their bodies. 66 00:03:22,930 --> 00:03:26,629 For instance, the level of liver enzymes that neutralize medication 67 00:03:26,629 --> 00:03:29,781 highly fluctuates during infancy and childhood. 68 00:03:29,781 --> 00:03:32,590 And that's just one of many complicating factors. 69 00:03:32,590 --> 00:03:33,461 Genetics, 70 00:03:33,461 --> 00:03:34,201 age, 71 00:03:34,201 --> 00:03:34,941 diet, 72 00:03:34,941 --> 00:03:35,685 disease, 73 00:03:35,685 --> 00:03:40,700 and even pregnancy influence the body's efficiency of processing medicine. 74 00:03:40,700 --> 00:03:45,841 Some day, routine DNA tests may be able to dial in the precise dose of medicine 75 00:03:45,841 --> 00:03:49,570 personalized to your liver efficiency and other factors, 76 00:03:49,570 --> 00:03:50,702 but in the meantime, 77 00:03:50,702 --> 00:03:52,341 your best bet is reading the label 78 00:03:52,341 --> 00:03:54,263 or consulting your doctor or pharmacist, 79 00:03:54,263 --> 00:03:57,922 and taking the recommended amounts with the recommended timing.