Have you ever wondered what happens to a painkiller, like ibuprofen, after you swallow it? Medicine that slides down your throat can help treat a headache, a sore back, or a throbbing sprained ankle. But how does it get where it needs to go in the first place? The answer is that it hitches a ride in your circulatory blood stream, cycling through your body in a race to do its job before it’s snared by organs and molecules designed to neutralize and expel foreign substances.
This process starts in your digestive system. Say you swallow an ibuprofen tablet for a sore ankle. Within minutes, the tablet starts disintegrating in the acidic fluids of your stomach. The dissolved ibuprofen travels into the small intestine and then across the intestinal wall into a network of blood vessels. These blood vessels feed into a vein, which carries the blood, and anything in it, to the liver.
The next step is to make it through the liver. As the blood and the drug molecules in it travel through liver blood vessels, enzymes attempt to react with the ibuprofen molecules to neutralize them. The damaged ibuprofen molecules, called metabolites, may no longer be effective as painkillers. At this stage, most of the ibuprofen makes it through the liver unscathed. It continues its journey out of the liver, through veins, into the body’s circulatory system. Half an hour after you swallow the pill, some of the dose has already made it into the circulatory blood stream.
This blood loop travels through every limb and organ, including the heart, brain, kidneys, and back through the liver. When ibuprofen molecules encounter a location where the body’s pain response is in full swing, they bind to specific target molecules that are a part of that reaction. Painkillers, like ibuprofen, block the production of compounds that help the body transmit pain signals. As more drug molecules accumulate, the pain-cancelling affect increases, reaching a maximum within about one or two hours.
Then the body starts efficiently eliminating ibuprofen, with the blood dose decreasing by half every two hours on average. When the ibuprofen molecules detach from their targets, the systemic blood stream carries them away again. Back in the liver, another small fraction of the total amount of the drug gets transformed into metabolites, which are eventually filtered out by the kidneys in the urine.
The loop from liver to body to kidneys continues at a rate of about one blood cycle per minute, with a little more of the drug neutralized and filtered out in each cycle. These basic steps are the same for any drug that you take orally, but the speed of the process and the amount of medicine that makes it into your blood stream varies based on drug, person, and how it gets into the body. The dosing instructions on medicine labels can help, but they’re averages based on a sample population that doesn’t represent every consumer.
And getting the dose right is important. If it’s too low, the medicine won’t do its job. If it’s too high, the drug and its metabolites can be toxic. That’s true of any drug. One of the hardest groups of patients to get the right dosage for are children. That’s because how they process medicine changes quickly, as do their bodies.
For instance, the level of liver enzymes that neutralize medication highly fluctuates during infancy and childhood. And that’s just one of many complicating factors. Genetics, age, diet, disease, and even pregnancy influence the body’s efficiency of processing medicine. Some day, routine DNA tests may be able to dial in the precise dose of medicine personalized to your liver efficiency and other factors, but in the meantime, your best bet is reading the label or consulting your doctor or pharmacist, and taking the recommended amounts with the recommended timing.