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Elimination of a drug or its metabolites occurs either by metabolism, usually by the liver or gut mucosa, or by excretion, usually by the kidneys and liver. The influence of concomitant medications on hepatic and intestinal metabolism becomes more complicated when a drug, including a prodrug, is metabolized to one or more active metabolites. In this case, the safety and efficacy of the drug/prodrug are determined not only by exposure to the parent drug but by exposure to the active metabolites, which in turn is related to their formation, distribution, and elimination.
Therefore, adequate assessment of the safety and effectiveness of a drug includes a description of its metabolism and the contribution of metabolism to overall elimination. For this reason, the development of sensitive and specific assays for a drug and its important metabolites is critical to the study of metabolism. An early understanding of the metabolism of a new chemical entity (NCE) in human subjects is a critical step in the R&D process in order to have confidence in the safety profile before testing new drug in a wider patient population.
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