Journal of Clinical Anesthesiology: Open Access

Drugs distribute in the body after absorption, in part to reach target tissues and in part to be disposed of in tissues where they have no clinically relevant effects. Drug metabolism and/or elimination usually end therapeutically relevant effects. The spleen's traditionally attributed role in these fundamental pharmacokinetic processes was clearly marginal. However, due to its high blood flow and microcirculation characteristics, this organ is expected to be significantly exposed to large, new generation drugs that cannot penetrate other tissues with tight endothelial barriers.

The spleen is barely mentioned in pharmacology textbooks and among its physiological roles, such as immunological surveillance, removal of aged blood cells, hematopoiesis and blood volume regulation, neither drug disposition nor involvement in pharmacological drug action are ever mentioned. The spleen received little attention in pharmacology due to a lack of evidence that it could play a significant role in the disposition of "classical" drugs. However, just as when a new character appears in a novel and our perspective on the story changes dramatically, our perspective on the relationship between drugs and the spleen is changing as a result of the development of "new-generation" drugs.