It can cause significant drug interactions; therefore, therapeutic drug monitoring may be necessary to ensure optimal dosing and avoid any adverse effects or treatment failure.
Once a drug enters the body, the process of elimination begins (hepatic, biliary, and urinary). Elimination involves both metabolism and excretion. When considering the sequence of events leading up to the removal of the drug from the body, phase 2 metabolism usually occurs before then. It involves conjugation reactions that make the drug or phase 1 metabolites more suitable for excretion. However, if the metabolites from phase 1 are sufficiently polar, they can be excreted by the kidneys. Many phase 1 metabolites are still too lipophilic so phase 2 occurs. I hope that helps!
