
On Mechanisms of Reactive Metabolite Formation from Drugs
Idiosyncratic adverse drug reactions (IADRs) cause a broad range of clinically severe conditions of which drug induced liver injury (DILI) in particular is one of the most frequent causes of safety-related drug withdrawals. The underlying cause is almost invariably formation of reactive
metabolites (RM) which by attacking macromolecules induce organ injuries. Attempts are being made in the pharmaceutical industry to lower the risk of selecting unfit compounds as clinical candidates. Approaches vary but do not seem to be overly successful at the initial design/synthesis stage.
We review here the most frequent categories of mechanisms for RM formation and propose that many cases of RMs encountered within early ADME screening can be foreseen by applying chemical and metabolic knowledge. We also mention a web tool, SpotRM, which can be used for efficient look-up and
learning about drugs that have recognized IADRs likely caused by RM formation.
Keywords: Reactive metabolite; bioactivation; drug safety; hepatotoxicity; idiosyncratic adverse drug reaction; structural alerts; web application
Document Type: Research Article
Publication date: April 1, 2013
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