Conjugates, the products of phase II metabolism, will be:
- Highly polar
- Generally biologically inactive (exception is morphine glucuronide, which is a more potent analgesic compared to the parent compound)
- Rapidly excreted in the urine
- More likely to be excreted in the bile if they have a high molecular weight compound attached. Intestinal flora may cleave the conjugate bond, and the parent compound may be released back into the systemic circulation. This process, known as "enterohepatic recirculation," results in delayed parent drug elimination and prolongation of drug effects.
The products of phase II conjugation reactions have increased molecular weights and are usually inactive and less toxic. The conjugated products are very water soluble and can be quickly eliminated by the kidneys.
Most of the transferases are located in the cytosol of cells, but UDP-glucuronyl transferase is located in microsomes (a small particle found within the cytoplasm of a cell). Microsomes consist of fragmented endoplasmic reticulum to which ribosomes are attached. Glucuronides are secreted in the bile and eliminated in the urine.
Glucuronidation is the most critical phase II reaction. Glucuronic acid has several hydroxyl functional groups and a carboxylic acid functional group, making it highly polar and water-soluble. Glucuronic acid conjugations are catalyzed by UDP-glucuronyl transferase. An example is the conjugation of glucuronic acid to morphine by UDP-glucuronyl transferase to produce the metabolites morphine-6-glucuronide and morphine-3-glucuronide. Other examples of drugs that are conjugated by UDP-glucuronyl transferase are acetaminophen, codeine, naloxone (a medication used to block the effects of opiate overdose), temazepam (a benzodiazepine used to treat insomnia), the tricyclic antidepressants amitriptyline and imipramine, meprobamate, and the beta blocker propranolol. In addition, endogenous substances such as bilirubin, progesterone, testosterone, and thyroxine are conjugated by UDP-glucuronyl transferase.
Examples of substrates conjugated by sulfotransferases are minoxidil and dopamine.
Methylation and acetylation are two reactions that contradict the notion that metabolism creates more water-soluble products and unmasks functional groups that other enzymes might conjugate. Instead, these two reactions can decrease water solubility and mask functional groups that could have been conjugated. They can also create more toxic metabolites. An example is the acetyl metabolites of some of the sulfonamides. These metabolites are insoluble in urine and can precipitate out to form crystals in the urine.
