Phase II reactions involve conjugation with an endogenous substance (eg, glucuronic acid, sulfate, glycine); these reactions are synthetic. Metabolites formed in synthetic reactions are more polar and thus more readily excreted by the kidneys (in urine) and the liver (in bile) than those formed in nonsynthetic reactions.
). Thus, drugs that are metabolized through this system reach higher levels and have prolonged half-lives in the elderly (see Figure: Comparison of pharmacokinetic outcomes for diazepam in a younger man (A) and an older man (B). Because neonates have partially developed hepatic microsomal enzyme systems, they also have difficulty metabolizing many drugs. With aging, the liver’s capacity for metabolism through the CYP450 enzyme system is reduced by ≥ 30% because hepatic volume and blood flow are decreased.
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Last full review/revision November 2017 by Jennifer Le, PharmD, MAS, BCPS-ID, FIDSA, FCCP, FCSHP.
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Ment for acute, cancer and non-cancer chronic pain (Collet. 2001; Quang-Cantagrel et al 2000; Bannwarth 1999). Morphine, which is commonly used for the treatment of severe pain, is metabolized essentially in the liver, gastrointestinal tract and kidneys (Pacifici et al 1986;. Stain-Texier et al 1998). Tramadol, a widely used.