By now you know that the transformation of a specific xenobiotic can be either beneficial or harmful—perhaps both depending on the dose and circumstances. A good example is the biotransformation of acetaminophen (Tylenol®), a commonly used drug to reduce pain and fever. When the prescribed doses are taken, the desired therapeutic response is observed with little or no toxicity. However, when excessive doses of acetaminophen are taken, hepatotoxicity can occur. This is because acetaminophen normally undergoes rapid biotransformation with the metabolites quickly eliminated in the urine and feces.
At high doses, the normal level of enzymes may be depleted and the acetaminophen is available to undergo reaction by an additional biosynthetic pathway, which produces a reactive metabolite that is toxic to the liver. For this reason, a user of Tylenol® is warned not to take the prescribed dose more frequently than every 4-6 hours and not to consume more than four doses within a 24-hour period. Biotransforming enzymes, like most other biochemicals, are available in a normal amount and in some situations can be "used up" at a rate that exceeds the bodies ability to replenish them. This illustrates the frequently used phrase, the "Dose Makes the Poison."
Biotransformation reactions are categorized not only by the nature of their reactions, e.g., oxidation, but also by the normal sequence with which they tend to react with a xenobiotic. They are usually classified as Phase I and Phase II reactions. Phase I reactions are generally reactions which modify the chemical by adding a functional structure. This allows the substance to "fit" into the Phase II enzyme so that it can become conjugated (joined together) with another substance. Phase II reactions consist of those enzymatic reactions that conjugate the modified xenobiotic with another substance. The conjugated products are larger molecules than the substrate and generally polar in nature (water-soluble). Thus, they can be readily excreted from the body. Conjugated compounds also have poor ability to cross cell membranes.