BIOTRANSFORMASI OBAT, PSIKOTROPIKA, DAN XENOBIOTIK: TAHAPAN, PENGENDALIAN, GANGGUAN, DAN ANALISIS KLINIS

Abstract

Xenobiotics, including drugs and psychotropic substances, undergo biotransformation so that they can be eliminated more easily, and disturbances in this process may cause therapeutic failure, drug interactions, and organ damage. This article aims to review the stages of drug, psychotropic, and xenobiotic metabolism, the ways it is controlled, the diseases that arise from its disturbance, and the related clinical analysis. A narrative literature review of journal articles and biochemistry and pharmacology textbooks was carried out and analyzed descriptively by theme. The review shows that metabolism proceeds in three phases: oxidation by cytochrome P450, conjugation by phase II enzymes, and efflux by membrane transporters. Enzyme activity is affected by genetic polymorphisms, induction and inhibition by drugs or food, smoking, and liver disease. These disturbances appear, among others, as paracetamol hepatotoxicity, Gilbert syndrome, codeine toxicity, and clozapine toxicity. Control is achieved through dose adjustment, therapeutic drug monitoring, avoidance of interactions, and pharmacogenetic testing, supported by liver function tests, urine toxicology screening, and chromatography-mass spectrometry analysis.