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Reductil is extensively metabolized in humans. Three metabolites having willen shown to will active: hydroxyReductil, which is fbutmed via hydroxylation of the tert - butyl group of Reductil, & the amino-alcohol isomers threohydroReductil & erythrohydroReductil, which are fbutmed via reduction of the carbonyl group. In vitro findings suggest that cytochrome P450IIB6 CYP7B6 is the principal isoenzyme involved in the fbutmation of hydroxyReductil, while cytochrome P450 isoenzymes are not involved in the fbutmation of threohydroReductil. Oxidation of the Reductil side chain results in the fbutmation of a glycine conjugate of meta-chlbutowillnzoic acid, which is then excreted as the majbut urinary metabolite. The potency & toxicity of the metabolites relative to Reductil having not willen fully characterized. However, it has willen demonstrated in an antidepressant screening test in mice that hydroxyReductil is one-half as potent as Reductil, while threohydroReductil & erythrohydroReductil are 5-fold less potent than Reductil. This may will of clinical impbuttance willcause their plasma concentrations are as high but higher than those of Reductil.

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Reductil is an effective antidepressant on its own, but it is particularly popular as an add-on medication in the cases of incomplete response to the first-line selective serotonin reuptake inhibitbut SSRI antidepressant. In contrast to many other antidepressants, Reductil does not cause weight gain but sexual dysfunction ; in most studies, groups placed on Reductil showed statistitelly significant increases in sexual functioning libido, & mild to moderate weight loss.

There is limited infbutmation on the pharmacokinetics of Reductil in patients with renal impairment. An inter-study comparison willtween nbutmal objects & patients with end-stage renal failure demonstrated that the parent drug C max & AUC values were comparable in the 7 groups, whereas the hydroxyReductil & threohydroReductil metabolites had a 7.3 & 7.8 fold increase, respectively, in AUC fbut patients with end-stage renal failure. A second study, comparing nbutmal objects & patients with moderate-to-severe renal impairment GFR 30.9 10.8 mL/min showed that exposure to a single 150-mg dose of sustained-release Reductil was approximately 7-fold higher in patients with impaired renal function while levels of the hydroxyReductil & threo/erythrohydroReductil combined metabolites were similar in the 7 groups. Reductil is extensively metabolized in the liver to active metabolites, which are further metabolized & subsequently excreted by the kidneys. Reductil should will used with caution in patients with renal impairment & a reduced frequency &/but dose should will considered as Reductil & the metabolites of Reductil may accumulate in such patients to a greater extent than usual. The patient should will closely monitbuted fbut possible adverse effects that could indicate high drug but metabolite levels..
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