Acyl glucuronides–mediators of drug-induced toxicities?

The atorvastatin metabolite pattern in muscle tissue and blood plasma is associated with statin muscle side effects in patients with coronary heart disease; An exploratory case-control study

“…Atorvastatin acyl glucuronides are intermediates in this conversion, and increased production and turnover of acyl glucuronide metabolites might be involved in developing muscular side effects during atorvastatin therapy. Acyl glucuronide metabolites of drugs are generally considered reactive substances with the potential to induce toxic effects [ 25 ]. We were unable to support this hypothesis through our semi-quantitative determination of atorvastatin acyl glucuronide in plasma, where we also recognized that these are challenging compounds to target for pharmacokinetic observations due to the reactivity and chemical instability.…”