Carbamazepine (CBZ) is one of the most widely prescribed anticonvulsants despite a high incidence of idiosyncratic side effects. Metabolism of CBZ is complex, and of the more than 30 metabolites identified, one of the most abundant is CBZ Nglucuronide. To date the uridine diphosphate glucuronosyltransferase (UGT) isoform responsible for the N-glucuronidation of CBZ has not been identified. We have developed a sensitive liquid chromatography/mass spectrometry assay to quantify CBZ glucuronidation, and we report that CBZ is specifically glucuronidated by human UGT2B7. Kinetics of CBZ glucuronidation in human liver, kidney, and intestine microsomes were consistent with those of recombinant UGT2B7, which displayed a K m value of 214 M and V max value of 0.79 pmol/mg/min. In addition to revealing the isoform responsible for CBZ glucuronidation, this is the first example of primary amine glucuronidation by UGT2B7.Carbamazepine (5H-dibenzo[b,f]azepine-5-carboxamide) is one of the most widely prescribed anticonvulsants and is used to treat a variety of conditions from epilepsy to muscle spasm and trigeminal neuralgia. However its use is associated with a number of idiosyncratic adverse side effects, including skin rash, blood disorders, and hepatitis in onethird to one-half of patients (Ju and Uetrecht 1999). These adverse side effects have been associated with the formation of CBZ metabolites (Shear and Spielberg 1988;Riley et al., 1989); therefore, the study of all CBZ metabolites has important clinical implications.The metabolism of CBZ is complex and has been widely studied in human and in animal models (Madden et al., 1996;Maggs et al., 1997) with over 30 metabolites (Lertratanangkoon and Horning, 1982) identified. The major metabolites are the 10,11-epoxide and its hydrolytic trans-dihydrodiol product. Glucuronidation is also an important detoxification pathway because the CBZ N-glucuronide and glucuronides of the hydroxylated metabolites are significant urinary metabolites; however, to date no glucuronide metabolite has been implicated in the incidence of side effects. Epoxide hydrolase has been the focus of most attention as a potential source of toxic metabolites; however, the available data do not support a major role for this enzyme in causing side effects (Pirmohamed et al., 1992;Green et al., 1995b). One minor metabolite, 2-hydroxy-CBZ, formed through loss of the carboxamide, could be metabolized to an iminoquinone, which due to its potential chemical reactivity might be the metabolite responsible for the idiosyncratic reactions, although this has not been shown to date (Ju and Uetrecht, 1999). In addition CBZ is also a well known enzyme inducer up-regulating cytochrome P450 (Luo et al., 2002) and UGT activity/expression (Tanaka, 1999) Carbamazepine is metabolized to an N-glucuronide (Bauer et al., 1976); in addition, glucuronide metabolites have been demonstrated for all 13 of the hydroxylated metabolites of CBZ (Maggs et al., 1997). Formation of N-glucuronides has been principally studied in nonro...