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Glucuronidation: UGTs catalyze an SN2 nucleophilic substitution where the substrate's nucleophilic functional group (OH, NH2, SH, COOH) attacks the C1 carbon of glucuronic acid in UDPGA, displacing UDP
This is the single most important fact for clinicians considering off-label use
In some cases, once a patient turns 18, transitioning from the adolescent-approved injectable to the daily oral pill may be a viable strategy
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