Free radical reactive intermediates bioactivation

In addition to oxygen free radicals, other compounds such a clozapine, olanzapine and procainamide induce reactive intermediates [8, 9]. Clozapine and olanzapine bioactivation is thought to occur through a nitrenium ion [20] however clozapine but not olanzapine induce toxicity to neutrophils. This can lead to an immune-mediated depletion of neutrophils and their precursors (CFU-GM) [21]. Also, nonsteroidal antiinflammatory drugs (NSAIDs) have pro-oxidant radicals that when metabolized could cause oxidative stress [22]. 

Kubow S, Wells P. In vitro bioactivation of phenytoin to a reactive free radical intermediate by prostaglandin synthase, horseradish peroxidase and thyroid peroxidase. Mol Pharmacol 1989 35 1-8. 

As indicated earlier, some drugs are bioactivated to reactive intermediates that interact with cellular constituents. One specific type of reactive substance mentioned previously is the free radical. Free radicals are highly reactive chemical species containing, in the outermost or bonding orbital, a single unpaired electron. As a result, this is an... 

Bioactivation to a free radical intermediate has been implicated in the teratological mechanism for a number of xenobiotics, including phenytoin and structurally-related AEDs, benzo[a]pyrene, thalidomide, methamphetamine, valproic acid, and cyclophosphamide (Fantel 1996 Wells et al. 2009 Wells and Winn 1996). Unlike in the case of most CYPs, the embryo-fetus has relatively high activities of PHSs and lipoxygenases (LPOs), which via intrinsic or associated hydroperoxidase activity can oxidize xenobiotics to free radical intermediates (Fig. 10) (Wells et al. 2009). These xenobiotic free radical intermediates can in some cases react with double bonds in cellular macromolecules to form covalent adducts, or more often react directly or indirectly with molecular oxygen to initiate the formation of potentially teratogenic reactive oxygen species (ROS). 

Fig. 10 Bioactivation of xenobiotics via the prostaglandin H synthase (PHS) and lipoxygenase (LPO) pathways-postuiated role in teratogenesis. The hydroperoxidase component of embryonic and fetal PHSs, and hydroperoxidases associated with LPOs, can oxidize xenobiotics to free radical intermediates that initiate the formation of reactive oxygen species causing oxidative stress (modified from Yu and Wells 1995)...

---