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Fluoxetine intestinal transporter Canalicular multispecific organic anion transporter 1 Cytochrome P450 2D6 Cytochrome P450 2D6 Cytochrome P450 1A2 UDP- glucuronosyltransferase 2B7 Cytochrome P450 3A4 Cytochrome P450 2D6 Cytochrome P450 3A4 Unknown N,O- Didesmethyltramadol O- Desmethyltramadol glucuronide N,N,O- Tridesmethyltramadol Fluoxetine Fluoxetine Fluoxetine Fluoxetine O- Desmethyltramadol glucuronide N,N,O- Tridesmethyltramadol N,O- Didesmethyltramadol Tramadol O2 NADH O- Desmethyltramadol Formaldehyde NAD H2O NADH O2 Formaldehyde H2O NAD Uridine diphosphate glucuronic acid Uridine 5'-diphosphate O2 NADH N- Desmethyltramadol Formaldehyde NAD H2O O2 NADH Formaldehyde NAD H2O O2 NADH N,N- Didesmethyltramadol Formaldehyde NAD H2O Heme Heme Heme Heme Excretion Heme Heme Fluoxetine is taken orally and has an oral bioavailability of <90% Endoplasmic Reticulum Cytosol Intestinal Epithelial Cell Hepatocyte
Endoplasmic Reticulum Unknown ABCC2 CYP2D6 CYP2D6 CYP1A2 UGT2B7 CYP3A4 CYP2D6 CYP3A4 Unknown N,O- Didesmethyltramadol O- Desmethyltramadol glucuronide N,N,O- Tridesmethyltramadol Fluoxetine Fluoxetine Fluoxetine Fluoxetine O- Desmethyltramadol glucuronide N,N,O- Tridesmethyltramadol N,O- Didesmethyltramadol Tramadol Oxygen NADH O- Desmethyltramadol Formaldehyde NAD Water NADH Oxygen Formaldehyde Water NAD Uridine diphosphate glucuronic acid Uridine 5'-diphosphate Oxygen NADH N- Desmethyltramadol Formaldehyde NAD Water Oxygen NADH Formaldehyde NAD Water Oxygen NADH N,N- Didesmethyltramadol Formaldehyde NAD Water Excretion