Sulfonamide metabolic pathways

Sulfonamide antimicrobial drugs are metabolized by oxidation of the arylamine group (shown in blue). Nontoxic metabolites are then excreted. Factors that slow metabolism, such as slow acetylator status or depletion of glutathione stores (in HIV infection), can affect the steps shown in bold red. This may lead to prolonged exposure to reactive metabolites and increased rate of hypersensitivity reactions.