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As approximately 1221% of Caucasians are poor CYP2D6 metabolizers, compared to only 1% of Pacific islanders, this may explain the higher incidence of hepatotoxicity in Western countries [45]

If Phase 1 runs faster than Phase 2/3, reactive intermediates build up and recirculate (enterohepatic recycling), causing headaches, fatigue, nausea, skin flares, or brain fog

doi: 10.1093/ajcn/74.2.219

Enzyme kinetics in drug metabolism: fundamentals and applications

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Oncology/Hematology 180, 103843