N-acetyltransferase enzymes (NAT1 and NAT2) are involved in the metabolism and detoxification of xenobiotics. NAT2 is predominantly expressed in the liver and has a role in the metabolism of numerous therapeutic drugs including caffeine and BiDil. Genetic variants in the NAT2 gene result in a slow, intermediate or rapid acetylator phenotype.
Numerous studies have reported an association between slow acetylator status (based on NAT2 genotype) and anti-TB drug-induced hepatotoxicity, though other studies find no such association. Similarly, the association between NAT2 genetic variants and side effects of co-trimoxazole or hydralazine is also unclear.
The PharmGKB VIP Summary for NAT2 discusses these contradictions and links to summaries of important NAT2 variants underlying these PGx associations.