J Bacteriol 168(3):13251331 Ogawa Y, Hosoyama H, Hamano M, Motai H (1991) Purification and properties of gamma-glutamyltranspeptidase from Bacillus subtilis (natto)
3,984,569, supra, which is hereby incorporated by reference
R 2 is selected from the group consisting of: hydrogen, -CH(R a )OPO(OH)2, -CO-Y, -i-PO(OY) 2 , --PO(OH) 2 , -C(=0)-Y, -CO-U, -C(=0)-(CH 2 )rU, and -CH 2 -V, where R a is hydrogen or CH 3 , where Y is -Z-(CH 2 )q-W-R b , q is 0-4, where Z and W are independently selected from the group consisting of: CH 2 , O, S, R C and R b , where R c is selected from the group consisting of: hydrogen, C1-C4 alkyl, and C 3 -C 6 cycloalkyl, R b is selected from the group consisting of: hydrogen, C1-C12 alkyl, C1-C12 substituted alkyl, C1-C12 alkenyl, C1-C12 substituted alkenyl, C1-C12 alkynyl, C1-C12 substituted alkynyl, C 3 -Cs cycloalkyl, C 3 -Cs substituted cycloalkyl, C 6 -Cio aryl, C 6 -Cio substituted aryl, C 3 -Cs heterocycloalkyl, C 3 -Cs substituted heterocycloalkyl, C4-C10 heteroaryl, and C4-C10 substituted heteroaryl, where r is 0-5, U is selected from aryl, heteroaryl or heterocycloalkyl, where V is -0-C(=0)-Q-(CH 2 )r-R d , where Q is selected from the group consisting of: a bond, O, and N(R C ), where R d is selected from the group consisting of: C6-C10 aryl, C4-C10 heteroaryl, C 3 -Cs heterocycloalkyl, a hexose, a pentose, and - (5-methyl-2-oxo-l,3-dioxol-4-yl)methyl), or alternatively -C(=0)-Y forms an amide bond thru a nitrogen atom on Y in which case Y is a selected from the group consisting of: glycine, sarcosine, ,-diemthyl glycine, alanine, valine, leucine, isoleucine, lysine, ornithine, arigine, serine, and theronine
When managing patients taking opioid analgesics, particularly those who have been treated for an extended period of time, and/or with high doses for chronic pain, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper
