Impact of CYP2D6 Pharmacogenomic Status on Pain Control Among Opioid-Treated Oncology Patients.
Natalie M ReizineKeith DanaheyEmily SchiererPing LiuMerisa MiddlestadtJenna LudwigTien M TruongXander M R Van WijkKiang-Teck Jerry YeoMonica MalecMark J RatainPeter H O'DonnellPublished in: The oncologist (2021)
Genomic variation in metabolic enzymes can predispose individuals to inefficacy when receiving opioid pain medications. Patients with intermediate and/or poor CYP2D6 metabolizer status do not adequately convert codeine, tramadol, and hydrocodone into active compounds, with resulting increased risk of inadequate analgesia. This study showed that patients with cancer frequently receive CYP2D6-dependent opioids. However, patients with CYP2D6 intermediate and poor metabolizer status had increased numbers of pain-related hospitalizations and more frequently required the potent non-CYP2D6 opioids morphine and hydromorphone. This may reflect inadequate initial analgesia with the common "first-line" CYP2D6-metabolized opioids. Preemptive genotyping to guide opioid prescribing during cancer care may improve pain-related patient outcomes.
Keyphrases
- pain management
- chronic pain
- end stage renal disease
- newly diagnosed
- primary care
- ejection fraction
- chronic kidney disease
- palliative care
- high throughput
- peritoneal dialysis
- gene expression
- emergency department
- prognostic factors
- postoperative pain
- spinal cord injury
- anti inflammatory
- adverse drug
- clinical decision support