Document Detail

Complicated pain management in a CYP450 2D6 poor metabolizer.
MedLine Citation:
PMID:  17986163     Owner:  NLM     Status:  MEDLINE    
We describe the case of a patient with significant adverse effects from posttraumatic analgesic therapy with opioid analgesics who was found by microarray analysis to have a CYP2D6 genotype predictive of a poor metabolizer phenotype. In addition to her poor tolerance and limited response to opioid analgesics, she developed further discomfort when the antiemetic promethazine was administered to treat her gastrointestinal adverse effects. In our discussion we review the literature about the clinical impact of CYP450 2D6 polymorphisms in treatment with the commonly used opioid analgesics codeine, oxycodone, hydrocodone, hydromorphone, and morphine, as well as the antiemetic promethazine. The case we present, as well as the literature we review, demonstrates the clinical utility of CYP2D6 genotyping in patients with adverse effects from analgesia therapy.
Adriana Foster; Elizabeth Mobley; Zixuan Wang
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-11-06
Journal Detail:
Title:  Pain practice : the official journal of World Institute of Pain     Volume:  7     ISSN:  1533-2500     ISO Abbreviation:  Pain Pract     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-20     Completed Date:  2007-12-21     Revised Date:  2009-01-16    
Medline Journal Info:
Nlm Unique ID:  101130835     Medline TA:  Pain Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  352-6     Citation Subset:  IM    
Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, Georgia 30912, USA.
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MeSH Terms
Analgesics, Opioid / adverse effects*,  pharmacokinetics*
Antiemetics / adverse effects,  pharmacokinetics
Cytochrome P-450 CYP2D6 / genetics*,  metabolism*
Middle Aged
Pain / drug therapy*
Promethazine / adverse effects,  pharmacokinetics
Spinal Fractures / complications
Thoracic Vertebrae / injuries
Reg. No./Substance:
0/Analgesics, Opioid; 0/Antiemetics; 60-87-7/Promethazine; EC P-450 CYP2D6
Comment In:
Pain Pract. 2008 Jul-Aug;8(4):329; author reply 330   [PMID:  18507781 ]

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