CYP2D6 phenotypes and opioid metabolism: the path to personalized analgesia

IF 3.9 3区医学 Q2 BIOCHEMISTRY & MOLECULAR BIOLOGY

Expert Opinion on Drug Metabolism & Toxicology Pub Date : 2022-04-03 DOI:10.1080/17425255.2022.2085552

P. Ballester, Javier Muriel, A. Peiró

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引用次数: 3

Abstract

ABSTRACT Introduction Opioids play a fundamental role in chronic pain, especially considering when 1 of 5 Europeans adults, even more in older females, suffer from it. However, half of them do not reach an adequate pain relief. Could pharmacogenomics help to choose the most appropriate analgesic drug? Areas covered The objective of the present narrative review was to assess the influence of cytochrome P450 2D6 (CYP2D6) phenotypes on pain relief, analgesic tolerability, and potential opioid misuse. Until December 2021, a literature search was conducted through the MEDLINE, PubMed database, including papers from the last 10 years. CYP2D6 plays a major role in metabolism that directly impacts on opioid (tramadol, codeine, or oxycodone) concentration with differences between sexes, with a female trend toward poorer pain control. In fact, CYP2D6 gene variants are the most actionable to be translated into clinical practice according to regulatory drug agencies and international guidelines. Expert Opinion CYP2D6 genotype can influence opioids’ pharmacokinetics, effectiveness, side effects, and average opioid dose. This knowledge needs to be incorporated in pain management. Environmental factors, psychological together with genetic factors, under a sex perspective, must be considered when you are selecting the most personalized pain therapy for your patients.

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CYP2D6表型与阿片代谢:个体化镇痛的途径

阿片类药物在慢性疼痛中起着重要作用，特别是考虑到五分之一的欧洲成年人(甚至更多的老年女性)患有慢性疼痛。然而，其中一半没有达到足够的疼痛缓解。药物基因组学能帮助选择最合适的镇痛药物吗?本综述的目的是评估细胞色素P450 2D6 (CYP2D6)表型对疼痛缓解、镇痛耐受性和潜在阿片类药物滥用的影响。直到2021年12月，通过MEDLINE, PubMed数据库进行文献检索，包括近10年的论文。CYP2D6在代谢中起主要作用，直接影响阿片类药物(曲马多、可待因或羟考酮)的浓度，性别差异明显，女性疼痛控制能力较差。事实上，根据监管药物机构和国际指南，CYP2D6基因变异是最有可能转化为临床实践的。专家意见CYP2D6基因型可影响阿片类药物的药代动力学、有效性、副作用和平均阿片类药物剂量。这些知识需要纳入疼痛管理。当你为你的病人选择最个性化的疼痛治疗时，必须从性别角度考虑环境因素、心理因素和遗传因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Opinion on Drug Metabolism & Toxicology 医学-生化与分子生物学

CiteScore

7.90

自引率

2.30%

发文量

审稿时长

4-8 weeks

期刊介绍： Expert Opinion on Drug Metabolism & Toxicology (ISSN 1742-5255 [print], 1744-7607 [electronic]) is a MEDLINE-indexed, peer-reviewed, international journal publishing review articles on all aspects of ADME-Tox. Each article is structured to incorporate the author’s own expert opinion on the scope for future development. The Editors welcome: Reviews covering metabolic, pharmacokinetic and toxicological issues relating to specific drugs, drug-drug interactions, drug classes or their use in specific populations; issues relating to enzymes involved in the metabolism, disposition and excretion of drugs; techniques involved in the study of drug metabolism and toxicology; novel technologies for obtaining ADME-Tox data. Drug Evaluations reviewing the clinical, toxicological and pharmacokinetic data on a particular drug. The audience consists of scientists and managers in the pharmaceutical industry, pharmacologists, clinical toxicologists and related professionals.