Many common pain medications require activation by an enzyme called CYP2D6 to become effective. Approximately half of all patients have genes that alter the function of CYP2D6. Other metabolic pathways include CYP2B6, CYP2C9, CYP2C19, CYP3A4, CYP3A5, COMT, and OPRM1 [17]. Testing for these gene alterations allows for dosage modifications to compensate for genetic differences and optimize the safety and efficacy of the opioid family of analgesics.
PGx AND CHRONIC PAIN
Learn How Chronic Pain, Medication, and Genes Work Together
At the 23rd Annual Meeting of the American Academy of Pain Medicine, a presentation on the clinical effect of gene variations in chronic pain patients revealed:
- 80% of patients reporting adverse drug events (ADEs) were shown to have poor CYP2D6 metabolism [18]
Population Frequency of Cytochrome P450 (CYP) Metabolizer Types [5]
| Poor (no or low enzyme levels) |
Intermediate (reduced enzyme levels) |
normal (normal enzyme levels) |
Ultra-Extensive (high enzyme levels) |
|
|---|---|---|---|---|
| CYP2D6* | 4-7% | 9-35% | 50-90% | 2-3% |
*CYP2D6 Variability depends on ethnicity and classification of Intermediate activity
Additional pain medications that are impacted by your genetics[3]:
| TRADE NAME | DRUG |
|---|---|
| Celebrex® | celecoxib |
| Tylenol® 1,2,3,4 | codeine |
| Ultram® | tramadol |
| Feldene® | piroxicam |