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Use of CYP2D6 substrates and inhibitors during pain management with analgesic opioids: Drug-drug interactions that lead to lack of analgesic effectiveness.
Muriel, J; Escorial, M; Carratalá, C; Margarit, C; Barrachina, J; López, A; Gallardo, E; Kringen, M K; Peiró, A M.
Afiliación
  • Muriel J; Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain.
  • Escorial M; Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain; Occupational Observatory, University Miguel Hernández, Avda. de la Universidad s/n, Elche 03202,
  • Carratalá C; Occupational Observatory, University Miguel Hernández, Avda. de la Universidad s/n, Elche 03202, Spain.
  • Margarit C; Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain; Pain Unit, Dr. Balmis General University Hospital, c/ Pintor Baeza, 12, Alicante 03010, Spain.
  • Barrachina J; Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain.
  • López A; Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain; Occupational Observatory, University Miguel Hernández, Avda. de la Universidad s/n, Elche 03202,
  • Gallardo E; Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), Av. Infante D. Henrique, Covilhã 6201-506, Portugal.
  • Kringen MK; Department of Psychopharmacology, Diakonhjemmet Hospital, Forskningsveien 7, Oslo 0373, Norway.
  • Peiró AM; Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain; Pain Unit, Dr. Balmis General University Hospital, c/ Pintor Baeza, 12, Alicante 03010, Spain; C
Biomed Pharmacother ; 176: 116882, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38876046
ABSTRACT

BACKGROUND:

Several opioids have pharmacogenetic and drug-drug interactions which may compromise their analgesic effectiveness, but are not routinely implemented into supportive pain management. We hypothesized that CYP2D6 phenotypes and concomitant use of CYP2D6 substrates or inhibitors would correlate with opioid analgesic outcomes. MATERIALS AND

METHODS:

An observational cross-sectional study was conducted with 263 adult chronic non cancer pain (CNCP) patients from a real-world pain unit under long-term CYP2D6-related opioid treatment (tramadol, hydromorphone, tapentadol or oxycodone). Metabolizer phenotype (ultrarapid [UM], normal [NM], intermediate [IM] or poor [PM]) was determined by the CYP2D6 genotype. The socio-demographic (sex, age, employment status), clinical (pain intensity and relief, neuropathic component, quality of life, disability, anxiety and depression), pharmacological (opioid doses and concomitant pharmacotherapy) and safety (adverse events) variables were recorded.

RESULTS:

The whole population (66 % female, 65 (14) years old, 70 % retired and 63 % attended for low back pain) were classified as PM (5 %), IM (32 %), NM (56 %) and UM (6 %). Multiple linear and logistic regressions showed higher pain intensity and neuropathic component at younger ages when using any CYP2D6 substrate (p = 0.022) or inhibitor (p = 0.030) drug, respectively, with poorer pain relief when CYP2D6 inhibitors (p=0.030) were present.

CONCLUSION:

The concomitant use of CYP2D6 substrates or inhibitors during opioid therapy for CNCP may result in lack of analgesic effectiveness. This aspect could be relevant for pharmacological decision making during CNCP management.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Citocromo P-450 CYP2D6 / Interacciones Farmacológicas / Manejo del Dolor / Inhibidores del Citocromo P-450 CYP2D6 / Analgésicos Opioides Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Biomed Pharmacother Año: 2024 Tipo del documento: Article Pais de publicación: Francia
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Citocromo P-450 CYP2D6 / Interacciones Farmacológicas / Manejo del Dolor / Inhibidores del Citocromo P-450 CYP2D6 / Analgésicos Opioides Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Biomed Pharmacother Año: 2024 Tipo del documento: Article Pais de publicación: Francia