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6 November 2011
Pain patients who do not respond to the analgesic properties of the most commonly used opioids have a significant chance of being genetically incapable of generating the clinically-active metabolite of these medications.
Since 2005, I have been testing patients for cytochrome P450-2D6 (CYP-2D6) genetic abnormalities. This was when the blood test was first available for use by us clinicians in private practice. An abnormality of the CYP-2D6 enzyme may be referred to elsewhere in this paper as a deficiency or defect. All told, I’ve tested 15 patients who I have suspected—on a clinical basis—of having a CYP-2D6 genetic defect and, indeed, all have shown an abnormality (see Table 1). This includes myself and my brother. Included in this cohort is a single patient who has CYP-2D6 gene duplicity and is termed a rapid- or ultra-metabolizer. The clinical history of these persons is quite typical and I share this information to help practitioners identify pain patients who may have a genetic defect of CYP-2D6. They will likely not respond to some opioids. These patients may require high dosages of opioids or may be falsely accused of drug-seeking behavior.
"quoted with permission of Dr. Tennant" to read full text go here …
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