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PHARMACOGENOMICS (PGx)

Pain Management PGx Test Panel

Pain Management PGx Test Panel

CYP2C19, CYP2D6, CYP2C9, CYP3A4, CYP3A5, CYP1A2, CYP2B6, COMT, OPRM1

Commonly used pain medications such as narcotics and over the counter pain medications are under influence of genetic make-up of individuals. A standard dose of a pain medication such as codeine may not be effective in one individual while the exact same dose may be toxic for another individual based on their genetic profile. Therefore, determining the genetic make-up of an individual can help with precision prescribing of the medications.

 

Opioids

Medication Gene
Codeine, Tramadol, Hydrocodone, Oxycodone, Oliceridine CYP2D6
Fentanyl, Buprenorphine, Oxycodone CYP3A4, CYP3A5
Methadone CYP2B6
Alfentanil, Sufentanil, Hydromorphone, Morphine, Fentanyl OPRM1

 

Frequency of Cytochrome P450 (CYP2D6) Metabolizer Types in the population

Cytochrome Poor metabolizer Intermediate metabolizer Normal metabolizer Rapid or ultra-rapid metabolizer
CYP2D6 4-7% 9-35% 50-90% 2-3%

 

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Medication Gene
Ibuprofen, Piroxicam, Lornoxicam, Meloxicam, Flurbiprofen, Celecoxib, Diclofenac, Tenoxicam CYP2C9
Carisoprodol CYP2C19

 

Frequency of Cytochrome P450 (CYP2D6 and CYP2C19) Metabolizer Types in the population

Cytochrome Poor metabolizer Intermediate metabolizer Normal metabolizer Rapid or ultra-rapid metabolizer
CYP2C9 3% 30% 68% N/A
CYP2C19 2-20% 24-36% 14-44% 30%

 

Drug To Drug Interaction

For drug-drug interactions, please go to Flockhart Table ™

References

  • Evans WE, McLeod HL. Pharmacogenomics -- Drug Disposition, Drug Targets, and Side Effect. The New England Journal of Medicine. 2003;348(6):538-549.
  • Agarwal, D., Udoji, M. A., & Trescot, A. (2017). Genetic Testing for Opioid Pain Management: A Primer. Pain and Therapy, 6(1), 93–105.
  • Crews KR, Gaedigk A, Dunnenberger HM, et al. Clinical Pharmacogenetics Implementation Consortium Guidelines for Cytochrome P450 2D6 Genotype and Codeine Therapy: 2014 Update. Clinical Pharmacology & Therapeutics. 2014;95(4):376-382. doi:10.1038/clpt.2013.254
  • https://cpicpgx.org/genes-drugs
  • https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling
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