CPIC Opioid Guideline: CYP2D6 Genotyping Recommended for Codeine and Tramadol Prescribing
This updated CPIC guideline provides evidence-based recommendations for using CYP2D6 genotype results to guide codeine and tramadol prescribing, while noting insufficient evidence for genotype-guided use of hydrocodone, oxycodone, and methadone. OPRM1 and COMT pharmacodynamic variants were also reviewed but do not yet meet the threshold for clinical implementation. The guideline gives laboratories clear, actionable reporting frameworks for CYP2D6 metabolizer phenotypes in the context of opioid safety and efficacy.
The original study
Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2D6, OPRM1, and COMT Genotypes and Select Opioid Therapy.
- Authors
- Crews KR, Monte AA, Huddart R, Caudle KE, Kharasch ED, Gaedigk A, et al.
- Journal
- Clinical pharmacology and therapeutics
- Type
- Journal Article, Practice Guideline, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't
- PMID
- 33387367
Original abstract
Opioids are mainly used to treat both acute and chronic pain. Several opioids are metabolized to some extent by CYP2D6 (codeine, tramadol, hydrocodone, oxycodone, and methadone). Polymorphisms in CYP2D6 have been studied for an association with the clinical effect and safety of these drugs. Other genes that have been studied for their association with opioid clinical effect or adverse events include OPRM1 (mu receptor) and COMT (catechol-O-methyltransferase). This guideline updates and expands the 2014 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 genotype and codeine therapy and includes a summation of the evidence describing the impact of CYP2D6, OPRM1, and COMT on opioid analgesia and adverse events. We provide therapeutic recommendations for the use of CYP2D6 genotype results for prescribing codeine and tramadol and describe the limited and/or weak data for CYP2D6 and hydrocodone, oxycodone, and methadone, and for OPRM1 and COMT for clinical use.