Review Article

Pharmacogenetics of Chronic Pain and Its Treatment

Table 4

The principal polymorphic DMEs involved in the metabolism of drugs used for chronic pain.

EnzymesImportant gene variantsInfluenced drug groupProven effect on PK or efficacy/safety in clinical trialsReferences

CYP2D6CYP2D6*1-wt
CYP2D6*3
2549A>del
CYP2D6*4
1846G>A
CYP2D6*5
CYP2D6*6
1707T>del
MxN
CYP2D6*10
TCA
Opioids
SSRI
Opioids (codeine, tramadol, hydrocodone, and oxycodone), TCA (amitriptyline, nortriptyline, imipramine, and desipramine), and SSRI (fluoxetine, paroxetine, and citalopram)[47, 48]

CYP2C9CYP2C9*1-wt
CYP2C9*2 (Cys144Arg)
CYP2C9*3 (Leu359Iso)
CYP2C9*5
NSAIDs
SSRIs
SNRIs
Coxibs (celecoxib)[4850]

CYP2C19CYP2C19*1-wt
CYP2C19*2
CYP2C19*3
CYP2C19*17-Ums
NSAID
Antidepressants
SSRI (citalopram)[48, 51, 52]

CYP2C8CYP2C8*1-wt
CYP2C8*2 (Ile269Phe)
CYP2C8*3 (Arg139Lys, Lys399Arg)
NSAIDNSAID (ibuprofen and diclofenac)[48, 5355]

CYP3A4CYP3A4*1 (2023G>A)
CYP3A4*2
CYP3A4*10
CYP3A4*17
OpioidsOpioids (methadone and fentanyl)[48, 5658]

UGT1A6UGT1A6*1
UGT1A6*2
NSAIDs, anticonvulsantsNSAID (acetylsalicylic acid)[59, 60]

UGT2B7UGT2B7*2 (802C>T, H268Y),
161C>T
NSAID
Opioids
Anticonvulsants
Opioids (morphine) and anticonvulsants (lamotrigine and valproic acid)[6165]

UGT1A1UGT1A1*28Paracetamol
Opioids
Paracetamol[62, 66]

SULT1A1SULT1A1*2 (G638A; Arg213His)
SULT1A1*3 (A667; Met223Val)
ParacetamolParacetamol[67]