CYP2D6-Guided Opioid Management and Postoperative Pain Control

Does postoperative opioid therapy guided by cytochrome P450 2D6 (CYP2D6) genotype and use of CYP2D6 enzyme inhibitors alter opioid use or reduce pain intensity?This randomized clinical trial including 351 participants evaluated postoperative CYP2D6-guided opioid therapy, with recommendations to avoid hydrocodone, tramadol, and codeine in CYP2D6 poor and intermediate metabolizers, vs usual opioid prescribing without genotyping. CYP2D6-guided opioid prescribing did not affect the primary composite end point of pain intensity or overall opioid use.Findings suggest that a CYP2D6-guided approach to opioid selection did not improve pain control in the setting of multimodal approaches to postoperative pain management.

Corresponding Authors: Larisa H. Cavallari, PharmD, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, PO Box 100486, Gainesville, FL 32610-3003 (lcavallari@ufl.edu); Julie A. Johnson, PharmD, Clinical and Translational Science Institute, The Ohio State University, 376 W 10th Ave, Prior Hall, Ste 260, Columbus, OH 43210 (julie.johnson@osumc.edu).

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