Pharmacogenetics of analgesic drugs

Roman Cregg, Giovanna Russo, Anthony Gubbay, Ruth Branford, Hiroe Sato, Roman Cregg, Giovanna Russo, Anthony Gubbay, Ruth Branford, Hiroe Sato

Abstract

• Individual variability in pain perception and differences in the efficacy of analgesic drugs are complex phenomena and are partly genetically predetermined. • Analgesics act in various ways on the peripheral and central pain pathways and are regarded as one of the most valuable but equally dangerous groups of medications. • While pharmacokinetic properties of drugs, metabolism in particular, have been scrutinised by genotype-phenotype correlation studies, the clinical significance of inherited variants in genes governing pharmacodynamics of analgesics remains largely unexplored (apart from the µ-opioid receptor). • Lack of replication of the findings from one study to another makes meaningful personalised analgesic regime still a distant future. • This narrative review will focus on findings related to pharmacogenetics of commonly used analgesic medications and highlight authors' views on future clinical implications of pharmacogenetics in the context of pharmacological treatment of chronic pain.

Keywords: Pharmacogenetics; analgesics; genetic association studies; genetic screening; inter-individual variability; metabolism; pain; pain perception; pharmacodynamics; pharmacogenomics; pharmacokinetics; phenotype; polymorphism; single-nucleotide polymorphism.

Conflict of interest statement

Conflict of interest: The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Heritable factors influencing drug–organism interaction. Source: American Society of Anesthesiologists, Inc. (p. 302).
Figure 2.
Figure 2.
Major metabolic pathways for (a) codeine and morphine, (b) oxycodone and (c) tramadol.

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