Complicated pain management in a CYP450 2D6 poor metabolizer

Pain Pract. 2007 Dec;7(4):352-6. doi: 10.1111/j.1533-2500.2007.00153.x. Epub 2007 Nov 6.


We describe the case of a patient with significant adverse effects from posttraumatic analgesic therapy with opioid analgesics who was found by microarray analysis to have a CYP2D6 genotype predictive of a poor metabolizer phenotype. In addition to her poor tolerance and limited response to opioid analgesics, she developed further discomfort when the antiemetic promethazine was administered to treat her gastrointestinal adverse effects. In our discussion we review the literature about the clinical impact of CYP450 2D6 polymorphisms in treatment with the commonly used opioid analgesics codeine, oxycodone, hydrocodone, hydromorphone, and morphine, as well as the antiemetic promethazine. The case we present, as well as the literature we review, demonstrates the clinical utility of CYP2D6 genotyping in patients with adverse effects from analgesia therapy.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / pharmacokinetics*
  • Antiemetics / adverse effects
  • Antiemetics / pharmacokinetics
  • Cytochrome P-450 CYP2D6 / genetics*
  • Cytochrome P-450 CYP2D6 / metabolism*
  • Female
  • Humans
  • Middle Aged
  • Pain / drug therapy*
  • Promethazine / adverse effects
  • Promethazine / pharmacokinetics
  • Spinal Fractures / complications
  • Thoracic Vertebrae / injuries


  • Analgesics, Opioid
  • Antiemetics
  • Cytochrome P-450 CYP2D6
  • Promethazine