Pharmacogenetics in palliative care

Abstract Response to analgesics, anticancer pharmacotherapy and pharmacotherapy of other cancer related symptoms vary broadly between individuals. Age, disease, comorbidities, concomitant medication, organ function and patients’ compliance may partly explain the differences. However, the focus of on...

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Bibliographic Details
Published in:Forensic science international 2010-12, Vol.203 (1), p.63-70
Main Authors: Kleine-Brueggeney, Maren, Musshoff, Frank, Stuber, Frank, Stamer, Ulrike M
Format: Article
Language:English
Subjects:
Analgesia
Analgesics
Analgesics, Opioid - pharmacokinetics
Antidepressive Agents, Tricyclic - pharmacokinetics
Antineoplastic Agents, Hormonal - pharmacokinetics
ATP Binding Cassette Transporter, Sub-Family B
ATP-Binding Cassette, Sub-Family B, Member 1 - genetics
Cancer
Catechol O-Methyltransferase - genetics
Cytochrome P-450 CYP2D6 - genetics
Cytochrome P450 (CYP)
Drug dosages
Drug therapy
Forensic medicine
Forensic sciences
Genetic Variation
Genetics
Genomics
Humans
Neoplasms - complications
Opioids
Pain
Pain - drug therapy
Pain - etiology
Pain management
Pain Measurement
Palliative Care
Pathology
Patients
Pharmacogenetics
Polymorphism
Receptors, Opioid, mu - genetics
Serotonin 5-HT3 Receptor Antagonists - pharmacokinetics
Studies
Tamoxifen
Tamoxifen - pharmacokinetics
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Summary:Abstract Response to analgesics, anticancer pharmacotherapy and pharmacotherapy of other cancer related symptoms vary broadly between individuals. Age, disease, comorbidities, concomitant medication, organ function and patients’ compliance may partly explain the differences. However, the focus of ongoing research has shifted towards genomic variants of phase I and II drug metabolizing enzymes with one important goal being an individual dose adjustment according to a patient's genotype. Polymorphisms of the cytochrome P 450 2D6 influence the metabolism of many drugs including the analgesics codeine, tramadol, hydrocodone and oxycodone, as well as the metabolism of tricyclic antidepressants and the anticancer drug tamoxifen. Other candidate genes such as (opioid)-receptors, transporters and other molecules important for pharmacotherapy in pain management are discussed. Although pharmacogenetics as a diagnostic tool has the potential to improve patient therapy, study results are often equivocal and limited by small sample sizes and often by their retrospective design. Well designed studies are needed to demonstrate superiority of pharmoacogenetics to conventional dosing regimes.
ISSN:0379-0738
1872-6283
DOI:10.1016/j.forsciint.2010.07.003