藥物基因學屬於精準醫療範疇，是指為個體量身打造特定的治療處方。類鴉片藥品為疼痛管理常用之藥物，而個體基因變異對藥物代謝和反應有重大影響。藥物基因學對類鴉片藥物的影響主要為藥物動力學及藥效學。Codeine、tramadol、oxycodone、hydrocodone 為前驅藥品，須經由CYP2D6 (cytochrome P450, family 2, subfamily D member 6) 酶代謝成活性代謝物以產生止痛效果。CYP2D6 基因的多態性與這些藥物的臨床療效和安全性的關聯已被證實。其他與類鴉片藥品療效、副作用及依賴風險相關之基因包括OPRM1 (opioid receptor mu 1)、COMT (catechol-Omethyltransferase)、DRD2 (dopamine receptor D2)。此外，無效的疼痛控制是濫用類鴉片藥品最常被提及的原因。越來越多的臨床研究證實，依據CYP2D6 指引進行疼痛管理可改善疼痛控制並減少鴉片類藥品的使用，進而避免類鴉片藥品的濫用。再者藥物交互作用可能也是影響藥物療效的因素，須適時調整劑量以避免出現戒斷症狀。因而應用藥物基因學指引選擇合適的類鴉片藥品，不僅可提升藥品療效、減少副作用，並提高病人疼痛管理計劃的用藥依順性，同時預防類鴉片藥品濫用的風險，是臨床重要的課題。
Pharmacogenetics is a branch of precision medicine that uses an individual's genetic information to tailor drug therapy. Opioids are commonly used to manage pain, but individual genetic variations can significantly impact how the body metabolizes and responds to these drugs. The main pharmacogenetic effects on opioids are in pharmacokinetics and pharmacodynamics. Codeine, tramadol, oxycodone, and hydrocodone are prodrugs that must be metabolized by the CYP2D6 enzyme to produce their analgesic effects. CYP2D6 (cytochrome P450, family 2, subfamily D member 6) gene polymorphisms have been shown to be associated with the clinical efficacy and safety of these drugs. Other genes that have been studied for their association with opioid response, side effects, and dependence risk include OPRM1 (Opioid Receptor Mu 1), COMT (Catechol-O-Methyltransferase), and DRD2 (Dopamine Receptor D2). Ineffective pain management is a major cause of opioid misuse. Clinical trials have shown that a CYP2D6-guided approach to pain management can improve pain control and reduce opioid use, which may help to combat opioid misuse. Drug interactions can also affect the efficacy of opioids, so it is important to adjust dosages as needed to avoid withdrawal symptoms. The use of pharmacogenetic guidelines to select appropriate opioid medications is a clinically important issue that can improve efficacy, reduce side effects, and increase adherence to pain management plans. It may also help to prevent opioid misuse.
Submitted for publication: 2023.6.12; Accepted for publication: 2023.8.1
