Clinical Pharmacogenetics Implementation Consortium Guidelines for Cytochrome P450 2D6 Genotype and Codeine Therapy: 2014 Update.

Crews KR1, Gaedigk A2, Dunnenberger HM1, Leeder JS2, Klein TE3, Caudle KE1, Haidar CE1, Shen DD4, Callaghan JT5, Sadhasivam S6, Prows CA7,Kharasch ED8, Skaar TC9.

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Abstract

Codeine is bioactivated to morphine, a strong opioid agonist, by the hepatic cytochrome P450 2D6 (CYP2D6); hence, the efficacy and safety of codeine are governed by CYP2D6 activity. Polymorphisms are a major cause of CYP2D6 variability. We summarize evidence from the literature supporting this association and provide therapeutic recommendations for codeine based on CYP2D6 genotype. This document is an update to the 2012 Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for CYP2D6 genotype and codeine therapy.Clinical Pharmacology & Therapeutics (2014); advance online publication 29 January 2014. doi:10.1038/clpt.2013.254.