Respiratory depression with tramadol in a patient with renal impairment and CYP2D6 gene duplication

Anesthesia and Analgesia
Ulrike M StamerFrank Musshoff

Abstract

We observed opioid-related respiratory depression in a patient receiving tramadol via patient-controlled analgesia. Predisposing factors were the patient's genetic background and renal impairment. Complete recovery occurred after naloxone administration, thus confirming opioid intoxication. Analysis of the patient's genotype revealed a CYP2D6 gene duplication resulting in ultra-rapid metabolism of tramadol to its active metabolite (+)O-desmethyltramadol. Concomitant renal impairment resulting in decreased metabolite clearance enhanced opioid toxicity. This genetic CYP2D6 variant is particularly common in specific ethnic populations and should be a future diagnostic target whenever administration of tramadol or codeine is anticipated, as both drugs are subject to a comparable CYP2D6-dependent metabolism.

References

Dec 1, 1996·Clinical Pharmacology and Therapeutics·L PoulsenS H Sindrup
Mar 15, 1997·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·K S Lewis, N H Han
Nov 5, 1997·Journal of Clinical Anesthesia·P TarkkilaL Lindgren
Apr 2, 1998·European Journal of Anaesthesiology·P TarkkilaL Lindgren
Apr 20, 1999·The American Journal of Forensic Medicine and Pathology·K A MooreM L Smith
Aug 4, 1999·Trends in Pharmacological Sciences·M Ingelman-SundbergR A McLellan
Sep 2, 2000·Anaesthesia and Intensive Care·E A Shipton
Feb 22, 2001·Forensic Science International : Synergy·F Musshoff, B Madea
Jan 29, 2003·Anesthesiology·Luc J TeppemaAlbert Dahan
Sep 23, 2003·Pain·Ulrike M StamerFrank Stuber
Dec 31, 2004·The New England Journal of Medicine·Yvan GascheJules Desmeules
May 25, 2006·Paediatric Anaesthesia·Bruce J HullettChris Johnson
Oct 20, 2006·Clinical Pharmacokinetics·Jörn LötschGerd Geisslinger
Mar 16, 2007·Clinical Pharmacology and Therapeutics·U M StamerF Stuber
Jun 15, 2007·Paediatric Anaesthesia·Polina VoronovNarasimhan Jagannathan
Feb 5, 2008·Pharmacogenomics·Hector C Keun, Toby J Athersuch

❮ Previous
Next ❯

Citations

Sep 22, 2010·European Journal of Clinical Pharmacology·Oliver KummerStephan Krähenbühl
Apr 12, 2011·Current Pain and Headache Reports·Wojciech Leppert
Apr 28, 2009·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Ulrike M Stamer, Frank Stuber
Jun 13, 2013·Journal of Forensic and Legal Medicine·Nunziata BarberaGuido Romano
Dec 15, 2010·Toxicological Sciences : an Official Journal of the Society of Toxicology·Inger Johansson, Magnus Ingelman-Sundberg
Nov 12, 2010·Seminars in Dialysis·Sarah Tomasello
Jan 1, 2009·Journal of Pain Research·Joanne Droney, Julia Riley
Dec 12, 2012·Pharmacogenomics and Personalized Medicine·Pascal H VuilleumierRuth Landau
Dec 19, 2009·Pharmacogenomics·Ana AlfirevicMunir Pirmohamed
May 28, 2010·Pharmacogenomics·Ulrike M StamerFrank Stüber
Apr 25, 2012·Indian Journal of Anaesthesia·Ghansham BiyaniPradeep Bhatia
Apr 6, 2013·Pharmacogenomics·Aline HajjKatell Peoc'h
Oct 30, 2013·Pain Research and Treatment·Yan Xu, Ana Johnson
Feb 13, 2014·Italian Journal of Pediatrics·Franca Benini, Egidio Barbi
May 26, 2011·Expert Opinion on Pharmacotherapy·Joseph V PergolizziRobert B Raffa
May 23, 2015·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Vincent Haufroid, Philippe Hantson
Jul 20, 2012·The American Journal of Emergency Medicine·Hossein Hassanian-MoghaddamHamid Owliaey
Mar 11, 2011·Trends in Molecular Medicine·Yijing HeHoward L McLeod
Sep 11, 2010·Forensic Science International : Synergy·Frank MusshoffBurkhard Madea
Aug 17, 2010·Forensic Science International : Synergy·Maren Kleine-BrueggeneyUlrike M Stamer
Jan 13, 2010·Best Practice & Research. Clinical Obstetrics & Gynaecology·Ruth Landau
Jul 21, 2009·Pharmacology & Therapeutics·Jörn LötschIrmgard Tegeder
Feb 21, 2009·Journal of Cellular and Molecular Medicine·Irmgard Tegeder, Jörn Lötsch
Oct 15, 2013·The Laryngoscope·Cynthia A ProwsSenthilkumar Sadhasivam
Mar 1, 2014·Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery·P J Robb
Sep 17, 2015·Journal of Pain & Palliative Care Pharmacotherapy·Jin H YoonMichael F Weaver
Dec 3, 2014·Journal of Pain and Symptom Management·Robert TwycrossAndrew Wilcock
Aug 12, 2014·European Annals of Otorhinolaryngology, Head and Neck Diseases·I ConstantUNKNOWN SFORL Work Group
Apr 26, 2015·Clinical Pharmacokinetics·Dorte LassenKim Brøsen
Jun 16, 2015·International Journal of Genomics·Eugenia Yiannakopoulou
Jul 9, 2016·Expert Opinion on Drug Metabolism & Toxicology·Tatiana TverdohlebNebojsa Nick Knezevic
Apr 6, 2017·Clinical Pharmacology and Therapeutics·Y ZhouV M Lauschke
Jun 2, 2009·Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences·Lukás ChytilOndrej Slanar
Jan 26, 2018·European Journal of Pain : EJP·J FariaR J Dinis-Oliveira
Apr 16, 2011·Pharmacology·Wojciech Leppert
Sep 25, 2018·Journal of Clinical Pharmacology·Shinya Ito
Sep 22, 2018·Current Opinion in Anaesthesiology·Senthil PackiasabapathySenthilkumar Sadhasivam
Mar 31, 2018·Archives of Disease in Childhood·Greta M PalmerKarel Allegaert
Apr 16, 2019·The Clinical Journal of Pain·Ernest A Kopecky

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.