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

Stamer, Ulrike M; Stüber, Frank; Muders, Thomas; Musshoff, Frank (2008). Respiratory depression with tramadol in a patient with renal impairment and CYP2D6 gene duplication. Anesthesia and analgesia, 107(3), pp. 926-9. Hagerstown, Md.: Lippincott Williams & Wilkins 10.1213/ane.0b013e31817b796e

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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.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Stüber, Frank

ISSN:

0003-2999

ISBN:

18713907

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

04 Oct 2013 15:03

Last Modified:

23 Jan 2018 12:17

Publisher DOI:

10.1213/ane.0b013e31817b796e

PubMed ID:

18713907

Web of Science ID:

000258702500035

URI:

https://boris.unibe.ch/id/eprint/27297 (FactScience: 105934)

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