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Resumen
Objetivo: Evaluar el impacto de los polimorfismos en genes que codifican enzimas del citocromo P450 en los patrones farmacocinéticos de los opioides, además de investigar su influencia en la aparición de reacciones adversas y trastornos relacionados con el uso de esta importante clase farmacológica. Métodos: Se trata de una revisión integradora, las bases de datos utilizadas fueron PubMed, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs) y SciELO. Resultados: Se recuperaron un total de 300 artículos con base en las estrategias de búsqueda, además de 2 artículos de fuentes externas. Entre los artículos analizados, 296 fueron excluidos por no cumplir los criterios de inclusión. Al final del análisis se seleccionaron 6 artículos. Los polimorfismos más investigados involucraron los genes CYP3A4, CYP3A5, CYP2D6, CYP2B6 y CYP1A2. Consideraciones finales: Los estudios farmacogenéticos son esenciales, especialmente aquellos que investigan polimorfismos de genes responsables de las enzimas del complejo CYP450, ya que ayudan a optimizar e individualizar los tratamientos farmacoterapéuticos con opioides. Sin embargo, aún existen varias lagunas por explorar en este campo, lo que refuerza la necesidad de nuevos estudios y el desarrollo de herramientas que permitan la aplicación de este conocimiento a gran escala en la práctica clínica.
Referencias
ANDREAGGI CA, et al. Safety concerns reported by consumers, manufacturers and healthcare professionals: A detailed evaluation of opioid-related adverse drug reactions in the FDA database over 15 years. Pharmacoepidemiologyanddrugsafety,2020 Dec;29(12):1627-1635.
BADIN RC, et al. Pharmacological profile and potential drug interactions in ovarian cancer hospitalized patients.Journal of Oncology Pharmacy Practice, 2022; 29(5):1103-1111.
BAGLEY EE, INGRAM SL. Endogenous opioid peptides in the descending pain modulatory circuit. Neuropharmacology. 2020 Aug 15; 173:108131.
BALLESTER P, Muriel J, Peiró AM. CYP2D6 phenotypes and opioid metabolism: the path to personalized analgesia. Expert Opinion onDrugMetabolism&Toxicology. 2022 Apr;18(4):261-275.
CAMILLERI M, et al. Opioids in Gastroenterology: Treating Adverse Effects and Creating Therapeutic Benefits. Clinical Gastroenterology and Hepatology. 2017 Sep;15(9):1338-1349.
CASAJÚS A, et al. Impact of CYP2D6 and CYP2B6 phenotypes on the response to tramadol in patients with acute post-surgical pain. Clinicaland Translational Science. 2024 Jan;17(1):e13698.
CHAMBOKO CR, et al. Human Cytochrome P450 1, 2, 3 Families as Pharmacogenes with Emphases on Their Antimalarial and Antituberculosis Drugs and Prevalent African Alleles. International Journal of MolecularSciences, 2023; 24(4): 3383.
CORDER G, et al. Endogenous and Exogenous Opioids in Pain. Annual review of neuroscience, 2018 Jul 8;41:453-473.
CPIC. Diretriz CPIC® para codeína e CYP2D6, 2019. Disponível em: https://cpicpgx .org/guidelines /guideline-for-codeine-and-cyp2d6/. Acessado em: 20 de dezembro de 2024.
DE MORAES SS, et al. Interações medicamentosa mediadas pela CYP 450 em pacientes críticos: ênfase em antifúngicos triazólicos. Revista Eletrônica Acervo Saúde, 2023 23, 6 (jun. 2023), e13085.
ETTIENNE EB, et al. Pharmacogenomics and Opioid Use Disorder: Clinical Decision Support in an African American Cohort. JournaloftheNational Medical Association, 2019 Dec;111(6):674-681.
ESCH T, et al. Emerging regulatory roles of opioid peptides, endogenous morphine, and opioid receptor subtypes in immunomodulatory processes: Metabolic, behavioral, and evolutionary perspectives. Immunology letters,2020 Nov;227:28-33.
FITZCHARLES MA, et al. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet. 2021 May 29;397(10289):2098-2110.
FREIERMUTH CE, et al. Genetic Variants Associated With Opioid Use Disorder. Clinical Pharmacology Therapy. 2023 May;113(5):1089-1095.
FRIEDMAN A, NABONG L. Opioids: Pharmacology, Physiology, and Clinical Implications in Pain Medicine. Physical medicine andrehabilitationclinicsof North America,2020 May;31(2):289-303.
HIGGINBOTHAM JA, et al. Endogenous opioid systems alterations in pain and opioid use disorder. Frontiers in Systems Neuroscience, 2022 Oct 19;16:1014768.
IWERSEN-BERGMANN S, et al. Brain/blood ratios of methadone and ABCB1 polymorphisms in methadone-related deaths. InternationalJournalof Legal Medicine, 2021 Mar;135(2):473-482.
JAKOBSSON G, et al. Oxycodone findings and CYP2D6 function in postmortem cases. Forensic Science International Genetics, 2021 Jul;53:102510.
LOPES GS, et al. Sex Differences in Associations Between CYP2D6 Phenotypes and Response to Opioid Analgesics. Pharmgenomics and Personalized Medicine, 2020 Mar 13;13:71-79.
MEADEN CW, et al. A review of the existing literature on buprenorphine pharmacogenomics. PharmacogenomicsJournal, 2021 Apr;21(2):128-139.
NOFZIGER C, et al. PharmVarGeneFocus: CYP2D6. Clinical pharmacology and therapeutics, 2020 Jan;107(1):154-170.
PAUL B, et al. Opioid signaling and design of analgesics. Progress in Molecular Biology and Translational Science, 2023;195:153-176.
PATOCKA J, et al. Fentanyl and its derivatives: Pain-killers or man-killers? Heliyon, 2024 Mar 28;10(8):e28795.
PRINCIPI N, et al. Impact of Pharmacogenomics in Clinical Practice. Pharmaceuticals 2023, 16, 1596.
PRISMA. Transparent Reporting of Systematic Reviews and Meta-Analyses [Internet]. 2024. Disponível em: https://www.prisma-statement.org/. Acesso em: 01 de dezembro de 2024.
RODRIGUEZ-ANTONA C, et al. PharmVarGeneFocus: CYP3A5. Clinical pharmacology and therapeutics, 2022 Dec;112(6):1159-1171.
SAIZ-RODRÍGUEZ M, et al. Involvement of CYP2D6 and CYP2B6 on tramadol pharmacokinetics. Pharmacogenomics, 2020 Jul;21(10):663-675.
SAIZ-RODRÍGUEZ M, et al. Polymorphisms associated with fentanyl pharmacokinetics, pharmacodynamics and adverse effects. Basic &clinicalpharmacology&toxicology,2019 Mar;124(3):321-329.
SANTOS D, et al. O papel da farmacogenómica na terapia com opioides: otimização do controlo da dor e redução do risco de dependência e overdose. Acta Farmaceutica Portuguesa, 2023; 12(1), 125-134.
SONG Y, et al. Drug-Metabolizing Cytochrome P450 Enzymes Have Multifarious Influences on Treatment Outcomes. ClinicalPharmacokinetics. 2021 May;60(5):585-601.
STEIDL S, et al. Opioid-induced rewards, locomotion, and dopamine activation: A proposed model for control by mesopontine and rostromedial tegmental neurons. Neuroscience and biobehavioral reviews,2017 Dec;83:72-82.
TOUBIA T, KHALIFE T. The Endogenous Opioid System: Role and Dysfunction Caused by Opioid Therapy. Clinical ObstetricsandGynecology. 2019 Mar;62(1):3-10.
WANG D, SADEE W. CYP3A4 intronic SNP rs35599367 (CYP3A4*22) alters RNA splicing. PharmacogeneticsandGenomics. 2016 Jan;26(1):40-3.
WONG AK, et al. The Role of Pharmacogenomics in Opioid Prescribing. Currenttreatmentoptions in oncology,2022 Oct;23(10):1353-1369.HEI