A 2-year-old girl whose father is a poor metaboliser (PM) with respect to CYP2D6, is about to under

Fråga: A 2-year-old girl whose father is a poor metaboliser (PM) with respect to CYP2D6, is about to undergo an anaesthetic procedure. The father has had a severe adverse drug reaction (apnoea) to an unknown drug used for premedication when he was about to undergo an anaesthetic procedure ten years ago. The question was raised as to whether there is an increased risk for the child to develop an adverse drug reaction upon using the following drugs: Alvedon (paracetamol), midazolam, atropine, Diprivan (propofol), Rapifen (alfentanil), morphine, Esmeron (rocuron), Pentothal (thiopental), sevoflurane, Celucurin-klorid (suxameton), and EMLA (lidocain/prilocain) for epidermal application.

The geno/phenotype of the child and the mother is unknown.

Sammanfattning: None of the above listed drugs is known to be metabolised by CYP2D6. However, theoretically, the child can be a poor CYP2D6 metaboliser. A determination of the geno/phenotype of the mother could be of value.

Svar: None of the listed drugs above are known to be a CYP2D6 substrate. A literature search including Medline and Drugline has not revealed any new information regarding involvement of CYP2D6 in the metabolism of these drugs. Furthermore, a PM regarding CYP2D6 has to be homozygous for the mutated gene. The calculated risk for the child in this case to inherit a mutant allele from the mother is approximately 26 per cent (1,2). 1 Bertilsson L, Dahl ML: Polymorphic drug oxidation. Relevance to the treatment of psychiatric disorders. CNS Drugs 1996; 5: 200-223 2 Thompson, Thompson: Genetics in medicine. 4th ed. WB Saunders Co. - 1986 3 Heiskanen T, Olkkola KT, Kalso E: Effects of blocking CYP2D6 on the pharmacokinetics and pharmacodynamics of oxycodone. Clin Pharmacol Ther 1998; 64: 603-611 4 Drugline no 14180 (year 1997)