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Ni L, Cao Z, Jiang J, Zhang W, Hu W, Zhang Q, Shen C, Chen X, Zheng L. Evaluating Drug Interactions between Ritonavir and Opioid Analgesics: Implications from Physiologically Based Pharmacokinetic Simulation. Pharmaceuticals (Basel) 2024; 17:640. [PMID: 38794210 PMCID: PMC11124264 DOI: 10.3390/ph17050640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/05/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Several commonly used opioid analgesics, such as fentanyl, sufentanil, alfentanil, and hydrocodone, are by report primarily metabolized by the CYP3A4 enzyme. The concurrent use of ritonavir, a potent CYP3A4 inhibitor, can lead to significant drug interactions. Using physiologically based pharmacokinetic (PBPK) modeling and simulation, this study examines the effects of different dosing regimens of ritonavir on the pharmacokinetics of these opioids. The findings reveal that co-administration of ritonavir significantly increases the exposure of fentanyl analogs, with over a 10-fold increase in the exposure of alfentanil and sufentanil when given with ritonavir. Conversely, the effect of ritonavir on fentanyl exposure is modest, likely due to additional metabolism pathways. Additionally, the study demonstrates that the steady-state exposure of hydrocodone and its active metabolite hydromorphone can be increased by up to 87% and 95%, respectively, with concurrent use of ritonavir. The extended-release formulation of hydrocodone is particularly affected. These insights from PBPK modeling provide valuable guidance for optimizing opioid dosing and minimizing the risk of toxicity when used in combination with ritonavir-containing prescriptions.
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Affiliation(s)
- Liang Ni
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China;
| | - Zhihai Cao
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; (Z.C.); (W.Z.); (W.H.); (Q.Z.)
- School of Pharmacy, Anhui Medical University, Hefei 230032, China
| | - Jiakang Jiang
- Department of Pharmacy and Biomedical Engineering, Clinical College of Anhui Medical University, Hefei 230031, China;
| | - Wei Zhang
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; (Z.C.); (W.Z.); (W.H.); (Q.Z.)
| | - Wei Hu
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; (Z.C.); (W.Z.); (W.H.); (Q.Z.)
| | - Qian Zhang
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; (Z.C.); (W.Z.); (W.H.); (Q.Z.)
| | - Chaozhuang Shen
- Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu 610041, China;
| | - Xijing Chen
- Clinical Pharmacokinetics Laboratory, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China;
| | - Liang Zheng
- Department of Clinical Pharmacology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China; (Z.C.); (W.Z.); (W.H.); (Q.Z.)
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Shu X, Yan Y, Yu J, Chi L. Cytochrome P4503A4 gene polymorphisms guide safe sufentanil analgesic doses in pregnant Chinese mothers: a multicenter, randomized, prospective study. Pharmacogenet Genomics 2024; 34:8-15. [PMID: 37962984 DOI: 10.1097/fpc.0000000000000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Sufentanil and ropivacaine when used as epidural anesthetics effectively reduce maternal pain during labor. From previous reports, rs2242480 single nucleotide polymorphisms (SNPs) can alter sufentanil metabolism, which affects analgesic efficacy. METHODS We randomly divided 573 eligible mothers into groups A and B (in a 1 : 3 ratio). The control group (group A) was given sufentanil at the usual 0.5 mg/L-1 dose + 0.15% ropivacaine hydrochloride mixture in 10 ml. The sufentanil dose given to the intervention group (group B) was determined by genotype: the GA and AA genotype group (group B1) was given 87.6% (design based on previous study results) of the usual sufentanil clinical dose (0.438 mg/L-1 sufentanil + 0.15% ropivacaine hydrochloride mixture in 10 ml) and the GG genotype group (group B2) was given the same dose as group A. Efficacy indicators consisting of maternal vital signs, obstetric transfer, neonatal prognostic indicators, and adverse effects were recorded before and after analgesia across groups. RESULTS Visual analog scale scores after analgesia across groups were significantly different from scores before analgesia, showing that analgesic effects across groups were effective. No significant differences were observed in efficacy, obstetric transfer, and neonatal prognosis indicators between groups. In comparison to groups B1 and B2, group A showed more markedly suppressed cardiovascular and respiratory effects, and also a higher incidence of negative side effects such as vomiting and urinary retention. CONCLUSION We confirmed that individualizing sufentanil doses based on maternal genotypes increased safety and success rates for women during childbirth.
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Affiliation(s)
- Xiangrong Shu
- Department of Pharmacy, Tianjin Huanhu Hospital
- College of Pharmacy, Tianjin Medical University, Tianjin
| | - Yan Yan
- Department of Pharmacy, Tianjin Huanhu Hospital
| | - Jingxian Yu
- Haidian Maternal & Child Health Hospital of Beijing, Beijing, China
| | - Liqun Chi
- Haidian Maternal & Child Health Hospital of Beijing, Beijing, China
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Yang W, Zhao H, Dou Y, Wang P, Chang Q, Qiao X, Wang X, Xu C, Zhang Z, Zhang L. CYP3A4 and CYP3A5 Expression is Regulated by C YP3A4*1G in CRISPR/Cas9-Edited HepG2 Cells. Drug Metab Dispos 2023; 51:492-498. [PMID: 36623883 DOI: 10.1124/dmd.122.001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 01/10/2023] Open
Abstract
Functional CYP3A4*1G (G>A, rs2242480) in cytochrome P450 3A4 (CYP3A4) regulates the drug-metabolizing enzyme CYP3A4 expression. The objective of this study was to investigate whether CYP3A4*1G regulates both basal and rifampicin (RIF)-induced expression and enzyme activity of CYP3A4 and CYP3A5 in gene-edited human HepG2 cells. CYP3A4*1G GG and AA genotype HepG2 cells were established using the clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9 (CRISPR/Cas9) single nucleotide polymorphism technology and homology-directed repair in the CYP3A4*1G GA HepG2 cell line. In CYP3A4*1G GG, GA, and AA HepG2 cells, CYP3A4*1G regulated expression of CYP3A4 and CYP3A5 mRNA and protein in an allele-dependent manner. Of note, significantly decreased expression level of CYP3A4 and CYP3A5 was observed in CYP3A4*1G AA HepG2 cells. Moreover, the results after RIF treatment showed that CYP3A4*1G decreased the induction level of CYP3A4 and CYP3A5 mRNA expression in CYP3A4*1G AA HepG2 cells. At the same time, CYP3A4*1G decreased CYP3A4 enzyme activity and tacrolimus metabolism, especially in CYP3A4*1G GA HepG2 cells. In summary, we successfully constructed CYP3A4*1G GG and AA homozygous HepG2 cell models and found that CYP3A4*1G regulates both basal and RIF-induced expression and enzyme activity of CYP3A4 and CYP3A5 in CRISPR/Cas9 CYP3A4*1G HepG2 cells. SIGNIFICANCE STATEMENT: Cytochrome P450 (CYP) 3A4*1G regulates both basal and rifampicin (RIF)-induced expression and enzyme activity of CYP3A4 and CYP3A5. This study successfully established CYP3A4*1G (G>A, rs2242480), GG, and AA HepG2 cell models using CRISPR/Cas9, thus providing a powerful tool for studying the mechanism by which CYP3A4*1G regulates the basal and RIF-induced expression of CYP3A4 and CYP3A5.
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Affiliation(s)
- Weihong Yang
- Department of Forensic Medicine (W.Y., H.Z., Y.D., X.Q., C.X.) and Department of Pharmacology (P.W., Q.C., X.W., L.Z.), School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China; and Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.Z.)
| | - Huan Zhao
- Department of Forensic Medicine (W.Y., H.Z., Y.D., X.Q., C.X.) and Department of Pharmacology (P.W., Q.C., X.W., L.Z.), School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China; and Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.Z.)
| | - Yaojie Dou
- Department of Forensic Medicine (W.Y., H.Z., Y.D., X.Q., C.X.) and Department of Pharmacology (P.W., Q.C., X.W., L.Z.), School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China; and Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.Z.)
| | - Pei Wang
- Department of Forensic Medicine (W.Y., H.Z., Y.D., X.Q., C.X.) and Department of Pharmacology (P.W., Q.C., X.W., L.Z.), School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China; and Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.Z.)
| | - Qi Chang
- Department of Forensic Medicine (W.Y., H.Z., Y.D., X.Q., C.X.) and Department of Pharmacology (P.W., Q.C., X.W., L.Z.), School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China; and Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.Z.)
| | - Xiaomeng Qiao
- Department of Forensic Medicine (W.Y., H.Z., Y.D., X.Q., C.X.) and Department of Pharmacology (P.W., Q.C., X.W., L.Z.), School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China; and Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.Z.)
| | - Xiaofei Wang
- Department of Forensic Medicine (W.Y., H.Z., Y.D., X.Q., C.X.) and Department of Pharmacology (P.W., Q.C., X.W., L.Z.), School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China; and Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.Z.)
| | - Chen Xu
- Department of Forensic Medicine (W.Y., H.Z., Y.D., X.Q., C.X.) and Department of Pharmacology (P.W., Q.C., X.W., L.Z.), School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China; and Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.Z.)
| | - Zhe Zhang
- Department of Forensic Medicine (W.Y., H.Z., Y.D., X.Q., C.X.) and Department of Pharmacology (P.W., Q.C., X.W., L.Z.), School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China; and Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.Z.)
| | - Lirong Zhang
- Department of Forensic Medicine (W.Y., H.Z., Y.D., X.Q., C.X.) and Department of Pharmacology (P.W., Q.C., X.W., L.Z.), School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China; and Department of Gastroenterology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Z.Z.)
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Wang L, Wu F, Xu J, Wang Y, Fei W, Jiang H, Geng P, Zhou Q, Wang S, Zheng Y, Deng H. Differential effects of ketoconazole, fluconazole, and itraconazole on the pharmacokinetics of pyrotinib in vitro and in vivo. Front Pharmacol 2022; 13:962731. [PMID: 36160438 PMCID: PMC9490176 DOI: 10.3389/fphar.2022.962731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
It has been reported that drug-drug interactions (DDIs) can affect the pharmacokinetics and pharmacodynamics of various oral drugs. To better understand the effects of azole antifungal drugs (ketoconazole, fluconazole, and itraconazole) on pyrotinib’s pharmacokinetics, DDIs between pyrotinib and three azoles were studied with Sprague-Dawley (SD) rat liver microsomes in vitro. Additionally, in vivo pyrotinib metabolic experiment was also performed. Twenty-four male SD rats were randomly divided into four groups: the ketoconazole (40 mg/kg), fluconazole (40 mg/kg), itraconazole (40 mg/kg), and the control group. UPLC-MS/MS was used for the determination of Pyrotinib’s plasma concentration in rats. In vitro experiments showed that IC50 values of ketoconazole, fluconazole and itraconazole were 0.06, 11.55, and 0.27 μM, respectively, indicating that these drugs might reduce the clearance rate of pyrotinib at different degrees. In rat studies, coadministration of pyrotinib with ketoconazole or fluconazole could dramatically increase the Cmax and AUC(0-t) values and decrease the clearance rate of pyrotinib, especially for ketoconazole. However, coadministration with itraconazole had no impact on the pharmacokinetic characters of pyrotinib. These data indicated that ketoconazole and fluconazole could significantly decrease the metabolism of pyrotinib both in vitro and in vivo. More attentions should be paid when pyrotinib is combined with azole antifungal drugs in clinic although further investigation is still required in future.
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Affiliation(s)
- Li Wang
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Wu
- Department of Pharmacy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jia Xu
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, China
| | - Yu Wang
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, China
| | - Weidong Fei
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Jiang
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, China
| | - Peiwu Geng
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, China
| | - Quan Zhou
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, China
| | - Shuanghu Wang
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, China
| | - Yongquan Zheng
- Department of Pharmacy, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Huadong Deng, ; Yongquan Zheng,
| | - Huadong Deng
- Department of Ultrasonography, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui People’s Hospital, Lishui, China
- *Correspondence: Huadong Deng, ; Yongquan Zheng,
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Kasai S, Nishizawa D, Hasegawa J, Fukuda KI, Ichinohe T, Nagashima M, Hayashida M, Ikeda K. Short Tandem Repeat Variation in the CNR1 Gene Associated With Analgesic Requirements of Opioids in Postoperative Pain Management. Front Genet 2022; 13:815089. [PMID: 35360861 PMCID: PMC8963810 DOI: 10.3389/fgene.2022.815089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/02/2022] [Indexed: 11/25/2022] Open
Abstract
Short tandem repeats (STRs) and variable number of tandem repeats (VNTRs) that have been identified at approximately 0.7 and 0.5 million loci in the human genome, respectively, are highly multi-allelic variations rather than single-nucleotide polymorphisms. The number of repeats of more than a few thousand STRs was associated with the expression of nearby genes, indicating that STRs are influential genetic variations in human traits. Analgesics act on the central nervous system via their intrinsic receptors to produce analgesic effects. In the present study, we focused on STRs and VNTRs in the CNR1, GRIN2A, PENK, and PDYN genes and analyzed two peripheral pain sensation-related traits and seven analgesia-related traits in postoperative pain management. A total of 192 volunteers who underwent the peripheral pain sensation tests and 139 and 252 patients who underwent open abdominal and orthognathic cosmetic surgeries, respectively, were included in the study. None of the four STRs or VNTRs were associated with peripheral pain sensation. Short tandem repeats in the CNR1, GRIN2A, and PENK genes were associated with the frequency of fentanyl use, fentanyl dose, and visual analog scale pain scores 3 h after orthognathic cosmetic surgery (Spearman’s rank correlation coefficient ρ = 0.199, p = 0.002, ρ = 0.174, p = 0.006, and ρ = 0.135, p = 0.033, respectively), analgesic dose, including epidural analgesics after open abdominal surgery (ρ = −0.200, p = 0.018), and visual analog scale pain scores 24 h after orthognathic cosmetic surgery (ρ = 0.143, p = 0.023), respectively. The associations between STRs in the CNR1 gene and the frequency of fentanyl use and fentanyl dose after orthognathic cosmetic surgery were confirmed by Holm’s multiple-testing correction. These findings indicate that STRs in the CNR1 gene influence analgesia in the orofacial region.
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Affiliation(s)
- Shinya Kasai
- Addictive Substance Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Daisuke Nishizawa
- Addictive Substance Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Junko Hasegawa
- Addictive Substance Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Ken-ichi Fukuda
- Department of Oral Health Science, Tokyo Dental College, Tokyo, Japan
| | - Tatsuya Ichinohe
- Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
| | - Makoto Nagashima
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazutaka Ikeda
- Addictive Substance Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- *Correspondence: Kazutaka Ikeda,
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Collins JM, Wang D. Regulation of CYP3A4 and CYP3A5 by a lncRNA: a potential underlying mechanism explaining the association between CYP3A4*1G and CYP3A metabolism. Pharmacogenet Genomics 2022; 32:16-23. [PMID: 34320606 PMCID: PMC8578198 DOI: 10.1097/fpc.0000000000000447] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The cytochrome P450 3A4 (CYP3A4) enzyme is the most abundant drug-metabolizing enzyme in the liver, displaying large inter-person variability with unknown causes. In this study, we found that the expression of CYP3A4 is negatively correlated with AC069294.1 (ENSG00000273407, ENST00000608397.1), a lncRNA generated antisense to CYP3A4. Knockdown of AC069294.1 in Huh7 cells increased CYP3A4 mRNA ~3-fold, whereas overexpression of AC069294.1 decreased CYP3A4 mRNA by 89%. We also observed changes in CYP3A5 expression when AC069294.1 was knocked down or overexpressed, indicating dual effects of AC069294.1 on both CYP3A4 and CYP3A5 expression. Consistently, the expression level of CYP3A5 is also negatively correlated with AC069294.1. Previous studies have shown associations between an intronic single nucleotide polymorphism CYP3A4*1G (rs2242480) and CYP3A metabolism, but the results are inconsistent and the underlying mechanism is unclear. We show here that CYP3A4*1G (rs2242480) is associated with 1.26-fold increased expression of AC069294.1 (P < 0.0001), and decreased expression of CYP3A4 by 31% (P = 0.008) and CYP3A5 by 39% (P = 0.004). CYP3A4*1G is located ~2.7 kb upstream of AC069294.1 and has been previously reported to have increased transcriptional activity in reporter gene assays. Taken together, our results demonstrate the regulation of CYP3A4 and CYP3A5 by a novel lncRNA AC069294.1. Our results also indicate that the clinically observed CYP3A4*1G associations may be caused by its effect on the expression of AC069294.1, and thereby altered expression of both CYP3A4 and CYP3A5. Furthermore, because CYP3A4*1G is in high linkage disequilibrium with CYP3A5*1, increased AC069294.1 expression caused by CYP3A4*1G may decrease expression of the normal-functioning CYP3A5*1, explaining additional inter-person variability of CYP3A5.
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Affiliation(s)
- Joseph M Collins
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, Center for Pharmacogenomics, University of Florida, Gainesville, Florida, USA
| | - Danxin Wang
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, Center for Pharmacogenomics, University of Florida, Gainesville, Florida, USA
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A Narrative Review on Perioperative Pain Management Strategies in Enhanced Recovery Pathways-The Past, Present and Future. J Clin Med 2021; 10:jcm10122568. [PMID: 34200695 PMCID: PMC8229260 DOI: 10.3390/jcm10122568] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 12/14/2022] Open
Abstract
Effective pain management is a key component in the continuum of perioperative care to ensure optimal outcomes for surgical patients. The overutilization of opioids in the past few decades for postoperative pain control has been a major contributor to the current opioid epidemic. Multimodal analgesia (MMA) and enhanced recovery after surgery (ERAS) pathways have been repeatedly shown to significantly improve postoperative outcomes such as pain, function and satisfaction. The current review aims to examine the history of perioperative MMA strategies in ERAS and provide an update with recent evidence. Furthermore, this review details recent advancements in personalized pain medicine. We speculate that the next important step for improving perioperative pain management could be through incorporating these personalized metrics, such as clinical pharmacogenomic testing and patient-reported outcome measurements, into ERAS program.
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Cheng H, Zeng R, Kong L, Ding C, He Y, Zhuang W, Sun Y. Establishment of predicting equation for individual sufentanil dosage postoperatively based on gene polymorphisms. Pain Pract 2021; 22:39-46. [PMID: 33977649 DOI: 10.1111/papr.13030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative analgesia is widely used for patients undergoing major surgeries. Individual differences in genetic polymorphisms may be obstructive factors for accurately anesthetics using. However, the equation for predicting sufentanil dosage postoperatively based on genetic design has been established yet. Our aim was to establish sufentanil dosage postoperatively prediction equation based on patients' genetic polymorphisms. METHODS One hundred forty patients with total gastrectomy and radical resection of pulmonary carcinoma were included. To establish sufentanil dosage postoperatively for patients with gastric cancer, we collected patients' basic information and CYP3A4*1G, COMTVal158Met, OPRM1A118G, and ABCB1C3435T gene sequencing results. To verify this equation, we put patients' with lung cancer surgeries information into it. RESULTS The sufentanil dosage prediction equation postoperatively was y = 4.104 - 0.222 × (gender) + 0.021 × (OPRM1A118G) + 0.249 × (ABCB1C3435T). Patients' with lung cancer surgeries information were substituted into it. The results showed no significant differences between predicted and actual sufentanil dosage (p > 0.05). CONCLUSION We established the prediction equation for individual sufentanil dosage postoperatively based on gene polymorphisms. The results showed this prediction equation was valid, which might be used for different types of surgeries. We established an equation for individual dosage of sufentanil for postoperative analgesia based on gene polymorphisms. The results show that the prediction equation is valid, the information might be used for different types of postoperative analgesia, and the painful patients will have great potential safe and personalized pain control after analgesic therapy. It might also have potential as a clinical tool.
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Affiliation(s)
- Huawei Cheng
- Division of Life Sciences and Medicine, Department of Pharmacy, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Rong Zeng
- Division of Life Sciences and Medicine, Department of Anesthesiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Lingsuo Kong
- Division of Life Sciences and Medicine, Department of Anesthesiology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Conglan Ding
- Division of Life Sciences and Medicine, Department of Medical Oncology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yifu He
- Division of Life Sciences and Medicine, Department of Medical Oncology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Wei Zhuang
- Division of Life Sciences and Medicine, Department of Pharmacy, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yancai Sun
- Division of Life Sciences and Medicine, Department of Pharmacy, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
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Chaturvedi R, Alexander B, A'Court AM, Waterman RS, Burton BN, Urman RD, Gabriel RA. Genomics testing and personalized medicine in the preoperative setting: Can it change outcomes in postoperative pain management? Best Pract Res Clin Anaesthesiol 2020; 34:283-295. [PMID: 32711834 DOI: 10.1016/j.bpa.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
Postoperative pain and opioid use are major challenges in perioperative medicine. Pain perception and its response to opioid use are multi-faceted and include pharmacological, psychological, and genetic components. Precision medicine is a unique approach to individualized health care in which decisions in management are based on genetics, lifestyle, and environment of each person. Genetic variations can have an impact on the perception of pain and response to treatment. This can have an effect on pain management in both acute and chronic settings. Although there is currently not enough evidence for making recommendations about genetic testing to guide pain management in the acute care setting, there are some known polymorphisms that play a role in surgical pain and opioid-related postoperative adverse outcomes. In this review, we describe the potential use of pharmacogenomics (PGx) for improving perioperative pain management. We first review a number of genotypes that have shown correlations with pain and opioid use and then describe the importance of PGx-guided analgesic protocols and implementation of screening in a preoperative evaluation clinical setting.
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Affiliation(s)
- Rahul Chaturvedi
- School of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - Brenton Alexander
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA.
| | - Alison M A'Court
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.
| | - Ruth S Waterman
- Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA.
| | - Brittany N Burton
- Department of Anesthesiology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School/Brigham and Women's Hospital, Boston, MA, USA.
| | - Rodney A Gabriel
- Department of Anesthesiology and Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA.
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Porela-Tiihonen S, Kokki H, Kokki M. An up-to-date overview of sublingual sufentanil for the treatment of moderate to severe pain. Expert Opin Pharmacother 2020; 21:1407-1418. [DOI: 10.1080/14656566.2020.1766025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Susanna Porela-Tiihonen
- Department of Anaesthesia and Operative Services, Kuopio University Hospital , Kuopio, Finland
| | - Hannu Kokki
- Department of Anaesthesia and Operative Services, Kuopio University Hospital , Kuopio, Finland
| | - Merja Kokki
- Department of Anaesthesia and Operative Services, Kuopio University Hospital , Kuopio, Finland
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11
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Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:151. [PMID: 32164593 PMCID: PMC7069013 DOI: 10.1186/s12884-020-2800-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/10/2020] [Indexed: 01/07/2023] Open
Abstract
Background Intravenous remifentanil patient-controlled analgesia (RPCA) is an alternative for epidural analgesia (EA) in labor pain relief. However, it remains unknown whether RPCA is superior to EA in decreasing the risk of intrapartum maternal fever during labor. Methods According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was performed by searching PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from inception to April 2019. All randomized controlled trials (RCTs) investigating the risk of intrapartum maternal fever with RPCA compared with EA alone or EA in combination with spinal analgesia during labor were included. Results A total of 825 studies were screened, and 6 RCTs including 3341 patients were identified. Compared with EA, RPCA was associated with a significantly lower incidence of intrapartum maternal fever (risk ratio [RR] 0.48, P = 0.02, I2 = 49%) during labor analgesia. After excluding 2 trials via the heterogeneity analysis, there was no difference in the incidence of intrapartum fever between patients receiving RPCA and those receiving EA. Satisfaction with pain relief during labor was lower in the RPCA group than that in the EA group (− 10.6 [13.87, − 7.44], P < 0.00001, I2 = 0%). The incidence of respiratory depression was significantly greater in the RPCA group than that in the EA group (risk ratio 2.86 [1.65, 4.96], P = 0.0002, I2 = 58%). The incidence of Apgar scores < 7 at 5 min in the RPCA group was equivalent to that in the EA group. Conclusion There is no solid evidence to illustrate that the incidence of intrapartum maternal fever is lower in patients receiving intravenous RPCA than in patients receiving EA.
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Szumlinski KK, Coelho MA, Tran T, Stailey N, Lieberman D, Gabriella I, Swauncy I, Brewin LW, Ferdousian S. Who is HOT and who is LOT? Detailed characterization of prescription opioid-induced changes in behavior between 129P3/J and 129S1/SvlmJ mouse substrains. GENES BRAIN AND BEHAVIOR 2019; 19:e12609. [PMID: 31489753 DOI: 10.1111/gbb.12609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 01/20/2023]
Abstract
Genetic factors are theorized to contribute to the substantial inter-individual variability in opioid abuse/addiction. To advance the behavioral genetics of prescription opioid abuse, our prior work identified the 129S1/SvlmJ (S1) and related 129P3/J (P3) mouse substrains, respectively, as low and high opioid-taking. Herein, we related our prior results to measures of sucrose reward/reinforcement, basal anxiety, opioid-induced place-conditioning, locomotor activity and Straub tail reaction, as well as behavioral and physiological signs of withdrawal. Substrains were also re-examined for higher-dose oxycodone and fentanyl intake under limited-access drinking procedures. S1 mice failed to acquire sucrose self-administration under various operant-conditioning procedures and exhibited lower sucrose intake in the home-cage. However, sucrose intake under limited-access procedures escalated in both substrains with repeated sucrose experience. S1 mice exhibited less spontaneous locomotor activity, as well as less opioid-induced locomotor activity and Straub tail reaction, than P3 mice and failed to exhibit an oxycodone-induced place-preference. The lack of conditioned behavior by S1 mice was unrelated to behavioral signs of withdrawal-induced negative affect or dependence severity, but might reflect high levels of basal anxiety-like behavior. Intriguingly, S1 and P3 mice initially exhibited equivalent oxycodone and fentanyl consumption in the home-cage; however opioid intake escalated only in P3 mice with repeated opioid experience. No sex differences were observed for any of our measures. These data provide additional evidence for robust differences in opioid addiction-related behaviors between P3 and S1 substrains and suggest that anxiety, learning, and/or motivational impairments might confound interpretation of operant- and place-conditioning studies employing the S1 substrain.
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Affiliation(s)
- Karen K Szumlinski
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California.,Department of Molecular, Developmental and Cell Biology, University of California Santa Barbara, Santa Barbara, California.,The Neuroscience Research Institute, University of California Santa Barbara, Santa Barbara, California
| | - Michal A Coelho
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Tori Tran
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Nicholas Stailey
- Department of Molecular, Developmental and Cell Biology, University of California Santa Barbara, Santa Barbara, California
| | - Dylan Lieberman
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Ivette Gabriella
- Department of Psychology, California State University Dominguez Hills, Carson, California
| | - Isaiah Swauncy
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Lindsey W Brewin
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Sami Ferdousian
- Department of Molecular, Developmental and Cell Biology, University of California Santa Barbara, Santa Barbara, California
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13
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Kumar S, Kundra P, Ramsamy K, Surendiran A. Pharmacogenetics of opioids: a narrative review. Anaesthesia 2019; 74:1456-1470. [DOI: 10.1111/anae.14813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- S. Kumar
- Department of Pharmacology JIPMER Puducherry India
| | - P. Kundra
- Department of Anaesthesiology JIPMER Puducherry India
| | - K. Ramsamy
- Department of Pharmacology JIPMER Puducherry India
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14
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Hahn J, Yang S, Min KL, Kim D, Jin BH, Park C, Park MS, Wi J, Chang MJ. Population pharmacokinetics of intravenous sufentanil in critically ill patients supported with extracorporeal membrane oxygenation therapy. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:248. [PMID: 31288863 PMCID: PMC6615282 DOI: 10.1186/s13054-019-2508-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/06/2019] [Indexed: 01/08/2023]
Abstract
Background Sufentanil is commonly used for analgesia and sedation during extracorporeal membrane oxygenation (ECMO). Both ECMO and the pathophysiological changes derived from critical illness have significant effects on the pharmacokinetics (PK) of drugs, yet reports of ECMO and sufentanil PK are scarce. Here, we aimed to develop a population PK model of sufentanil in ECMO patients and to suggest dosing recommendations. Methods This prospective cohort PK study included 20 patients who received sufentanil during venoarterial ECMO (VA-ECMO). Blood samples were collected for 96 h during infusion and 72 h after cessation of sufentanil. A population PK model was developed using nonlinear mixed effects modelling. Monte Carlo simulations were performed using the final PK parameters with two typical doses. Results A two-compartment model best described the PK of sufentanil. In our final model, increased volume of distribution and decreased values for clearance were reported compared with previous PK data from non-ECMO patients. Covariate analysis showed that body temperature and total plasma protein level correlated positively with systemic clearance (CL) and peripheral volume of distribution (V2), respectively, and improved the model. The parameter estimates of the final model were as follows: CL = 37.8 × EXP (0.207 × (temperature − 36.9)) L h−1, central volume of distribution (V1) = 229 L, V2 = 1640 × (total plasma protein/4.5)2.46 L, and intercompartmental clearance (Q) = 41 L h−1. Based on Monte Carlo simulation results, an infusion of 17.5 μg h−1 seems to reach target sufentanil concentration (0.3–0.6 μg L−1) in most ECMO patients except hypothermic patients (33 °C). In hypothermic patients, over-sedation, which could induce respiratory depression, needs to be monitored especially when their total plasma protein level is low. Conclusions This is the first report on a population PK model of sufentanil in ECMO patients. Our results suggest that close monitoring of the body temperature and total plasma protein level is crucial in ECMO patients who receive sufentanil to provide effective analgesia and sedation and promote recovery. Trial registration Clinicaltrials.gov NCT02581280, December 1st, 2014.
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Affiliation(s)
- Jongsung Hahn
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea
| | - Seungwon Yang
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea
| | - Kyoung Lok Min
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea
| | - Dasohm Kim
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea.,Department of Clinical Pharmacology, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Byung Hak Jin
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea.,Department of Clinical Pharmacology, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Changhun Park
- Department of Clinical Pharmacology, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Min Soo Park
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea.,Department of Clinical Pharmacology, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jin Wi
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea. .,Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
| | - Min Jung Chang
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea. .,Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, 21983, Republic of Korea.
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