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Some individuals may be ultra-rapid metabolizers because of a specific CYP2D6 genotype (gene duplications denoted as *1/*1xN or *1/*2xN).
In the 45-patient pilot study of inpatients treated with CYP450 substrates noted above, individuals with either poor metabolism or ultrarapid metabolism had 1-year treatment costs approximately $4000-$6000 greater than wild-type metabolizers or IMs, and PMs had longer mean durations of hospitalization (15).
The traditional assignment of phenotype is as follows: extensive metabolizer (EM), intermediate metabolizer (IM), poor metabolizer (PM), and ultrarapid metabolizer (UM).
The baby had a high blood morphine level, and genetic testing determined that the baby's mother, who had been taking codeine and acetaminophen for episiotomy pain for 2 weeks, was an ultrarapid metabolizer of codeine, as was her own mother, due to a polymorphism of cytochrome P450 2D6 (CYP2D6).
The prevalence of intermediate metabolizers is 28 percent for
focus on a group of individuals who would conventionally be grouped within the extensive metabolizer phenotype.
Of these individuals, nearly 300 were screened for eligibility to achieve the goal of enrolling more than 130 CYP2D6 poor metabolizers for this study.
More than one-third of African Americans and Asians, for example, produce reduced amounts of CYP2D6 and are therefore slow metabolizers of drugs--including certain atypical antipsychotics, selective serotonin reuptake inhibitors, and tricyclics--that are substrates for that enzyme.
A good example is cytochrome P450 screening (2D6 mutation genotyping), which can prevent ADRs by identifying poor drug metabolizers or accelerated drug metabolism in rapid metabolizers.
Intermediate metabolizers often need a dosage reduction because of side effects.
Depending on which alleles a person inherits, their phenotype can range from normal metabolizers to intermediate or slow metabolizers.
Hospitalized psychiatric patients who are poor metabolizers cost $4,000 - $6,000 more in medical care compared to patients with an average metabolizer genotype.