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PAINKILLERS suitable to use with less CYP2C9, CYP2D6 functions.

Resolved Question:

what painkillers can I use if needed for severe pain as I have a 30-50% function with CYP2C9 and less than 50% with CYP2D6 Many thanks Moira

Category: Internal Medicine Specialist

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Category: HIV- AIDS Specialist
 25 Doctors Online

Thank you for your query at
I understand your concern.
Yes, both the enzymes are required in metabolising Opioid analgesics and hence if used, they can cause drug reactions.
Can you please mention for what reason have you taken the analgesics before? Opioids are not suggested unless the pain is really bad.
You can use NSAID based analgesic like Ibuprofen as an alternative.
Ibuprofen won't cause any serious drug reactions or side effects apart from mild gastric upset or irritation.
Please feel free to discuss further,

Patient replied :

I have had opoids for surgery over the years eg emergency broken leg, hysterectomy etc. Now all I really want to know is what I can take in a similar emergency as the broken leg eg, for future ref. so that I don't go through the awfu vomiting again. ie something I can ask for in ER if, heaven forbid, I was in an accident. I have only used codeine bought over the counter about 4 or 5 times over my lifetime, due to the broken leg when walking/falling while travelling later. I no longer take it, since about 3 yrs ago, since I realised the vomiting was not due to a tummy bug but the codeine.

Yes, unfortunately due to the enzyme inhibition the metabolism will be low, you will have problems with absorption of the drugs.
That leaves us with only NSAID based medicines, which can be given in higher dose to control pain.
Even antidepressants are influenced by the enzyme, so they are not recommended either.
So that leaves us with the option of NSAIDs.
Please feel free to discuss further,

Patient replied :

Thank you, yes, the trouble is, I have a complete list of what drugs I cannot take, from the drug DNA people who conducted the test.But I don't know what heavy duty pain killer I CAN take, if ever I needed it. eg I took my husband to ERa few yrs ago with kidney stones and he was able to obtain relief with morphine, but what can I do if I was in the same pain? I was so sick ie vomiting, after pethidine for childbirth for my first 2 child births 40 yrs ago, so that I never used pain relief for the next 2. I had worked out after twice that it was the pethidine, but no one suggested an alternative. Since then I had the DNA results, which explained my reaction to many things over the years, as you say anti depressants etc. But the painkiller relief is a concern for me, for the future possibly. Thank you.

Thank you for the follow-up.
Opioid analgesics are the first line options in such emergency cases. Has any doctor ever tried Morphine for you? All chemical compounds differ, and may be morphine will be a better drug than pethidine.
In such cases we need to see the benefits of Morphine and proceed.
Otherwise, the only option left is high dose NSAIDs such as Advil.
There are no other pain medications.
Feel free to discuss further,

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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