CYP2D6 pharmacogenetic and oxycodone pharmacokinetic association study in pediatric surgical patients

Rajiv Balyan, Marc Mecoli, Raja Venkatasubramanian, Vidya Chidambaran, Nichole Kamos, Smokey Clay, David L. Moore, Jagroop Mavi, Chris D. Glover, Peter Szmuk, Alexander Vinks, Senthilkumar Sadhasivam

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Aim: Oxycodone is partly metabolized to the active metabolite oxymorphone by hepatic CYP2D6 in the liver. Significant genetic variability in CYP2D6 activity affects oxymorphone formation. This study aimed to associate CYP2D6 genotype and oxycodone's metabolism. Methods: 30 children were administered oral oxycodone postoperatively. Plasma levels of oxycodone and oxymorphone, and CYP2D6 genotype were analyzed. CYP2D6 genotype and oxycodone metabolism phenotype were determined based on CYP2D6 total activity score (TAS) and metabolism phenotype: poor metabolizer (PM), intermediate metabolizer (IM), extensive metabolizer (EM) or ultrarapid metabolizer (UM). Results: Compared with PM/IM subjects, significantly greater oxymorphone exposure was seen in EM subjects (p = 0.02 for Cmax, p = 0.016 for AUC0-6 and p = 0.026 for AUC0-24). Similarly, higher TAS value was found to be associated with greater oxymorphone exposure. Higher conversion of oxycodone to oxymorphone was observed in EM subjects compared with PM/IM subjects (p = 0.0007 for Cmax, p = 0.001 for AUC0-6 and p = 0.004 for AUC0-24). Conclusion: CYP2D6 phenotypes explain metabolism of oxycodone in children, and oxymorphone exposure is higher in CYP2D6 EM phenotype. Further studies are needed to predict the occurrence of adverse event and tailor oxycodone dose for a specific CYP2D6 phenotype.

Original languageEnglish (US)
Pages (from-to)337-348
Number of pages12
Issue number4
StatePublished - Mar 2017


  • CYP2D6
  • oxycodone
  • pediatrics
  • pharmacogenetics
  • pharmacokinetics
  • surgical pain

ASJC Scopus subject areas

  • Molecular Medicine
  • Genetics
  • Pharmacology


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