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Pharmacogenomic Testing for Postoperative Pain Optimization Before Total Joint Arthroplasty

A Focus on Drug-Drug-Gene Interaction with Commonly Prescribed Drugs and Prior Opioid Use

Awad, Mohamed E., MD1,2,3,4; Padela, Muhammad Talha, MD, MSc1,2,4,5,6; Sayeed, Zain, MD, MHA1,4,5,6; El-Othmani, Mouhanad M., MD5; Zekaj, Mark, MD5; Darwiche, Hussein F., MD5; Saleh, Khaled J., MD, MSc, FRCS(C), MHCM, CPE2,3,4

doi: 10.2106/JBJS.RVW.18.00058
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Disclosures

  • » Pharmacogenomic testing, together with early detection of drug-drug interactions, drug-gene interactions, and drug-drug-gene interactions prior to initiating pain management, can improve the selection of optimal opioid medication, and can reduce adverse drug interactions and therapeutic failures.
  • » The ABCB1 gene and its variants influence pharmacodynamics by controlling plasma levels through limiting uptake or enhancing the clearance of commonly prescribed drugs.
  • » Orthopaedic surgeons should pay close attention to drug-gene interactions in patients with the GG allele of ABCB1 (rs1045642) when these patients are being treated with opioids and simvastatin simultaneously. They will require higher doses of fentanyl, methadone, morphine, or oxycodone to achieve an optimal 24-hour pain response as well as be at higher risk of statin-induced myopathy.
  • » Patients with the CC genotype of ABCB1 (rs2032582) polymorphism will require either alternatives to or higher dosages of tramadol to manage pain and rivaroxaban to achieve optimal venous thromboembolism prophylaxis following total joint arthroplasty.

1Resident Research Partnership, Detroit, Michigan

2FAJR Scientific, Detroit, Michigan

3Michigan State University College of Osteopathic Medicine, Detroit, Michigan

4John D. Dingell VA Medical Center, Detroit, Michigan

5Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan

6Department of Orthopaedic Surgery, Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois

E-mail address for M.T. Padela: tpadela@gmail.com

E-mail address for K.J. Saleh: kjsaleh@gmail.com

Investigation performed at the John D. Dingell VA Medical Center, Detroit, Michigan, and Michigan State University College of Osteopathic Medicine, Detroit, Michigan

Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A461).

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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