Clinical pharmacology and therapeutics
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"What does not change is the will to change."-Charles Olson, "The Kingfishers"The world is in the midst of scientific revolutions that can transform medicine and public health. Yet translation to needed products remains slow and expensive. ⋯ A plan by the US Food and Drug Administration (FDA), "Advancing Regulatory Science," identifies eight priorities and numerous actions to help catalyze transformation. Scientific excellence and collaboration, including public and private sectors, are essential for change that benefits health and economies globally.
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Clin. Pharmacol. Ther. · Feb 2012
Practice GuidelineClinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for codeine therapy in the context of cytochrome P450 2D6 (CYP2D6) genotype.
Codeine is bioactivated to morphine, a strong opioid agonist, by the hepatic cytochrome P450 2D6 (CYP2D6); hence, the efficacy and safety of codeine as an analgesic are governed by CYP2D6 polymorphisms. Codeine has little therapeutic effect in patients who are CYP2D6 poor metabolizers, whereas the risk of morphine toxicity is higher in ultrarapid metabolizers. The purpose of this guideline (periodically updated at http://www.pharmgkb.org) is to provide information relating to the interpretation of CYP2D6 genotype test results to guide the dosing of codeine.
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Clin. Pharmacol. Ther. · Feb 2012
Rational opioid dosing in the elderly: dose and dosing interval when initiating opioid therapy.
Opioids are the mainstay of treatment for moderate to severe pain. However, opioid therapy in the elderly is often associated with significant morbidity because of excessive ventilatory depression. The large amount of interindividual variability in opioid dose-response relationships makes it difficult to individualize the dose and dosing interval to provide safe and effective analgesia. By examining how aging affects the pharmacokinetics (PK) and pharmacodynamics (PD) of opioids, it is possible to provide a rational basis for age adjustment in opioid dosing.