Posted by Larry Hoover on May 12, 2006, at 9:41:16
In reply to Re: Liver Enzyme Article (Wash. Post), posted by honeybee on May 12, 2006, at 8:47:50
> The example of the quibbling psychiatrist who claims she can suss out poor metabolizers by their reactions to robutussein, asking for family history, etc., does not inspire confidence.
I think response to codeine is a better indicator. Codeine has fairly mild effects, on its own. But, once processed by the liver, it becomes morphine. Codeine is therefore administered more for its prodrug activity, its potential for becoming morphine, than for its parent drug effects.
Slow or absent activity at 2D6 means little or no morphine, and thus, little or no analgesia. But what do emergency rooms dispense? Tylenol 3, or the like. Codeine. Virtually does nothing for me, but I have a friend who is an ultra-rapid metabolizer. T3's are like IV morphine, for her. Only lasts about 20 minutes or so, but she loves the ride.
> Any ideas on what doctors do if they discover that their patients are poor metabolizers or intermediate metabolizers?
If they have discovered that, then they are already in the vanguard of psych treatment. There is no set rule of what to do, though. Some drugs have active metabolites. Some are only active until they are metabolized. It's a factor to account for, in both drug selection, and dosing.
Lar
poster:Larry Hoover
thread:642166
URL: http://www.dr-bob.org/babble/20060510/msgs/642966.html