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Re: More questions for Larry Cecilia

Posted by Larry Hoover on September 3, 2007, at 15:19:40

In reply to More questions for Larry, posted by Cecilia on August 31, 2007, at 2:06:45

> As for pain meds, oxycodone, also appears to use CYP2D6, but you say it still works for people with a deficiency in this enzyme? I'm confused.

You're right, oxycodone (Percocet, Oxycontin) can be metabolized to oxymorphone (Numorphan). The latter is a very powerful analgesic, generally administered intravenously. Oxycodone, however, is no slouch, either. It is quite active in its parent form, prior to any enzymatic/metabolic actions. That stands in contrast to the codeine/morphine pair, with the former having less than 1% of morphine's affinity at mu opioid receptors.

> I guess the 1st thing is to see if I can convince my doctor to figure out if I really am deficient in this enzyme, though it sure sounds like it from my reaction to Vicodin.

I'm a little surprised by that, honestly, as hydrocodone should be analgesic in its parent form, too. It is much less potent than hydromorphone, but like oxycodone, its not generally thought of as being a weak analgesic. Nonetheless, the typical user of oxycodone and hydrocodone experiences some substantial extra effects from the desmethylated forms. Absent that bonus-round kick, it really isn't fair, is it?

> I've given up hope of ever finding anything that would work for depression, but it sure would be nice to be in less pain from my severe arthritis. Cecilia

Amen to that. I wish you success.





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