CYTRAM (Cytochrome P450, Tramadol)
Information source: University Hospital, Caen
Information obtained from ClinicalTrials.gov on October 19, 2009
Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Post-operative Patients Treated by Tramadol
Intervention: Monitoring seric concentrations of O-demethyl-tramadol and tramadol (Biological)
Phase: N/A
Status: Not yet recruiting
Sponsored by: University Hospital, Caen Official(s) and/or principal investigator(s):
Blandine de la Gastine, MD, Principal Investigator, Affiliation: University Hospital, Caen
Overall contact:
Blandine de la Gastine, MD, Phone: 2.31.06.46.70, Ext: +33, Email: delagastine-b@chu-caen.fr
Summary
Many methods to detect CYP2D6 poor metabolizers have been validated. Some of them are based
on phenotyping (metabolism of dextromethorphan or debrisoquine) and some others on
genotyping. Up to now, CYP2D6 pharmacogenetics has been restricted to the field of research,
in spite of poor metabolizer profile concerns 5 to 10 % of caucasian population.
Nevertheless, the polymorphism of CYP2D6 is responsible for the metabolism of many drugs,
particulary of two opioids involved in pain management: codeine and tramadol, their
metabolites representing the most effective part of the drug effect. So prescribing codeine
or tramadol in a patient poor metabolizer for the CYP2D6 is likely to be ineffective in pain
management.
O-demethyl-tramadol, the metabolite of tramadol via CYP2D6, is important to consider because
its analgesic effect is 2 to 4 times more potent than tramadol.
The investigators propose to phenotype CYP2D6 in post-operative patients treated by tramadol
by monitoring seric concentrations of O-demethyl tramadol and tramadol to make a ratio in
comparision with genotype, and to find a threeshold to determine poor metabolizers. As
already described, genotyping CYP2D6 will use a rapid detection method of the alleles
implicated in poor metabolizer status (CYP2D6*3, *4, *5 et *6) in a caucasian population.
Sampling will be executed at two times (H24 and H48 after surgery) and only with blood
(three EDTA tubes) during the post-operative monitoring of the patients. This study is
likely to include 320 post-operative patients treated with intravenous tramadol during one
year in three university hospitals centers (CHU of Caen, Créteil and Rouen).
The first aim of this study is the validation of monitoring seric concentrations of
O-demethyl-tramadol and tramadol to make the ratio in order to detect CYP2D6 poor
metabolizers in therapeutic situation, comparing the result with genotyping. The finding of
a poor metabolizer status in a patient will make the choice of antalgic drugs easier,
avoiding tramadol and codeine. The final objective of this research is to be able to
determine the CYP2D6 phenotype in a patient treated by tramadol without a good analgesia. By
a single take of blood and a rapid response, this method should be liked to improve pain
managment. Furthermore, CYP2D6 phenotyping is interesting for the patient because many other
drugs depend on this way of metabolism.
Clinical Details
Official title: Validation of a New Method to Detect CYP2D6 Poor Metabolizers by Monitoring Seric Concentrations of O-demethyl-tramadol and Tramadol to Make a Ratio in Comparison With Genotyping in Post-operative Patients Treated With Intravenous Tramadol
Study design: Cohort, Prospective
Primary outcome: To phenotype CYP2D6 in post-operative patients treated by tramadol by monitoring seric concentrations of O-demethyl tramadol and tramadol to make a ratio in comparision with genotype, and to find a threeshold to determine poor metabolizers.
Eligibility
Minimum age: 18 Years.
Maximum age: N/A.
Gender(s): Both.
Criteria:
Inclusion Criteria:
- age > 18 years, post-operative patient treated with intravenous tramadol
- caucasian origin
- take of blood at H24 and H48 in the post-operative monitoring
Exclusion Criteria:
- patient taking opioid drugs before surgery
- patient taking one or more drugs inhibiting the CYP2D6 before or during surgery
- pregnancy or breast feeding- patients having one ore more contre-indication for
taking tramadol in post-operative analgesy
- hepato-cellular incapacity (TP < 70%)
Locations and Contacts
Blandine de la Gastine, MD, Phone: 2.31.06.46.70, Ext: +33, Email: delagastine-b@chu-caen.fr
Caen University Hospital, CAEN 14033, France
Rouen University Hospital, ROUEN 76000, France
Créteil University Hospital, Créteil, France
Additional Information
Starting date: September 2009
Ending date: December 2010
Last updated: August 10, 2009
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