Potential role of pharmacogenomics testing in the setting of enhanced recovery pathways after surgery

Figures & data

Table 1 Examples of commonly used drugs in anesthesia, corresponding metabolizing enzyme(s), known variants, and their impact on metabolism

Drug of interest	Metabolizing enzyme	Variant	Effect
1. Midazolam	CYP3A4/5	CYP3A5*3	50% enzyme induction
2. NSAIDs	CYP2C8/9	CYP2C8/9*1 CYP2C8/9*2, *3	Normal metabolizer Poor metabolizers
3. Ketamine	Depending on ketamine plasma level: – At high levels: CYP3A4 – At clinically relevant levels: CYP2B6	CYP2B6*6/*6 CYP2B6*1/*6 or CYP2B6*1/*1	Low plasma clearance Better clearance
4. Propofol	CYP2B6 UGT1A9	CYP2B6*4	Reduced clearance
5. Succinylcholine	BCHE	BCHE*FS126, BCHE*I3E4-14C and BCHE*328D	Prolonged effect
6. Metoclopramide	CYP2D6	rs1080985 and rs1694,7 rs3892097	Fewer side effects Higher incidence of side effects