The current Dutch Pharmacogenetics Working Group (DPWG) guideline, describes the gene–drug interaction between CYP2D6 and the opioids codeine, tramadol and oxycodone. CYP2D6 genotype is translated into normal metaboliser (NM), intermediate metaboliser (IM), poor metaboliser (PM) or ultra-rapid metaboliser (UM). Codeine is contraindicated in UM adults if doses >20 mg every 6 h (q6h), in children ≥12 years if doses >10 mg q6h, or with additional risk factors. In PMs, an alternative analgesic should be given which is not or to a lesser extent metabolised by CYP2D6 (not tramadol). In IMs with insufficient analgesia, a higher dose or alternative analgesic should be given. For tramadol, the recommendations for IMs and PMs are the same as the recommendation for codeine and IMs. UMs should receive an alternative drug not or to a lesser extent metabolised by CYP2D6 or the dose should be decreased to 40% of the commonly prescribed dose. Due to the absence of effect on clinical outcomes of oxycodone in PMs, IMs and UMs no action is required. DPWG classifies CYP2D6 genotyping for codeine “beneficial” and recommends testing prior to, or shortly after initiation of treatment in case of higher doses or additional risk factors. CYP2D6 genotyping is classified as “potentially beneficial” for tramadol and can be considered on an individual patient basis.

目前的荷兰药物遗传学工作组 (DPWG) 指南描述了CYP2D6与阿片类药物可待因、曲马多和羟考酮之间的基因-药物相互作用。CYP2D6 基因型被翻译为正常代谢者 (NM)、中间代谢者 (IM)、不良代谢者 (PM) 或超快代谢者 (UM)。如果 UM 成人每 6 小时 (q6h) 剂量 > 20 mg，则禁用可待因；如果 ≥12 岁儿童，如果剂量 > 10 mg q6h，或存在其他危险因素，则禁用可待因。对于 PM，应使用不被 CYP2D6 代谢或在较小程度上被 CYP2D6 代谢的替代镇痛药（不是曲马多）。对于镇痛不足的 IM，应给予更高剂量或替代镇痛剂。对于曲马多，IM 和 PM 的建议与可待因和 IM 的建议相同。UM 应接受不被 CYP2D6 代谢或在较小程度上被 CYP2D6 代谢的替代药物，或者剂量应减少至常用处方剂量的 40%。由于羟考酮对 PM、IM 和 UM 的临床结果没有影响，因此无需采取任何行动。DPWG 将可待因的CYP2D6基因分型分类为“有益”，并建议在治疗开始前或治疗后不久进行测试，以防剂量较高或存在其他危险因素。CYP2D6基因分型被归类为对曲马多“潜在有益”，可以根据个体患者进行考虑。