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Genetic Defects and Metabolizing Medications

I recently had some genetic testing done and found out that I am an Intermediate Metabolizer for CYP 450 2C9 and CYP 450 3A5. This directly affects some medications and answers some questions that I have had. I had been given Fentanyl when I was medivaced and it did not touch my pain. They gave me quite a bit and I was still in pain. I told my primary care doctor that Meloxicam did not really do anything for me and that Aleve seemed to work better. I think he thought at the time that I was just trying to get stronger narcotics. I simply was stating that the darn Meloxicam did not work. Well, low and behold, Meloxicam is metabolized with the CYP 2C9 enzyme! Imagine that! I can't process it properly, so of course it won't work! Fentanyl is processed with 3A5! This all came to light when I had a procedure and they used Fentanyl for anesthetic during my epidural injection. It didn't work and I still hurt like mad during the cervical injection. Doctor gave me two shots of Fentanyl. After this I asked my new primary care doctor for the genetic testing. I truly feel so relieved that I got the testing done.

I have been treated as though I have a drug seeker. I know that if I had further testing done that I would likely come up as somehow metabolizing 2D6 incorrectly as well. Almost every time I have ever taken any pain medications they work briefly for a few hours and then stop. If a drug is supposed to last 6-8 hours it only lasts maybe 2-3 hours for me. The genetic testing report stated that the testing showed I did not have a 2D6 abnormality but that it did not mean it was a complete profile. I have a feeling that I have some strange one that is not normal. I have found varied information on 3A5 affecting medications like codeine, hydrocodone, oxycodone, fentanyl. methadone. meperidine. buprenorphine and sufentanil. This would explain that the buprenorphine does not help me as much as really need it to, at least the sublingual. The Butrans patch was effective, but when we had to switch to the sublingual due to the chemical burns the patch was causing me the method of administration changed and the the oral route is not effective because of the 3A5. I wonder if they make a patch that doesn't have the same chemical horror that burned me.

I need a break from pain. That is all.
Try to keep smiling and doing but oh sooooo tired of intense pain battle---tired. I hurt and know it doesn't define me but it sure does change things.


  • The burns from the patch are a common side effect. I use an otc steroid spray (like Flonase), let it dry, then apply the patch. I also apply the patch under my sports bra areas. One, because the skin is thinner and it seems to work better and longer, and two, it helps hold it on.

    I also can't metabolize morphine. It does nothing at all.
  • That was the first thing my pain management doctor had me try when it started to burn my skin. It did nothing to help---I looked like a patchwork burn victim. It was horrible. I was so, so very upset because it actually worked with my pain levels. UGH! So stressful!
    Try to keep smiling and doing but oh sooooo tired of intense pain battle---tired. I hurt and know it doesn't define me but it sure does change things.
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  • I tried going off the Butrans and it was hell! I will gladly take some slightly burned skin over being curled up in bed crying. I wish they could figure out a better way to keep the burning down. Hope you find something that works.
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