{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T09:20:27Z","timestamp":1787908827559,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T00:00:00Z","timestamp":1731542400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T00:00:00Z","timestamp":1731542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Paracetamol\u2013codeine combination tablet is widely used in pain management after day surgery. For safety reasons, its use has decreased in recent years. Codeine is a prodrug metabolised in the liver by the cytochrome P450 2D6 (CYP2D6) enzyme to morphine that produces the analgesic effect of codeine. CYP2D6 is highly polymorphic, and based on genotypes, individuals can be divided into four categories: poor\u2010, intermediate\u2010, normal\u2010 and ultrarapid metabolisers. Differences in morphine and its metabolite concentrations have been described between different CYP2D6 genotypes following codeine administration. The aim of the study was to investigate the possible effect of\n                      <jats:italic>CYP2D6<\/jats:italic>\n                      genotype on codeine efficacy and adverse effects in a large cohort of adult patients undergoing ambulatory surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 987 patients scheduled for ambulatory surgery were included in the analyses. Operation types or anaesthesia methods were not limited in the study protocol. All study patients received a fixed dose of paracetamol (1000\u2009mg) and codeine (60\u2009mg) orally for premedication. A blood sample was drawn to identify the genotype of CYP2D6. At home, the first\u2010line analgesic was paracetamol\u2013codeine combination of 1\u20132 tablets at 1\u20133 times per day. Data on the efficacy and side effects of codeine were collected on the day of surgery and the following two postoperative days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the studied patients, 37 (3.7%) were poor CYP2D6 metabolisers, 264 (27%) were intermediate, 623 (63%) were normal and 63 (6.4%) were ultrarapid metabolisers. Activity scores ranged from 0 to 4. CYP2D6 genotype was not associated in a statistically significant manner with postoperative pain, opioid consumption or the adverse effects of codeine, except for constipation at home. Poor CYP2D6 metabolisers reported significantly less severe constipation compared with normal metabolisers (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.009, OR 0.40, 95% Cl 0.20\u20130.80).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      <jats:italic>CYP2D6<\/jats:italic>\n                      genotype appears to be of minor importance for the analgesic efficacy of oral paracetamol\u2010codeine combination therapy after ambulatory surgery in adult patients undergoing similar types of surgery as in the present study but it may affect the risk of constipation.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.14549","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T21:03:43Z","timestamp":1731618223000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does cytochrome\n                    <scp>2D6<\/scp>\n                    genotype affect the analgesic efficacy of codeine after ambulatory surgery? Prospective trial in 987 adults"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8853-151X","authenticated-orcid":false,"given":"Satu","family":"Poikola","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Perioperative and Intensive Care Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1288-8495","authenticated-orcid":false,"given":"Hanna","family":"von Plato","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Perioperative and Intensive Care Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jukka","family":"Harju","sequence":"additional","affiliation":[{"name":"Gastroenterological surgery University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna I.","family":"Kiiski","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, University of Helsinki and HUS Diagnostic Center Helsinki University Hospital  Helsinki Finland"},{"name":"Individualized Drug Therapy Research Program, Faculty of Medicine University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristiina","family":"Mattila","sequence":"additional","affiliation":[{"name":"Terveystalo Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus T.","family":"Olkkola","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Perioperative and Intensive Care Helsinki University Hospital  Helsinki Finland"},{"name":"Individualized Drug Therapy Research Program, Faculty of Medicine University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"Niemi","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, University of Helsinki and HUS Diagnostic Center Helsinki University Hospital  Helsinki Finland"},{"name":"Individualized Drug Therapy Research Program, Faculty of Medicine University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eija","family":"Kalso","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Perioperative and Intensive Care Helsinki University Hospital  Helsinki Finland"},{"name":"Department of Pharmacology University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesa","family":"Kontinen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, 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