Cytochrome CYP2D6 substrate

Lewis DF, Eddershaw PJ, Goldfarb PS, Tarbit MH. 1997. Molecular modelling of cytochrome P4502D6 CYP2D6) based on an alignment with CYP102 structural studies on specific CYP2D6 substrate metabolism. Xenobiotica 27 319-339. 

In the history of drug metabolism, prominent were the discoveries of genetic variability of the metabolism of debrisoquine (14) and of sparteine (15). Subsequent studies indicated that both drugs are metabolized by the same enzyme (16), which turned out to be the P450 cytochrome CYP2D6 (17). The enzyme s variations were found to be complex (18) enzyme activity could be absent because of frameshift mutations, splicing defects, gene deletion, or the presence of a stop codon. The enzyme may function slowly because of various kinds of mutation, whereby some mutations affected only the interaction with specific substrates. Enzyme duplication or multiplication could lead to very fast action. 

Codeine, hydrocodone, morphine, methadone, and oxycodone are substrates of the cytochrome P-450 isoenzyme CYP2D6.47 Inhibition of CYP2D6 results in decreased analgesia of codeine and hydrocodone due to decreased conversion to the active metabolites (e.g., morphine and hydromorphone, respectively) and increased effects of morphine, methadone, and oxycodone. Methadone is also a substrate of CYP3A4, and its metabolism is increased by phenytoin and decreased by cimetidine. CNS depressants may potentiate the sedative effects of opiates. 

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