title: [Chronic dizziness in a pain patient--pharmacogenomic identification of tramadol as cause].
abstract: This casuistic reports on a 59-year-old pain patient taking normal dosage Tramadol as analgetic drug, who suffered from chronic dizziness leading to immobilisation for more than 9 months. On admission to inpatient rehabilitation Tramadol was removed in exchange for morphine sulphate with the unexpected result of a prompt and lasting stop of dizziness. A molecular-genetic investigation showed a duplication in the CYP2D6 gene. This genetic situation caused a quick metabolizing-status for substances dependent on CYP2D6 like Tramadol, which is a prodrug. The quick metabolizing-status resulted in an increased rate of active Tramadol-metabolites which caused the chronic dizziness. Under morphine sulphate which is metabolized independently of CYP2D6, a sufficient analgetic outcome could be achieved. Dizziness did not appear in the patient any longer, and he could be mobilised during rehabilitation. Pharmacogenomic knowledge has helped develop a sustainable concept for rehabilitation of this seriously ill patient, and to put it into practise successfully.
authors.affiliation: Klinik Nordfriesland, Fachklinik für onkologische Rehabilitation und Anschlussheilbehandlung, St. Peter-Ording. dr.eichhorn@hamm-kliniken.de
authors.forename: A
authors.initials: A
authors.lastname: Eichhorn
authors.forename: J
authors.initials: J
authors.lastname: Barth
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000493:pharmacokinetics* / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics*; D003692:Delayed-Action Preparations; D004177:Dipyrone / Q000627:therapeutic use; D004244:Dizziness / Q000139:chemically induced* / Q000235:genetics* / Q000534:rehabilitation; D004359:Drug Therapy, Combination; D020131:Genes, Duplicate / Q000235:genetics*; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy / Q000601:surgery; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000235:genetics*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000235:genetics; D010997:Pleural Neoplasms / Q000188:drug therapy / Q000601:surgery; D012047:Rehabilitation Centers; D014147:Tramadol / Q000009:adverse effects* / Q000493:pharmacokinetics* / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003692:Delayed-Action Preparations; D014147:Tramadol; D004177:Dipyrone; D009020:Morphine; D019389:Cytochrome P-450 CYP2D6