Pain meds

Pain medications and pharmacogenetics

Also known as: Analgesics, Painkillers

12 medications 14 brand products CYP2D6CYP2C9

Why pharmacogenetics matter for pain medications

Pharmacogenetics affects pain management on two fronts: how opioids are activated (or not) and how NSAIDs are cleared. The CYP2D6 gene is central to the opioid story because it converts codeine and tramadol from their inactive forms into their active metabolites. Poor metabolizers get little pain relief; ultrarapid metabolizers can reach dangerous opioid levels on standard doses.

The FDA added a boxed warning against codeine in pediatric patients specifically because CYP2D6 ultrarapid metabolizer status has been linked to fatal respiratory depression. Tramadol carries similar risk. Non-CYP2D6 opioids like morphine and hydromorphone are safer choices when CYP2D6 status is unknown.

Key genes in this class

CYP2D6

Cytochrome P450 2D6

CYP2D6 is the most clinically important pharmacogene. It metabolizes around a quarter of all prescription drugs, including many antidepressants, opioids, and stimulants. The gene is unusually variable: roughly 7 percent …

CYP2C9

Cytochrome P450 2C9

CYP2C9 metabolizes warfarin, phenytoin, celecoxib, and some NSAIDs. Variants that reduce its activity are most consequential for warfarin, where even small changes in drug clearance translate into very different doses …

Medications in this class with pharmacogenetic guidelines

Each link goes to the drug's full pharmacogenetics page with CPIC and FDA phenotype recommendations.

Carisoprodol CYP2C19 Celecoxib CYP2C9 Codeine CYP2D6 Flurbiprofen CYP2C9 Ibuprofen CYP2C9 Lornoxicam CYP2C9 Meloxicam CYP2C9 Oliceridine CYP2D6 Piroxicam CYP2C9 Pitolisant CYP2D6 Tenoxicam CYP2C9 Tramadol CYP2D6

Brand products in the Pain meds class

Combined products and brand names for the medications above. Each links to a pharmacogenetic breakdown.

codeine, acetaminophen

Which pain meds is right for your genetics?

This page covers the pharmacogenetics of pain medications in general. A Gene2Rx report tells you how your personal genotype interacts with every drug on this page.

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Informational only, not medical advice. Pharmacogenetic guidelines describe population-level patterns that inform prescribing decisions. Never start, stop, or change a medication without talking to your prescribing clinician.