Buprenorfin Farmakokinetiğinde ve Farmakodinamiğinde Rol Oynayan Gen Polimorfizmleri: Genel Bakış

Öz

Buprenorfin opioid bağımlılığının tedavisinde etkili olmasına rağmen, opioid kullanıcıları arasında nüksetme ve/veya tedaviyi bırakmak gibi nedenlerle tedavi başarısızlığı oranı yüksektir. Bu da sağlık hizmetleri ve adalet açısından topluma önemli maliyetlere yol açmaktadır. Opioid kullanım bozukluğu için farmakoterapilerin etkinliğinin %60-70 arasında olduğu tahmin edilmektedir. Tedavi etkinliğini artırmak ve yüksek olan tedaviyi bırakma oranlarını azaltmak için, hastaların genetik profil gibi bireysel özelliklerinin daha detaylı anlaşılması önem arz etmektedir. Tedaviye yanıt verme ile ilaçların metabolizmasını, etki mekanizmasını ve taşınmasını düzenleyen genetik varyantlar arasında bir etkileşim olduğu yaygın olarak kabul edilmektedir. Bu nedenle, hastaya göre tedavi uygulaması, tedavi sonuçlarının iyileştirmesi ve ayrıca tedavi başarısızlığı riski yüksek olan bağımlılarda daha uzun süren yoksunluk dönemlerininin kolaylaştırılması için iyi bir yaklaşım olacaktır. Opioid kullanım bozukluğu tedavisinde buprenorfin dozunun bireyselleştirilmesi ve buprenorfin dozu ile etkinlik arasındaki ilişkiyi anlamak için daha fazla çalışmaya gerek vardır.

Anahtar Kelimeler

• Buprenorfin
• opioid kullanım bozukluğu
• farmakogenetik
• Buprenorphine
• opioid use disorder
• pharmacogenetics

Gene Polymorphisms Playing Roles in Pharmacokinetics and Pharmacodynamics of Buprenorphine: An Overview

Abstract

Although buprenorphine is effective in the treatment of opioid use disorder, treatment failure rates are high among opioid users due to relapse and/or drop-out. This leads to significant costs to society in terms of health services and justice. The efficacy of pharmacotherapy for opioid use disorder is estimated to be between 60-70%. It is important to understand the individual characteristics of patients, such as genetic profile in detail to increase the effectiveness of treatment and reduce the high drop-out rates. It is widely accepted that there is an interaction between responsiveness to treatment and genetic variants that regulate the metabolism, mechanism of action and transport of drugs. Therefore, individualized treatment would be a good approach to improve treatment outcomes and also to facilitate longer periods of abstinence in opioid users at high risk of treatment failure. More studies are needed to understand the individualization of buprenorphine dose and the relationship between buprenorphine dose and efficacy in the treatment of opioid use disorder.

Keywords

• Buprenorphine
• opioid use disorder
• pharmacogenetics

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