Oxycodone Dosing Methods
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Presently physicians dose medications for patients based on a range they get from the Physicians' Desk Reference (PDR). By dosing a medication this way, the physician does not take into account individual patient's metabolic variation. This can be seen when physicians prescribe an opioid such as oxycodone. In this study, we present four simulated ways of oxycodone dosing and compare them to the standard dosing method. These were simulated using a virtual population. First, we compare weight based dosing to the standard, which is based on the PDR. Our results suggests that weight based dosing gives a significantly higher dosage than the standard. We then used a pharmacokinetic model, which takes into account the volume of blood in a patient based on a patient's weight. The data obtained from this model showed a significant decrease in recommended dose, compared to the standard, for most patients. The next step we took was looking at the phenotype of each patient's CYP2D6 gene, which creates the CYP2D6 enzyme that partly metabolizes oxycodone. The CYP2D6 phenotype determines the rate the patient eliminates oxycodone from the body. Dosing a patient based on his or her genetics is called pharmacogenetics. We used pharmacogenetics in combination with pharmacokinetics to determine the right oxycodone dose for each patient. The resultant dose was mostly lower than the standard but higher than the purely pharmacokinetic-based model. In the last dosing technique, we used the pharmacogentic-pharmacokinetic model but, combined it with a standard dose of the medication paroxetine, which inhibits the CYP2D6 enzyme lowering the dose across the board by 20%.