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CYP2D6
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== Ethnic factors in variability == Ethnicity is a factor in the occurrence of CYP2D6 variability. The reduction of the liver cytochrome CYP2D6 enzyme occurs approximately in 7–10% in [[White people|white]] populations, and is lower in most other ethnic groups such as [[Asian people|Asians]] and [[African-Americans]] at 2% each. A complete lack of CYP2D6 enzyme activity, wherein the individual has two copies of the polymorphisms that result in no CYP2D6 activity at all, is said to be about 1-2% of the population.<ref>{{cite book|title=Pharmacology and the Nursing Process | vauthors = Lilley LL, Harrington S, Snyder JS, Swart B |publisher=Mosby Elsevier|year=2007|isbn=9780779699711|location=Toronto|pages=25}}</ref> The occurrence of CYP2D6 ultrarapid metabolizers appears to be greater among [[Middle East]]ern and [[North Africa]]n populations.<ref name="pmid9241658">{{cite journal | vauthors = McLellan RA, Oscarson M, Seidegård J, Evans DA, Ingelman-Sundberg M | title = Frequent occurrence of CYP2D6 gene duplication in Saudi Arabians | journal = Pharmacogenetics | volume = 7 | issue = 3 | pages = 187–191 | date = June 1997 | pmid = 9241658 | doi = 10.1097/00008571-199706000-00003 }}</ref><ref name="pmid19512959">{{cite journal | vauthors = Owen RP, Sangkuhl K, Klein TE, Altman RB | title = Cytochrome P450 2D6 | journal = Pharmacogenetics and Genomics | volume = 19 | issue = 7 | pages = 559–562 | date = July 2009 | pmid = 19512959 | pmc = 4373606 | doi = 10.1097/FPC.0b013e32832e0e97 }}</ref> In [[Ethiopia]], a particularly high percentage (30%) of the population are ultrametabolizers. As a result, the analgesic codeine is banned in Ethiopia due to the high rate of adverse events associated with ultrarapid metabolism of codeine in this population.<ref>{{cite journal | vauthors = Baker JL, Shriner D, Bentley AR, Rotimi CN | title = Pharmacogenomic implications of the evolutionary history of infectious diseases in Africa | journal = The Pharmacogenomics Journal | volume = 17 | issue = 2 | pages = 112–120 | date = March 2017 | pmid = 27779243 | pmc = 5380847 | doi = 10.1038/tpj.2016.78 }}</ref> Caucasians with European descent predominantly (around 71%) have the functional group of CYP2D6 alleles, producing extensive metabolism, while functional alleles represent only around 50% of the allele frequency in populations of Asian descent.<ref name="pmid11972444">{{cite journal | vauthors = Bradford LD | title = CYP2D6 allele frequency in European Caucasians, Asians, Africans and their descendants | journal = Pharmacogenomics | volume = 3 | issue = 2 | pages = 229–243 | date = March 2002 | pmid = 11972444 | doi = 10.1517/14622416.3.2.229 }}</ref> This variability is accounted for by the differences in the prevalence of various ''CYP2D6'' alleles among the populations–approximately 10% of whites are intermediate metabolizers, due to decreased CYP2D6 function, because they appear to have the one ([[heterozygous]]) non-functional ''CYP2D6*4'' allele,<ref name="Droll_1998">{{cite journal | vauthors = Droll K, Bruce-Mensah K, Otton SV, Gaedigk A, Sellers EM, Tyndale RF | title = Comparison of three CYP2D6 probe substrates and genotype in Ghanaians, Chinese and Caucasians | journal = Pharmacogenetics | volume = 8 | issue = 4 | pages = 325–333 | date = August 1998 | pmid = 9731719 | doi = 10.1097/00008571-199808000-00006 }}</ref> while approximately 50% of Asians possess the decreased functioning ''CYP2D6*10'' allele.<ref name="Droll_1998" />
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