**4. Conclusion**

This chapter about PG and TR highlights important related issues including pharmacological and genetic aspects of TR. It clarified the interindividual variability in response and toxicity to TR in order to support the use of genetic screening to predict individual responses to pain medications and the risk of adverse events. This in turn will encourage the use of PG as part of clinical practice for TR. Finally, novel machine learning approaches using multigenic model can comprehensively analyze genotype-phenotype relationships that hold significant promise for application to predict response to TR, which may contribute to the relatively high rate of TR-related fatalities.

#### **Acknowledgements**

This work was supported by Science and Technology Development Fund— French Institute of Egypt (STDF-IFE), No. 31133.

**169**

**Author details**

Suez Canal University, Ismailia, Egypt

sur la Santé Humaine, Lille, France

provided the original work is properly cited.

Sanaa M. Aly1,2\*, Jean-Michel Gaulier2,3 and Delphine Allorge2,3

2 CHU Lille, Unité Fonctionnelle de Toxicologie, Lille, France

\*Address all correspondence to: sasydayem@hotmail.com

1 Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine,

3 Université de Lille, ULR 4483 – IMPECS – IMPact de l'Environnement Chimique

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Pharmacogenetics and Tramadol-Related Fatalities DOI: http://dx.doi.org/10.5772/intechopen.98250*

IMs Intermediate metabolizers

M1 or ODT *O-*desmethyltramadol M2 *N-*desmethyltramadol M5 or NODT *N,O-*didesmethyltramadol MAOI Monoamino oxidase inhibitors NM-F Fast normal metabolizers NM-S Slow normal metabolizers

PG Pharmacogenetics PMs Poor metabolizers

UMs Ultra-rapid metabolizers

TR Tramadol

EMs or NMs Extensive or normal metabolizers GC-MS Gas chromatography-mass spectrometry

OIVI Opioid-induced ventilatory impairment

LC-MS/MS Liquid chromatography-tandem mass spectrometry

**Appendices and nomenclature**

#### **Conflict of interest**

The authors declare no conflict of interest.

*Pharmacogenetics and Tramadol-Related Fatalities DOI: http://dx.doi.org/10.5772/intechopen.98250*
