Why There Is No Cookbook Approach to Palliative Care: Implications of the P450 Enzyme System

A plethora of literature describes the impact of the P450 enzyme system, but this information is limited regarding its relevancy to nursing practice. However, oncology nurses providing palliative symptom management must have a working knowledge of the P450 enzyme system to recognize the variability that exists among individual medication reactions or why a "cookbook approach" to symptom management is not always effective and appropriate. This article describes the variations associated with medication metabolism with reference to ethnic differences. Having a basic understanding of the P450 enzyme system and, more specifically, the CYP2D6 influence on the metabolism of common medications used in palliative symptom management can help to prevent medication toxicity or underdosing, which interferes with patients' quality of life.