Objectives: To determine the rates of co-prescription of CYP2D6-inhibiting medications with pain medication and the impact on response rates to pain medications, in the UK primary care setting. MethOds: Codeine and tramadol are prodrugs requiring activation by the CYP2D6 enzyme. These drugs may have limited effectiveness when co-prescribed with other medications known to inhibit the CYP2D6 pathway. This contrasts with CYP2D6-independent analgesia, e.g. buprenorphine, which do not require CYP2D6 activation. We identified the co-prescription of three study pain medications; buprenorphine, codeine and tramadol with CYP2D6-inhibiting drugs including amitriptyline and fluoxetine. Patients aged ≥ 18 years with chronic non-malignant pain and prescribed buprenorphine, codeine or tramadol between

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