Managing expectations with pharmacogenetic testingRuslan Dorfman, PhD, MBA
Pharmacogenetics is the science of how genes affect your body’s response to medications. Enzymes in the liver metabolize drugs so they can be cleared from the body. These enzymes are coded by genes, and variations in these genes can determine how individuals respond to drugs.
A pharmacogenomic test, such as Pillcheck, measures the genetic variations involved in drug metabolism. Pharmacogenomic testing helps match individuals to the medications that work best based on their unique metabolic profile. However, pharmacogenetic testing should not be perceived as a cure-all tool that resolves every complication associated with medication therapy.
Some people suffering from chronic pain or mental health conditions may experience frustration when pharmacogenetics test results show they have a normal response to their medication because they feel that the drug is not effective or causing side effects.
Drug response is affected by many variables
Drug response is governed by multiple mechanisms including the nature of underlying disease, age, gender, nutrition, the body’s ability to absorb and metabolize the medication, as well as genetic variations.
When someone with a normal drug metabolism experiences significant side effects to a medication, it may indicate that re-assessment of the diagnosis might be warranted. For example, acute intolerance of SSRIs and other antidepressants, is an indicator that the patient may have another mental health condition rather than a general depression. You can read an explanation here.
It is also important to understand that every medication carries a risk of side effects, many of which are unavoidable. Even individuals with normal drug clearance will experience these side effects. Sometimes medications are given to manage disease symptoms, but most chronic conditions cannot be cured by drugs. Recovery from neuropathic pain can take several years until symptoms subside and go away.
Some medical conditions require a comprehensive treatment approach
Some medical conditions, such as chronic pain and depression, require comprehensive treatment. Functional, cognitive behavior therapy to teach pain coping techniques, relaxation and exercise have been shown to improve rates of recovery, in addition to drug therapy. Pharmacogenetic testing should be a part of the comprehensive treatment protocol. Knowing a patient’s drug metabolic profile ensures they are receiving the right treatment. Even results that show a “normal” metabolic response can have a reinforcing effect, helping patients adhere to their medication. Multiple clinical trials show that pharmacogenomic testing improves adherence to treatment, which is important for chronic disease management.
Pharmacogenomic testing can inform future medication decisions
Since your DNA does not change, an investment in a pharmacogenomic test provides a lifetime benefit – even if you are not taking the medication to which you are at higher risk of side effects. Test results are relevant for future medical events, and can improve treatment outcome.
Pillcheck currently predicts your response to over 139 medications and continues to expand the number of medications reported as new scientific research becomes available. Updated reports are regularly made available to Pillcheck customers.
- Dolgin E. Pharmacogenetic tests yield bonus benefit: better drugadherence. Nat Med. 2013 Nov;19(11):1354-5.
- Fagerness J,Fonseca E, Hess GP, Scott R, Gardner KR, Koffler M, Fava M, Perlis R, Brennan FX, Lombard J. Pharmacogenetic-guided psychiatric intervention associated with increased adherence and cost savings. Am J Manag Care. 2014 May;20(5):e146-56.