Pharmacogenetics in Practice
Studies over the last two decades have identified several genes influencing drug metabolism. Most notably, it has been shown that allelic variation in the genes encoding the CYP2D6 and CYP2C19 enzymes leads to differences in the metabolism of numerous medications relevant to psychiatry, in particular antidepressants and antipsychotics. Individuals with genetic variants causing extreme drug metabolism phenotypes are at increased risk for adverse events, and some evidence suggests such patients are less likely to respond to treatment.
International Society of Psychiatric Genetics: Pharmacogenetic Tests to Guide Optimal Treatment
Pillcheck reports on over 50 antidepressants and antipsychotic medications according to FDA drug labels and CPIC guidelines:
Clinical utility of pharmacogenetics in treatment of depression, anxiety and other mental health conditions:
Within the realm of utility, genetic predictions of opioid pharmacokinetics and pharmacodynamics are among the most accurate and clinically actionable because these reflect drug-gene interactions. These offer risk-management stratification to safeguard the patients who are least likely to benefit from opioids or who require a greater degree of oversight and monitoring while on opioids while identifying the others who are likely to respond and may be deprived of the most potential benefit if opioids are unduly restricted.
Pillcheck reports on over 15 analgesics including opioid prodrugs, TCAs and SNRIs according to FDA drug labels and CPIC guidelines:
Pillcheck reports on antiplatelets and oral anticoagulants, as well as statins and beta blockers according to FDA drug labels and CPIC guidelines:
Pillcheck reports on chemotherapy medications according to FDA drug labels and CPIC guidelines:
For women treated with tamoxifen, Pillcheck can help to identify whether a dose increase is warranted for women with reduced CYP2D6 function or if a switch to aromatase inhibitors is needed for women with absent CYP2D6 function. Pillcheck can also identify whether the use of tamoxifen poses a higher risk of thrombosis and stroke for women carrying mutations in F2 or F5 genes as per the FDA drug warning label.
Nausea poses a significant challenge for most cancer patients. Commonly used antiemetics dolasetron, ondansetron, palonosetron and tropisetron are ineffective for people with greatly enhanced CYP2D6 activity. These patients need treatment with alternative antiemetic medications.