Personalized prescribing: a new medical model for clinical implementation of psychotropic drugs

The use of pharmacogenetic tests was already being proposed in psychiatry in the early 2000s because genetic factors were known to influence drug pharmacokinetics and pharmacodynamics. However, sufficient levels of evidence to justify routine use have been achieved for only a few tests (eg, major hi...

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Bibliographic Details
Published in:Dialogues in clinical neuroscience 2016-09, Vol.18 (3), p.313-322
Main Author: Eap, Chin B.
Format: Article
Language:English
Subjects:
antidepressant
antipsychotic
Cytochrome P-450 Enzyme System - genetics
Cytochrome P-450 Enzyme System - metabolism
cytochrome P450
Humans
Mental Disorders - drug therapy
Mental Disorders - genetics
pharmacodynamic
pharmacogenetic
pharmacogenomic
Pharmacogenomic Testing
pharmacokinetic
Pharmacological Aspects
Practice Patterns, Physicians
Precision Medicine
psychiatry
psychotropic drug
Psychotropic Drugs - adverse effects
Psychotropic Drugs - metabolism
Psychotropic Drugs - pharmacokinetics
Psychotropic Drugs - therapeutic use
therapeutic drug monitoring
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Summary:The use of pharmacogenetic tests was already being proposed in psychiatry in the early 2000s because genetic factors were known to influence drug pharmacokinetics and pharmacodynamics. However, sufficient levels of evidence to justify routine use have been achieved for only a few tests (eg, major histocompatibility complex, class I, B, allele 1502 [HLA-B*1502] for carbamazepine in epilepsy and bipolar disorders); many findings are too preliminary or, when replicated, of low clinical relevance because of a small effect size. Although drug selection and dose adaptation according to cytochrome P450 genotypes are sound, a large number of patients need to be genotyped in order to prevent one case of severe side effect and/or nonresponse. The decrease in cost for genetic analysis shifts the cost: benefit ratio toward increasing use of pharmacogenetic tests. However, they have to be combined with careful clinical evaluations and other tools (eg, therapeutic drug monitoring and phenotyping) to contribute to the general aim of providing the best care for psychiatric patients.
ISSN:1958-5969
1294-8322
1958-5969
DOI:10.31887/DCNS.2016.18.3/ceap