The best studied CYP enzyme concerning polymorphisms, enzyme inhibition and dosage individualization according to phenotype is probably CYP2D6, followed by CYP2C9 and CYP2C19. These enzymes are highly polymorphic, contrary to CYP3A4, where the m e t a b o l i c a c t i v i t y m a y v a r y d u e t o d i f f e r e n c e s i n C Y P 3 A 4 g e n e e x p r e s s i o n a n d pharmacokinetic interactions [Ingelman-Sundberg 2004]. Nevertheless, any shift in metabolic capacity of individual CYP enzyme may result either in decreased or increased therapeutic response or intensity of adverse effects. For example, after paroxetine administration to the patients on tamoxifen, a decrease in plasma levels of active metabolite of tamoxifen was detected [Stearns et al. 2003]. This can be crucially important in breast cancer treatment. On the other hand, CYP2D6 ultrarapid metabolizer phenotype may cause failure of pharmacotherapy due to the very low and thus ineffective drug plasma levels [Corruble 2008]. In antipsychotic treatment, an association has been observed between extrapyramidal adverse effects and CYP2D6 genotype [Fleeman et al. 2011]. Significant clinical consequences of CYP2D6 genotype or enzyme inhibition were described also in beta-blockers, antianginal, antiarrythmic drugs, antihistamines and antiemetics. The clinical www.intechopen.com Topics on Drug Metabolism 192 impact of enzyme polymorphism or changes due to inhibition or induction usually depends on the contribution of other CYP forms to the total drug's elimination. By this, the relative therapeutic potency of the parent drug or any of its metabolites may be altered [Zhou 2009]. Methodological approaches such as assessment of metabolic ratio of specific substrate to metabolite(s) in saliva, plasma / serum or urine are most widely used to assess metabolic activity in vivo. Besides determination of the concentrations of probe and metabolite in biological fluids, specific substrates are used in various breath tests. Rarely some other approaches are used, e.g. the pupilometry after opioid administration. It is essentially important to differentiate between in vivo and in vitro metabolic activity assessments, as they show very often discrepant results. One of the greatest advantages of genotype assessment is that it does not need to be repeated because it does not change with time or under the simultaneous influences of drugs and other factors. On the other side the disadvantage of the pharmacogenetic testing is, that genotype does not always correlate with observed metabolic activity recorded using probe drug(s). This discrepancy may be caused by various epigenetic factors as well as by inhibition or induction of enzyme metabolic activity caused by other xenobiotics coadministered. 2.2 Conventional probe substrates for in vivo metabolic activity assessment Metabolic activity of various CYP enzymes is most often assessed using selective substrate of distinct CYP enzyme ("marker of metabolic activity"), i.e. a drug (or substance) which is ideally metabolized by th...