Overview of pharmacogenomic testing in clinical practice

Abstract

Introduction:Pharmacogenomic tests relevant to neuropsychiatric medications have been clinically available for more than a decade, but the utility of regular testing is still unknown. Tests available include both pharmacokinetic and pharmacodynamic targets. The potential practice benefits vary with each target.Methods:A 10-year literature review was completed utilizing the PubMed database to identify articles relating to the specific pharmacogenomic targets discussed. Further article selection was based on author review for clinical utility.Results:The clinical dosing guidance available for neuropsychiatric medications such as selective serotonin reuptake inhibitors and tricyclic antidepressants with varying genotypes is useful and has strong evidence to support testing, but it is limited to mainly pharmacokinetic application. Pharmacodynamic targets are gaining additional evidence with increased research, and although the mechanisms behind the potential interactions are scientifically sound, the bridge to clinical practice application is still lacking.Discussion:Although the benefits of decreasing adverse reactions and improving response time are appealing, clinicians may not utilize pharmacogenomic testing in routine practice due to several barriers. Further clinical guidance and studies are needed to support testing for other neuropsychiatric medications and targets.

Heterogeneity in the distribution of 159 drug-response related SNPs in world populations and their genetic relatedness

“…There is a global concern to increase pharmacogenetic testing to ensure drug safety and enhance drug efficacy [125,126]. However, most GWAS to identify drug-response related variants have been performed in the western populations and others have lagged behind [7,127,128].…”

Rural Community Perceptions and Interests in Pharmacogenomics

“…As pharmacogenomics and other genetic testing services becomes more mainstream, it is becoming easier to engage all stakeholders in conversations about the benefits of pharmacogenomics testing. Most studies published on the attitudes of the lay public educated the survey participant prior to giving them the survey [ 1 , 3 , 4 , 16 , 18 , 24 , 25 ]. In our rural assessment of patients at community pharmacies, we provided no education on the benefits of pharmacogenomics testing and yet the individuals believed pharmacogenomics could be beneficial to them.…”

“…Precision medicine utilizes a patient’s unique genetic makeup, environment, and lifestyle to make healthcare decisions. While still an emerging field, the practice is gaining considerable momentum and study [ 1 ]. Pharmacogenomics, where medication use and precision medicine intersect, accounts for the genetic variability of drug response.…”

Pharmacogenomic Characterization in Bipolar Spectrum Disorders

“…The drug metabolism (phase I) of psychiatric medications involves CYP 1 to three families, including CYP1A2, CYP2B6, CYP3A4/5, CYP2C9, CYP2C19, and CYP2D6. These CYP enzymes can be analyzed to personalize drug prescription and administration [163].…”