Prescription Advice Based on Data of Drug-Drug-Gene Interaction of Patients with Polypharmacy

Abstract

Purpose Pharmacogenetic counselling is a complex task and requires the efforts of an interdisciplinary team, which cannot be implemented in most cases. Therefore, simple rules could help to minimize the risk of medications incompatible with each other or with frequent genetic variants. Patients and Methods One hundred and eighty-four multi-morbid Caucasian patients suffering from side effects or inefficient therapy were enrolled and genotyped. Their medication was analyzed by a team of specialists using Drug-PIN ® (medication support system) and individual recommendations for 34 drug classes were generated. Results In each of the critical drug classes, 50% of the drugs cannot be recommended to be prescribed in typical drug cocktails. PPIs and SSRI/SNRIs represent the most critical drug classes without showing a single favorable drug. Among the well-tolerated drugs (not recommended for less than 5% of the patients) are metamizole, celecoxib, olmesartan and famotidine. For each drug class, a ranking of active ingredients according to their suitability is presented. Conclusion Genotyping and its profound analysis are not available in many settings today. The consideration of frequent alterations of metabolic elimination routes and drug–drug–gene interactions by using simple rankings can help to avoid many incompatibilities, side effects and inefficient therapies.

Frequencies of Combined Dysfunction of Cytochromes P450 2C9, 2C19, and 2D6 in an Italian Cohort: Suggestions for a More Appropriate Medication Prescribing Process

“…The more drugs are taken together, the higher the risk of deleterious DDIs, which, in turn, affects the treatment’s efficacy, safety, and compliance [ 11 , 12 ]. Nowadays, DDI evaluation is increasingly affordable and advisable, since many bioinformatics tools (free or commercial) have been established to check DDIs and to optimize pharmacological therapies by drug exchange/dose adjustment [ 13 , 14 , 15 ]. However, it is noteworthy that DDI analysis tools usually suppose a normal activity of DMEs, whereas the DDI profile of a drug cocktail should be corrected by the genomic profile of each patient.…”