There is a strong and ever-growing body of evidence regarding the use of pharmacogenomics to inform cardiovascular pharmacology. Given the broad relevance of pharmacogenomics to areas, such as thrombosis and coagulation, interventional cardiology, heart failure, arrhythmias, clinical trials and policy / regulatory activity within cardiovascular medicine, as well as to genomic and pharmacology subspecialists, the newest position statement from February 2021 attempts to address these issues and recommend prospective genotyping test prior to anticoagulants, antipalets, statins and betablockers. European Heart Journal - Cardiovascular Pharmacotherapy, pvab018, https://doi.org/10.1093/ehjcvp/pvab018
Up to 30% of patients do not respond well to the anticonvulsants they try. A recent report shows that people on a more aggressive treatment regimen, with three or more antiepileptic medications, have a three times lower risk of sudden death than people treated with one AED alone. Combinations including lamotrigine, valproic acid and levetiracetam were associated with reduced risk. Concurrent treatment with statins also reduced the risk of death, while antidepressants had no effect. While no one specific antiepileptic drug was associated with a higher risk than the others, poor adherence to treatment significantly raises the chance of seizure-related death. In general, the chance of side effects increases the more medications a person takes. Pharmacogenetic testing can be instrumental in guiding medication selection and tailoring medication dosage to reduce these risks and improve peace of mind with overall treatment. First published September 23, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010874 Pharmacogenetic testing informs epilepsy treatment Pharmacogenetic tests can assess the metabolism of multiple medications used for epilepsy treatment. Personal Medicine Profile is a leading pharmacogenetic medication optimization service that includes a state-of-the-art pharmacogenetic test and a medication review by a clinical pharmacist. Personal Medicine Profile pharmacists will provide written recommendations for your doctor on safe AED drug selection and dosage ranges to help manage your epilepsy. Summary Epilepsy medication should be matched to epilepsy type and your genetic profile Mismatched treatment can lead to undesired side effects and reduced compliance with treatment, which could be fatal HLA genes determine the risk of SJS, severe AED-induced skin toxicity. Ask your doctor if you are in a high-risk category Pharmacogenetic testing coupled with a pharmacist review of medications can provide insights into your metabolism of many drugs used for epilepsy treatment Knowing your inherited drug metabolic profile can help your doctor select appropriate drug doses and reduce side effects.
Studier af Karina Porsborg Kibsdal og Heidi Kudsk viser at knap 690.000 danskere (12%) får seks eller flere lægemidler, hvilket er forbundet med bivirkninger, der kan føre til indlæggelser. Det er dyrt for regionerne, og det nedsætter livskvaliteten for dem, det rammer. Medicingennemgang i almen praksis er en kompleks og tidskrævende opgave, og hvis ikke vi gør noget nyt, må vi forvente at antallet og udgifterne til medicinrelaterede indlæggelser stiger. https://bpno.dk/artikler/farmaceuter-som-ny-faggruppe-i-almen-praksis/
The use of clopidogrel and PPIs either alone or in combination is quite widespread, in particular among the elderly and persons with diabetes. This further supports the emerging need of accessing and accounting for not only DDI (drug-drug-interactions) but also for applying PGx-guided drug therapy in clinical decision making for antiplatelet therapy with clopidogrel having a particular focus on persons with diabetes and the elderly. https://doi.org/10.3390/metabo11020096 Keywords: clopidogrel; proton pump-inhibitors, drug use, pharmacogenomics, polypharmacy, drug-drug interactions, drug-gene interactions, drug-drug-gene interactions, diabetes, elderly, cardiovascular disease.
The literature on pharmacogenomics as a tool to support antidepressant precision is burgeoning. In this prospective, single-blind randomized controlled design, the impact of pharmacogenomics guided versus standard antidepressant was evaluated. Participants were 213 outpatients diagnosed with major depressive disorder and/ or generalized anxiety disorder, randomized to receive pharmacogenomics guided (n = 105) or standard antidepressant treatment (n = 108); participants were blinded to the study. Patient reported outcomes of depression, anxiety, disability, and treatment satisfaction were assessed at months 0, 1, 3, and 6. Hypotheses were investigated using mixed effect models on the full data. All clinical outcomes improved significantly. A randomized controlled trial. Clin Transl Sci. 2021;00:1–10. https://doi.org/10.1111/cts.12986
A Danish register study shows that 49 drugs have "actionable guidelines" related to CYP2C6 and CYP2C19 corresponding 14.5% of the total sales in DDD. Pantoprazole, lansoprazole, omeprazole, clopidogrel and metoprolol constituted fifty-eight percent of the consumption in DDD of drugs having "actionable guidelines". The consumption of antidepressant drugs, opioides, and antipsychotic drugs were 441.850 users, 427.765 users and 128.935 users, respectively. Age distribution of consumption of drugs and drug combinations e.g., for sertraline redeemed either alone or in combination with metoprolol and tramadol, are presented in the study. The exploratory register study clearly showed that a large fraction of the Danish population, especially the elderly, are exposed to drugs or drug combinations for which there excist "actionable guidelines" related to CYP2C6 AND CYP2C19. Westergaard et al. J. Pers.Med 2020, 10(3); doi:10.3390/jpm10010003