Professional opportunity for pharmacists to integrate pharmacogenomics in medication therapy

摘要

Over the past decade, the integration of genetic information into the daily care of patients has led to a redefined concept of individualized medicine and has made significant progress. Pharmacogenomics (PGx) is becoming one of the pillars of proactive health care and represents the "low-hanging fruit" in the emerging field of genomic medicine, given its potential in predicting medication safety and efficacy. PGx is the study of how variations in an individual's genetic makeup affect the response to medications. Genetic variants may affect the pharmacokinetics as well as the pharmacody-namics of a medication. For example, genetic variations in the cytochrome P-450 (CYP) iso-enzymes can produce differences in enzyme activity that change the amount of drug available in the body. This can have a clinical significance regarding adverse drug reactions, drug efficacy and dose requirements for commonly used drugs, such as antidepressants, opiates, proton pump inhibitors and many more. For instance, clopidogrel is a prodrug that is metabolically converted by the CYP2C19 gene in the liver to its active metabolite and irreversibly inhibits platelet aggregation. Individuals who have significantly reduced function of the CYP2C19 gene may not respond to clopidogrel therapy because of diminished platelet response and may benefit from alternative antiplatelet therapy such as prasugrel or ticagrelor.