Exciting research is underway to understand how genomic information can be used to develop more personalized and cost-effective strategies for using drugs to improve human health. Everyone has unique, complex genetic characteristics. We typically think of these as things that determine our hair color or whether we are likely to develop certain diseases. However, genetics also affect how we respond to most commonly prescribed medications.
The majority of people have genetic variations that determine how their bodies process drugs. This applies not only to prescription medications, but also to over-the-counter medicines, herbal and dietary supplements, and recreational drugs such as marijuana. Because of their genetic makeup, some people process (metabolize) drugs slowly. As a result, a drug may accumulate in the body, causing toxicity. Other people metabolize drugs so quickly that after they take a usual dose, drug levels in the blood never become high enough for the drug to be effective. In some cases, drug-related side effects can be serious or cause death – even though the drug was prescribed correctly by the doctor and used correctly by the patient. People who take several different drugs face an even greater risk of dangerous side effects, especially if they are over 65 years of age.
Since a patient’s response to pain and opioids is quite variable, it makes identifying patients who are good (risk-free) candidates for opioid therapy difficult. Differences in the degree of pain stimulation and pain sensitivity, weight and age differences, prior opioid use and tolerance, as well as the differences in bioavailability of various opioid formulations have been cited as causes for the wide variability. Physicians have limited tools when it comes to evaluating which patients could benefit from opioids versus nonopioids, which opioids to initiate, and/or which patients are more likely to become addicted to these opioids. Genetics may explain the variability of responses and help to predict more effective (or less dangerous) medication choices and doses. Genetics may also help to predict the response to specific opioids and antidepressants.
The study of how genetics can affect drug response is known as pharmacogenomics a new field combining the science of how drugs work with the science of the human genome. Pharmacogenomic testing is one tool that can help your healthcare provider determine the best medication for you. Currently, more than 100 FDA-approved drugs have pharmacogenomics information on their labels, in diverse fields such as analgesics, antivirals, cardiovascular drugs, and anti-cancer therapeutics. Doctors are starting to use pharmacogenomic information to prescribe drugs, but such tests are routine for only a few health problems. However, given the field’s rapid growth, pharmacogenomics is soon expected to lead to better ways of using drugs to manage heart disease, cancer, asthma, depression and many other common diseases.
Armed with the results of Pharmacogenetic testing (PGT), clinicians are better equipped to predict drug responsiveness before a patient receives a single dose. What your physician learns from genetic testing can provide information to aid in determining a target drug regimen, avoiding dangerous side effects, and achieving the desired response. This can reduce the ‘trial and error’ of prescribing and go directly to medications that offer optimal benefit and minimal adverse events, without subjecting patients to unsuccessful trials. Drug responses won’t have to be a mystery when treatments can be tailored to custom fit an individual’s specific genetic code.
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