ACLSmed™

Pharmacogenomic testing in primary care

Pharmacogenomics (PGx) in Primary Medicine – Benefits of Personalized Medicine.


Pharmacogenomics (PGx) testing is a type of genetic test that assesses a patient’s risk of an adverse response or likelihood to respond to a given drug, informing drug selection and dosing.1 As a pillar of the personalized medicine movement, PGx testing is anticipated to be important across all medical specialties,2 but particularly in primary medicine, where the majority of all drug prescriptions are written.3 It has been estimated that many of the drugs commonly prescribed by primary medical physicians such as fluoxetine, metoprolol, warfarin, and simvastatin are affected by PGx variation.4,5

As a primary medical physician, you frequently find yourself challenged by patients with multiple health issues already taking several medications by the time they’re referred to your practice. There are more than 100 commonly prescribed medications that have significant pharmacogenetic information on the FDA label and a skyrocketing number of possible drug interactions. How do you make the best treatment choice for your patient?


What is included in the ACLSmed test bundle?

UDT

The use of urine drug testing has increased over recent years. Physicians can use UDT to assist in monitoring treatment plans in a patient-centered fashion, where the patient and physician interests are maintained.

OFT

Oral fluid testing provides confidential lab-based drug test results in an easy-to-use collection method. Donors can collect samples on-site, reducing the likelihood of tampering.

PGx

One of the many challenges in the cardiology setting is treating patients who are already taking multiple medications. Until recently practitioners had no choice than to prescribe treatment without understanding how individual patients will respond. Pharmacogenomic testing provides valuable personalized information about the patient and the potential outcomes of treatment.


ACLSmed™ testing is designed to:

  • Evaluate patient genetic variability that could potentially deem a particular drug ineffective.
  • Determine appropriate therapy for each patient, based on genetic variability.
  • Evaluate potential drug-drug interactions and susceptibility of each patient.
  • Improve informed consent by communicating current and future therapy trends specifically engineered for each individual.
  • ACLSmed™ testing is the foundation of personalized medicine and it will help us select the right drug at the right dose, for the right patient.

Medications with Significant Pharmacogenetic Information on the FDA Label.

DrugBiomarkerDrugBiomarkerDrugBiomarker
AmitriptylineCYP2D6ClopidogrelCYP2C19MetoprololCYP2D6
AripiprazoleCYP2D6ClozapineCYP2D6NortriptylineCYP2D6
AtomoxetineCYP2D6CodeineCYP2D6PerphenazineCYP2D6
CarisoprodolCYP2C19DesipramineCYP2D6PropafenoneCYP2D6
CarvedilolCYP2D6DiazepamCYP2C19Quinidine / Dextrome- thorphanCYP2D6
CelecoxibCYP2C9DoxepineCYP2C19 and CYP2D6RisperidoneCYP2D6
CevimelineCYP2D6FluvoxamineCYP2D6ThioridazineCYP2D6
CitalopramCYP2C19GlalantamineCYP2D6TolterodineCYP2D6
ClobazamCYP2C19IloperidoneCYP2D6RramadolCYP2D6
ClomipramineCYP2D6ImipramineCYP2D6WarfarinCYP2C9

ACLSmed™ Helps You Achieve Optimal Prescribing

More than fifty percent of all commonly prescribed medications are metabolized through the cytochrome pathway and as the table below demonstrates, variations are extremely common. This genetic variability is a critical aspect governing how an individual patient will respond to medications.

ACLSmed™ Test Panel includes testing of all clinically significant genetic variants in CYP2D6, CYP2C9, CYP2C19, VKORC1, CYP3A4, CYP3A5 and other important drug-metabolizing genes.


ACLSmed™ Helps You with Polypharmacy Safety – Now and in the Future

Many patients are also battling other conditions such as heart disease, psychiatric conditions, or cancer that make multiple prescriptions necessary. Our body’s limited capacity to process medications is easily slowed by competition between other drugs, supplements, and over-the-counter medications. This is further compromised in patients with genetic variations.

Whether a patient is genetically a poor metabolizer or has become a poor metabolizer because of other medications, it’s been shown by prospective trials, population analyses, and case studies he or she can experience an increase in adverse drug events due to reduced elimination.


References

  1. WangL,McLeodHL,WeinshilboumRM.Genomicsanddrugresponse. N Engl J Med. 2011;364(12):1144–1153.
  2. ManolioTA,ChisholmRL,OzenbergerB,etal.Implementinggenomic medicine in the clinic: the future is here. Genet Med. 2013;15(4): 258–267.
  3. CDC/NCHS.NationalAmbulatoryMedicalCareSurvey:2010Summary Tables. Atlanta, GA: Centers for Disease Control and Prevention; 2010. Available from: http://www.cdc.gov/nchs/data/ahcd/namcs_ summary/2010_namcs_web_tables.pdf. Accessed August 1, 2013.
  4. Frueh FW, Amur S, Mummaneni P, et al. Pharmacogenomic biomarker information in drug labels approved by the United States Food and Drug Administration: prevalence of related drug use. Pharmacotherapy. 2008;28(8):992–998.
  5. Grice GR, Seaton TL, Woodland AM, McLeod HL. Defining the opportunity for pharmacogenetic intervention in primary care. Pharmacogenomics. 2006;7(1):61–65.