Clinical practice pharmacogenetics

Kirchheiner, J. Fuhr, U. Brockmoller, J. Pharmacogenetics-based therapeutic recommendations—ready for clinical practice Nat. Rev. Drug Discov. 2005, 4 (8), 639-647. 

Gardiner SJ, Begg EJ. Pharmacogenetics, drug-metabolizing enzymes, and clinical practice. Pharmacol Rev. Sep 2006 58(3) 521-590. 

Kirchheiner J, Fuhr U, Brockmoller J (2005) Pharmacogenetics-based therapeutic recommendations - ready for clinical practice Nat Rev Drug Discov 4 639-647... 

To illustrate how clinical decision support tools can be used to optimize patient care, a few clinical scenarios have been included. In current clinical practice, the results of pharmacogenetic testing are likely to be available at different times relative to the induction of warfarin therapy. For the hospitalized patient for whom warfarin therapy is anticipated, genotyping results can be made available before the patient receives the first dosage. In this clinical scenario, the pharmacogenetic test results can be useful in the design... 

Perhaps the best laboratory test to compare with pharmacogenetic testing is a drug blood level, technically called therapeutic drug monitoring (TDM), which could be considered a phenotypic test of metabolic enzymes [97]. Almost no studies of TDM cost effectiveness exist [98], except for some studies of antibiotics. However, TDM appears to be standard clinical practice (medical insurers routinely reimburse for it) for classic anticonvulsants, theophylline, digoxin, immunosuppressants, and some psychiatric drugs [98]. 

Grossman 1. Routine pharmacogenetic testing in clinical practice dream or reality Pharmacogenomics 2007 8 1449-59. 

---