A Case For Alerts
Cytochrome P450 genes are the major enzymes involved in drug activation and metabolism. People who carry certain gene variations (polymorphisms) may be at risk of nonresponse or overresponse to medications, adverse drug reactions and drug toxicity. Such documentation in a patient's electronic medical record is akin to a flashing, genomic, medical alert band. Understanding an individual's pharmacogenomics profile makes this possible.
The right drug … at the right dose … at the right time. Those goals drive pharmacogenomics — how genetics influence a person's response to medications.
Chemotherapy drugs are more effective when treating certain types of cancers. Codeine offers no pain relief in some patients and in others causes life-threatening reactions, such as respiratory depression. Other individuals experience harmful side effects from statin drugs designed to lower cholesterol levels. Finding the right dose of blood-thinning agents, such as warfarin, can involve a long process of trial and error.
Some Food and Drug Administration-approved drug labels contain warnings or information about potential adverse event risks, variable responses, drug-action mechanisms or genotype-based drug dosing. Recommendations are based on genomic information about the drug.
Pharmacogenomics drives greater drug effectiveness, with increased safety and reduced side effects. At Mayo Clinic, drug-gene alerts are part of the electronic medical record system, assisting providers in delivering safer, more effective care.
Each day, research uncovers new gene variants or novel drug-gene interactions that influence whether a patient may be harmed or helped by a medication. Keeping up to date with complex, new genomic information is a challenging task for clinicians, but decision-support tools and online education helps.
For the record
The Center for Individualized Medicine at Mayo Clinic is adding drug-gene interactions to the patient electronic medical record to alert physicians and pharmacists at the point of care as part of the clinical decision-support system.
If genomic information exists for a drug-gene interaction, alerts are triggered in the patient's electronic medical record to guide the clinician regarding prescription choices and dosing recommendations.
A team of physicians, pharmacists, genetic counselors and medical educators provides just-in-time education linked to these pop-up alerts. Online resources provide information about:
- Appropriate genetic testing
- Patients at increased risk of adverse side effects
- Suggested dosing recommendations
Ongoing discovery and validation of new drug-gene pairs at Mayo Clinic and elsewhere will result in additional alerts being added to the electronic medical record.
Individualized Medicine — Andrew's Story
Applied pharmacogenomics resolves a patient's lifelong anxiety and depression.