October 2019

This month I want to draw from a very fresh topic. One in which I have been engaged with at work as Mayo Clinic has taken the lead on both the national and international level. Pharmacogenomics or personalized medicine refers to the effects of genes on a patient’s response to medication. Genetic variations may impact a drug's pharmacokinetics (absorption, distribution, metabolism, and excretion) and pharmacodynamics (relationship between a drug's concentration, site of action, and its resultant clinical effects). In some patients, a particular drug at the standard dose might not work well enough or may even trigger a serious adverse reaction. The reasons for this lie, at least in part, in your genes. By using your unique genetic makeup as a factor when prescribing a drug for you, your doctor can maximize treatment effectiveness while avoiding potentially life-threatening side effects.

The Right10K Protocol from the Mayo Clinic Center for Individualized Medicine's Pharmacogenomics Program screened 10,000 patients for variants in 84 genes known to influence drug response. Clinicians treating patients in the study can act on this information with the help of a pharmacogenomic "drug-gene pair" alert system programmed into the electronic medical record. If an actionable item is found the clinician can then consider changing the dosage or drug due to the likelihood of toxicity or lack of drug effect.

Until recently, pharmacogenomics has been isolated to specialty clinics (i.e. HIV, oncology and transplant). Specialists in these areas deal with therapies on a daily basis that have severe, sometimes deadly side effects, so patients almost always undergo genetic testing before taking the drug. Now more routine disease states (pain control, Hyperlipidemia, depression) can be individualized for optimal health outcomes.

Some common medications/classes that are affected by genetic variations can be seen below:

Medications, which can be optimized with genetic testing, will be added to this list often. The test is a simple lab draw with results being available to patient 2-3 weeks later. If you decide to get tested it is recommended that you follow-up with your physician regularly to see if your drug therapies are impacted. I, too, can be a resource if needed.

Together we can be a healthier community.

God Bless – Joe Flynn, PharmD