According to World Health Organization (WHO), major depressive disorder will be major cause of disability by 2030. The current prescribing model is based mainly on trial and error. It can take months for a patient to get to a therapeutic level. Using pharmacogenomics (PGx) as a tool to guide therapy can cut down the time to get to therapeutic level.
PGx can also be used in guiding cancer treatment where drug resistance and severe side effects are the major barriers. Genetic variance in some patients can interfere with their ability to process their medication which when on chemotherapy, it can put a patient at risk. FDA requires genomics testing on some medications ahead of starting chemotherapy.
The current practice model for prescribing medications related to mental health is a lengthy trial and error process. We have counseled numerous patients on managing their chronic conditions and have seen them go through 6 to 9 months of mental instability before they find the medication that works for them. We wanted to change that and shorten the time it takes to achieve the quality of life they deserve.
Every medication works differently for every single one of us. There are many factors that play a part in how the body reacts to a medication, including age, race, sex, and genetic makeup. Pharmacogenomics testing has been around a very long time but many providers do not have the time to implement that in their daily practice. More importantly, there is a huge gap in being able to interpret the complex raw data into an actionable clinical plan. So, we wanted to change that.
Utilizing a trained pharmacogenomics certified pharmacist as a part of an inter-disciplinary team, can give power to providers and their patients to increase the quality of care. The extensive training our pharmacists go through fills in that huge gap by creating a one-page summary of actionable plan. This is called precision medicine, where medications are personalized based on a patient’s genetic makeup.
Everyone has unique genes that code for enzymes which are needed to activate or break down a medication. The level of activity of an enzyme (slow, intermediate, fast acting) will determine how the body will react to that medication. There are many people who are on clopidogrel (Plavix), an inactive drug, which requires the enzyme CYP2C19 to activate before it can have its therapeutic effect.
If a patient is a poor metabolizer of CYP2C19, the enzyme is not able to activate clopidogrel; therefore, the concentration of active metabolite is greatly decreased to almost none. This can cause therapeutic failure and put patient at risk for stroke or heart attacks. A pharmacogenomics test before a patient starts clopidogrel could be a life changer for a patient. Can be a life and death situation in some cases. So, pharmacogenomics plays a key factor in many disease states.
There are many people who are on omeprazole (Prilosec) for stomach acid which is a CYP2C19 inhibitor. This is the same enzyme needed for activation of clopidogrel. Taking both would inhibit the activation of clopidogrel which again means no therapeutic effect. This is a classic example of a drug-gene interaction.
With a painless cheek swab, pharmacogenomics test can be done to help understand that genetic makeup so that medications can be personalized.