Pharmacogenomics--the potential of genetically guided prescribing.

BACKGROUND

Matching patients to effective tolerable medications can take months of trial and error. Genetic factors can strongly influence drug response. One of the potential clinical applications of the Human Genome Project is prediction of medication response--pharmacogenomics.

OBJECTIVE

This article reviews the emerging field of pharmacogenomics and its clinical potential using the example of antidepressant and anticoagulant medication prescribing.

DISCUSSION

Growing evidence suggests genomic profiling for common variants in cytochrome P450 enzymes and transport systems involving serotonin, noradrenaline and the blood-brain barrier could inform antidepressant prescribing. Similarly, genetic testing for variants in cytochrome CYP2C9 and vitamin K epoxide reductase could inform decisions about prescribing warfarin. Large clinical trials to determine the clinical utility of this approach are required before pharmacogenomics enters routine clinical practice.