Pharmacopsychiatry 2024; 57(02): 89
DOI: 10.1055/s-0044-1779567
Abstracts │ XVth Symposium of the Task Force Therapeutic Drug Monitoring of the AGNP
Lecture Abstracts

International Guidelines of pharmacogenetic testing focusing on pharmacokinetically relevant genes and there relevance in neuropsychopharmacology

M. Schwarz
1   Institut für Laboratoriumsmedizin, LMU Klinikum München
› Author Affiliations
 

In 2020, the European Medicines Agency (EMA) recommended that patients have to be tested for the absence of the enzyme dihydropyrimidine dehydrogenase (DPD) before starting systemic cancer therapy with fluorouracil or related drugs. The international guidelines clearly refer to genotype-based dose adjustment or strict avoidance of these drugs if the genotype predicts a non-functioning DPD phenotype. This is one of the most recent examples of the use of pharmacogenetic (PGx) testing for a pharmacokinetically relevant gene in clinical medicine. Fortunately, there is no neuropsychopharmacological substance with a comparable toxicity potential, but we can learn from this application. International guidelines recommend genetic testing of pharmacogenetically relevant genes for several neuropsychopharmacological drugs, e.g. tricyclic antidepressants. The guidelines not only recommend genetic testing for specific drugs, but also include recommendations for genotype-related dose adjustment.

There is no doubt that phenotype-related, i.e. TDM-guided dose adjustment is the ideal way to optimize individual drug doses. However, in patients who show unexpected dose-dependent concentrations or unusual metabolic ratios without pharmacokinetic interactions, genotyping is strongly recommended. Apart from these cases, recent data show that genotyping-guided selection of a neuropsychopharmacological drug leads to a better therapeutic outcome. Thus, genotyping in neuropsychopharmacology appears to be an efficient tool for individualizing drug therapy that complements TDM.



Publication History

Article published online:
12 March 2024

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