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Pharmacogenomics (PGx): The New Frontier in Medication Use

Pharmacogenomics (PGx) has potential to revolutionize current and future medication therapy. Are we ready?

Much of medication use now and in the past has been trial and error. Try a med, then either it works, doesn’t work or produces an adverse drug reaction (ADR) resulting in the changing of the medication to something else and repeating the process. This process is inconvenient to both provider, patient and in the long run increases the cost of healthcare through less than optimal patient outcomes.

Wouldn’t it be great if we could take much of the guesswork out of medication use ,where based on genetic make-up, we could pick the right drug at the right dose the first time?

PGx testing can make this happen with a much higher frequency than is now obtainable. One can now use PGx testing to determine how multiple genes direct the metabolism of anticoagulants such as warfarin and use the results in an online calculator to arrive at a more accurate starting dose of warfarin to help avoid bleeds or to increase the odds of being in therapeutic range to prevent clotting when the drug is first started. PGx testing can help prevent repeated lab draws and changing of the dose over many days or weeks to get the patient into therapeutic range. With PGx testing one can determine if clopidogrel will work after a heart attack. If tamoxifen will work after breast cancer surgery. If a patient will have a chance of a possible severe, life threatening reaction to some medications such as carbamazepine, allopurinol or certain chemotherapy or antiviral agents.

Now is the time for medicine and pharmacy to change our thinking about medication use and leverage this new technology. It is also time for third party payers to adequately pay for PGx lab testing and associated PGx clinical services provided by physicians and pharmacists. In the long run healthcare costs will be decreased using PGx labs and services effectively.

Granted, the science is still being studied to increase the level of evidence needed for better polymorphism predictability and some genes are much better studied than others. However, enough data are available now, if not for precise clinical decision making, to use as a guide in many cases.

After several years as a PGx clinician, seeing the benefits and potential of PGx testing and clinical services, I’m a believer in the science and see it as a new frontier in medication use with unlimited possibilities. But collectively, are we ready?