- Trial and error approaches for drug selection and dosing have typically been the standard for patients suffering from anxiety, depression, bipolar disorder and other behavioral disorders
- Optimizes clinician’s medication selection through PGx-based decision support, reducing the lag-time between medication intervention and optimal therapeutic benefit
- Multiple classes of psychiatric medications including antidepressants, antipsychotics, benzodiazepines, norepinephrine reuptake inhibitors, substituted amphetamines and more.
Psychiatric Pharmacogenetic Test
Most psychiatric drugs are metabolized by the Cytochrome P450 enzymes. Antidepressants and antipsychotics are mainly metabolized by CYP2D6, CYP3A4, CYP3A5, CYP2C9 and CYP2Cl 9.
This test is designed to identify drug and disease associated variants in DNA that facilitate development of prevention,
diagnostic and treatment strategies for the provider.
Currently the patient drug therapy is based on provider experience and trial and error. 30 – 50% of individuals prescribed psychopharmaceutical agents have a suboptimal experience.
Pharmacogenetic testing may provide information that can assist in the selection and dosing of medications.
Psychiatric Pharmacogenetic Panel
CYP2D6 It plays a primary role in the metabolism of more than 70 substrate medications which include 12 psychotropic medications. Some of the drugs metabolized by CYP2D6 are: Fluoxetine, paroxetine, venlafaxine, despiramine, nortriptyline, Fluphenazine and Clozapine
CYP2C9 CYP2C9 is directly or in-directly involved in the metabolism of several psychiatric medications (e.g. fluoxetine, amitriptyline, doxepin, escitalopram, duloxetine, olanzapine, etc). CYP2C9 also provides
a secondary pathway for the metabolism of some medications like fluoxetine. As a result, patients who have variants in this gene may be at higher risk of adverse effects.
CYPC19 This is important because it allows clinicians to decrease the risk of iatrogenic side effects.
CYPCl 9 polymorphisms are associated with differences in drug metabolism for many antidepressants . It primarily metabolizes citalopram, escitalopram, clomipramine and amitriptyline and has substantial involvement in the metabolism of sertraline, imipramine and doxepin.
CYP3A They metabolize over 50% of currently approved drugs. CYP3A4 and CYP3A5 are the most common expressed in the liver and therefore important in drug metabolism. CYP3A4 and CYP3A5 have been associated with decreased enzyme activity possibly leading to increased drug levels and toxicity.
Example of drugs metabolized by CYP3A4 and CYP3A5 : Carbamazepine, fentanyl, nifedipine and cyclosporine.