Department of Quality and Patientsafety, Zorggroep Noorderbreedte, PO Box 888, 8901 BR Leeuwarden, The Netherlands.
Int J Clin Pharm. 2011 Feb;33(1):3-9. doi: 10.1007/s11096-011-9485-2. Epub 2011 Feb 11.
The translation of evidence based medicine to a specific patient presents a considerable challenge. We present by means of the examples nortriptyline, tramadol, clopidogrel, coumarins, abacavir and antipsychotics the discrepancy between available pharmacogenetic information and its implementation in daily clinical practice.
Literature review.
A mechanism based approach may be helpful to personalize medicine for the individual patient to which pharmacogenetics may contribute significantly. The lack of consistency in what we accept in bioequivalence and in pharmacogenetics of drug metabolising enzymes is discussed and illustrated with the example of nortriptyline. The impact of pharmacogenetics on examples like tramadol, clopidogrel, coumarins and abacavir is described. Also the present status of the polymorphisms of 5-HT2A and C receptors in antipsychotic-induced weight gain is presented as a pharmacodynamic example with until now a greater distance to clinical implementation.
The contribution of pharmacogenetics to tailor-made pharmacotherapy, which especially might be of value for patients deviating from the average, has not yet reached the position it seems to deserve.
将循证医学转化为特定患者面临着相当大的挑战。我们通过使用去甲替林、曲马多、氯吡格雷、香豆素、阿巴卡韦和抗精神病药物的例子，说明了现有药物遗传学信息与其在日常临床实践中的应用之间的差异。
文献回顾。
基于机制的方法可能有助于为个体患者实现个体化医学，而药物遗传学可能对此有重大贡献。我们接受生物等效性和药物代谢酶的药物遗传学之间的一致性的缺乏进行了讨论，并通过去甲替林的例子进行了说明。还描述了药物遗传学对曲马多、氯吡格雷、香豆素和阿巴卡韦等例子的影响。还介绍了 5-HT2A 和 C 受体多态性在抗精神病药引起的体重增加中的目前状况，作为一个药效动力学的例子，到目前为止，它与临床实施还有更大的距离。
药物遗传学在量身定制的药物治疗中的贡献，特别是对偏离平均值的患者可能有价值，但尚未达到它似乎应有的地位。
