Identifying drugs needing pharmacogenetic monitoring in a Korean hospital.
OBJECTIVE
A decision matrix for identifying drugs for which pharmacogenetic drug monitoring (PDM) provides the greatest benefit in a Korean setting is described.


CONCLUSIONS
We developed a decision matrix including the ethnic frequency of clinically relevant polymorphic cytochrome P-450 (CYP) enzymes, and the metabolic profiles and adverse drug reactions of drugs. Using the developed decision matrix based on the population allele frequencies of CYP enzymes, we identified potential candidates for PDM among the most commonly used drugs at Seoul National University Hospital (SNUH). Collectively, 17 of these drugs were largely metabolized by at least one polymorphic CYP enzyme. Pharmacogenetic information was used to identify CYP2C9, CYP2C19, and CYP2D6 as the major CYP enzymes of clinical importance for pharmacologic effect and safety in Koreans. The frequencies of poor and intermediate metabolizers among Koreans were 0% and 2.3-12% for CYP2C9, 12% and 42% for CYP2C19, and 0.44% and 28% for CYP2D6, respectively. The frequency of ultrarapid metabolizers of CYP2D6 was 2.28%. The decision matrix and pharmacogenetic information were used to identify seven drugs for PDM: warfarin, glimepiride, diazepam, amitriptyline, nortriptyline, codeine, and oxycodone. This approach can be applied to other institutional hospitals or other ethnic populations and would be helpful for advancing pharmacy practice. Further work is required to assess the practical and potential clinical relevance of pharmacogenetic variations on drugs of interest before the implementation of PDM.


CONCLUSIONS
A decision matrix helped identify drugs for which PDM provides the greatest potential benefit at one Korean hospital.
Kim
Young Mi
YM
Department of Pharmacy, Seoul National University Hospital, Seoul, Korea.
Yoo
Seung Hee
SH
Kang
Rae Young
RY
Kim
Min Jung
MJ
Bae
Yoon Young
YY
Lee
Yeon Kyung
YK
Jeon
Su Jin
SJ
Chon
Kung Ju
KJ
Shin
Sang Mi
SM
Kim
Sang Geon
SG
Park
Kyoung Ho
KH
Son
In Ja
IJ
D000483:Alleles; D044466:Asian People / Q000235:genetics; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics* / Q000378:metabolism; D003657:Decision Making; D016903:Drug Monitoring; D064420:Drug-Related Side Effects and Adverse Reactions; D005787:Gene Frequency; D005838:Genotype; D006761:Hospitals; D006801:Humans; D007723:Korea; D004364:Pharmaceutical Preparations / Q000378:metabolism*; D010597:Pharmacogenetics; D011110:Polymorphism, Genetic
D004364:Pharmaceutical Preparations; D003577:Cytochrome P-450 Enzyme System