From evidence based medicine to mechanism based medicine. Reviewing the role of pharmacogenetics.
OBJECTIVE
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.


METHODS
Literature review.


RESULTS
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.


CONCLUSIONS
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.
Department of Quality and Patientsafety, Zorggroep Noorderbreedte, P.O. Box 888, 8901 BR Leeuwarden, The Netherlands. B.Wilffert@ZNB.NL
Bob
B
Wilffert
Jesse
J
Swen
Hans
H
Mulder
Daan
D
Touw
Anke-Hilse
AH
Maitland-Van der Zee
Vera
V
Deneer
D064420:Drug-Related Side Effects and Adverse Reactions; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010597:Pharmacogenetics; D011110:Polymorphism, Genetic; D057285:Precision Medicine / Q000379:methods; D013810:Therapeutic Equivalency; D057170:Translational Research, Biomedical / Q000379:methods*
D004364:Pharmaceutical Preparations