title: From evidence based medicine to mechanism based medicine. Reviewing the role of pharmacogenetics.
abstract: 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.
authors.affiliation: Department of Quality and Patientsafety, Zorggroep Noorderbreedte, PO Box 888, 8901 BR Leeuwarden, The Netherlands. B.Wilffert@ZNB.NL
authors.forename: Bob
authors.initials: B
authors.lastname: Wilffert
authors.forename: Jesse
authors.initials: J
authors.lastname: Swen
authors.forename: Hans
authors.initials: H
authors.lastname: Mulder
authors.forename: Daan
authors.initials: D
authors.lastname: Touw
authors.forename: Anke-Hilse
authors.initials: AH
authors.lastname: Maitland-Van der Zee
authors.forename: Vera
authors.initials: V
authors.lastname: Deneer
mesh_terms: D003577:Cytochrome P-450 Enzyme System / Q000235:genetics*; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions; D019317:Evidence-Based Medicine; D006801:Humans; D008511:Medicine; D010597:Pharmacogenetics; D011110:Polymorphism, Genetic; D013810:Therapeutic Equivalency
chemical_list: D003577:Cytochrome P-450 Enzyme System