title: Novel Use of Pharmacogenetic Testing in the Identification of CYP2C9 Polymorphisms Related to NSAID-Induced Gastropathy.
abstract: OBJECTIVE
  To illustrate the potential value of pharmacogenetic testing to identify patients at risk for nonsteroidal anti-inflammatory drug-induced gastropathy.
  
  
  METHODS
  Case report.
  
  
  METHODS
  We report a case encountered in an outpatient setting for pain management.
  
  
  METHODS
  We present a case of a patient treated with celecoxib who developed severe nonsteroidal anti-inflammatory drug-induced gastropathy.
  
  
  METHODS
  Suspecting a relation between this adverse event and altered drug metabolism, pharmacogenetic testing was performed to assess the role of the cytochrome P450 (CP450) enzyme profile.
  
  
  RESULTS
  Pharmacogenetic testing revealed a relation between this adverse event and an allelic variant of cytochrome P450, CYP2C9, subsequently leading to discontinuation of the drug along with counseling to caution the patient to avoid the use of celecoxib and other drugs metabolized by the same enzyme.
  
  
  CONCLUSIONS
  Although pharmacogenetic testing is not routinely used in clinical decision making, pain physicians must be aware of the potential benefits of this testing for managing patients with pain, and to improve drug efficacy and safety profile.
authors.affiliation: University Pain Institute, Division of Pain Medicine & Regional Anesthesiology.
authors.forename: Anita
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Clinical Research Group, Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Lu
authors.initials: L
authors.lastname: Zheng
authors.affiliation: Clinical Research Group, Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Vendhan
authors.initials: V
authors.lastname: Ramanujam
authors.affiliation: Clinical Research Group, Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gallagher
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000068579:Celecoxib / Q000009:adverse effects*; D018856:Cystitis, Interstitial / Q000188:drug therapy; D065729:Cytochrome P-450 CYP2C9 / Q000235:genetics*; D005260:Female; D005756:Gastritis / Q000139:chemically induced*; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D020641:Polymorphism, Single Nucleotide; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; D000068579:Celecoxib
keywords: CP450; CYP2C9; Efficacy; Gastropathy; NSAIDs; Outcomes; Pharmacogenetic Testing