title: Personalized prescribing: a new medical model for clinical implementation of psychotropic drugs.
abstract: The use of pharmacogenetic tests was already being proposed in psychiatry in the early 2000s because genetic factors were known to influence drug pharmacokinetics and pharmacodynamics. However, sufficient levels of evidence to justify routine use have been achieved for only a few tests (eg, major histocompatibility complex, class I, B, allele 1502 [HLA-B*1502] for carbamazepine in epilepsy and bipolar disorders); many findings are too preliminary or, when replicated, of low clinical relevance because of a small effect size. Although drug selection and dose adaptation according to cytochrome P450 genotypes are sound, a large number of patients need to be genotyped in order to prevent one case of severe side effect and/or nonresponse. The decrease in cost for genetic analysis shifts the cost: benefit ratio toward increasing use of pharmacogenetic tests. However, they have to be combined with careful clinical evaluations and other tools (eg, therapeutic drug monitoring and phenotyping) to contribute to the general aim of providing the best care for psychiatric patients.
authors.affiliation: Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland; School of Pharmacy, Department of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
authors.forename: Chin B
authors.initials: CB
authors.lastname: Eap
mesh_terms: D003577:Cytochrome P-450 Enzyme System / Q000235:genetics* / Q000378:metabolism; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy / Q000235:genetics*; D000071185:Pharmacogenomic Testing; D010818:Practice Patterns, Physicians'; D057285:Precision Medicine; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000378:metabolism* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D011619:Psychotropic Drugs; D003577:Cytochrome P-450 Enzyme System
keywords: antidepressant; antipsychotic; cytochrome P450; pharmacodynamic; pharmacogenetic; pharmacogenomic; pharmacokinetic; psychiatry; psychotropic drug; therapeutic drug monitoring