title: Precision Medicine in Toxicology.
abstract: Precision medicine applies primarily to pharmacokinetics in toxicology. Mastering hepatic metabolism through an understanding of the genetics behind Phase I, or oxidation/reduction and some Phase II, or conjugation, enhances the scientific and clinical application of common drug toxicology. This review includes basic hepatic metabolism, the common substrates, inducers and inhibitors of cytochrome P450 along with genetic variants behind the enzymes. Detailed metabolism of commonly measured opioids in clinical practice is provided. Finally, evidence based research and clinical correlations conclude that knowledge of inducers and inhibitors, in conjunction with genetic variations, are integral components for applied precision medicine in toxicology.
authors.affiliation: The Center for Pain Recovery, 18444 West 10 Mile Road, Suite 102, Southfield, MI 48075, USA. Electronic address: dr@painrecoverymd.com.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Schwarz
authors.affiliation: Laboratory Operations, Alere Toxicology, 9417 Brodie Lane, Austin, TX 78748, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: George
authors.affiliation: Department of Pathology, Wayne State University School of Medicine, 540 East Canfield, Detroit, MI 48201, USA; Consolidated Laboratory Management Systems, 24555 Southfield Road, Southfield, MI 48075, USA.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Bluth
mesh_terms: D065607:Cytochrome P-450 Enzyme Inhibitors; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects* / Q000378:metabolism; D004247:DNA / Q000235:genetics; D004790:Enzyme Induction; D006801:Humans; D008099:Liver / Q000378:metabolism*; D010084:Oxidation-Reduction; D020641:Polymorphism, Single Nucleotide; D057285:Precision Medicine / Q000379:methods*
chemical_list: D065607:Cytochrome P-450 Enzyme Inhibitors; D004247:DNA; D003577:Cytochrome P-450 Enzyme System
keywords: Cytochrome; Metabolism; Pharmacogenetics; Pharmacogenomics; Precision medicine; Toxicology