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Complexities of Personalized Medicine: How Genes, Drug-Drug Interactions, Dosing Schedules, and Other Factors Can Combine to Produce Clinically Meaningful Differences in a Drug’s Effect

PRESKORN, SHELDON H. MD

doi: 10.1097/01.pra.0000435038.91049.cb
COLUMNS: Psychopharmacology

Given increased knowledge from molecular biology and pharmacology, it is apparent that multiple factors can interact to produce clinically meaningful differences in a drug’s effect in specific individuals (i.e., personalized medicine). This topic is discussed in this column using iloperidone as an example. The variables discussed include dose, dosing schedule, genes, drug-drug interactions, and other medical factors. How such variables can combine to alter a drug’s effect is illustrated with a case example and the results of a thorough QTc study of iloperidone. (Journal of Psychiatric Practice 2013;19:397–405)

SHELDON H. PRESKORN, MD, is Professor, Department of Psychiatry, University of Kansas School of Medicine-Wichita; Chief Science Officer and Medical Director, Kansas University-Wichita Clinical Trials Unit (KU-W CTU), Wichita, Kansas; and research psychiatrist, Laureate Institute for Brain Research, Tulsa, Oklahoma. He has more than 35 years of drug development research experience at all levels (i.e., preclinical through Phase IV) and has been a principal investigator on over 350 clinical trials—funded by industry, the federal government, or private foundations—including trials of every antidepressant and antipsychotic medication marketed in the United States over a period of 25 years. Dr. Preskorn maintains a website at www.preskorn.com where readers can access previous columns and other publications.

Disclosure statement: Over his career, Dr. Preskorn has worked with over 100 pharmaceutical companies in the United States and throughout the world. Over the past year, Dr. Preskorn has received grants/research support from or has served as a consultant, on the advisory board, or on the speakers bureau for the following: Abbott, Assurex Health, AstraZeneca, Envivo, Johnson & Johnson, Merck, National Institute of Mental Health, Naurex, Novartis, Pfizer, Stanley Medical Research Institute, Sunovion, and Taisho.

© 2013 by Lippincott Williams & Wilkins, Inc.