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Knowledge of the Pharmacology of Antidepressants and Antipsychotics Yields Results Comparable With Pharmacogenetic Testing

MACALUSO, MATTHEW, DO; PRESKORN, SHELDON H., MD

Journal of Psychiatric Practice®: November 2018 - Volume 24 - Issue 6 - p 416–419
doi: 10.1097/PRA.0000000000000345
COLUMNS

Several companies offer pharmacogenetic testing for psychiatry on the basis of the claim that the outcome of drug selection is better when guided by such testing than when such testing is not used. This column examines the results of the GeneSight Psychotropic Test which groups various antidepressants and antipsychotics into 3 bins: green (“use as directed”), yellow (“use with caution”), and red (“use with increased caution and more frequent monitoring”). The authors examined how frequently the same drugs appeared in these different bins in 19 patients. They found that of the 22 antidepressants evaluated, 2 were virtually always (>90%) in the green bin: desvenlafaxine and levomilnacipran; and 8 were almost never (≤10.5%) in the green bin: citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, paroxetine, and sertraline. Of the 16 antipsychotics evaluated, they found that 4 were virtually always (>90%) in the green bin: asenapine, lurasidone, paliperidone, and ziprasidone; and 2 were almost never (≤10.5%) in the green bin: chlorpromazine and thioridazine. What was common among those drugs almost always in the green bin versus those almost never in the green bin were newer versus older marketed drugs and those not dependent versus dependent on oxidative metabolism for their clearance. The authors concluded that the results of this pharmacogenetic testing could be predicted on the basis of knowledge of the pharmacology of the drugs, particularly whether their clearance was dependent on oxidative drug metabolism.

MACALUSO and PRESKORN: University of Kansas School of Medicine, Wichita, KS

S.H.P. has worked with over 135 pharmaceutical companies in the United States and throughout the world. Over the past year, he has received grants/research support from or has served as a consultant, on the advisory board, or on the speaker’s bureau for Alkermes, Allergan, BioXcel, Food and Drug Administration, Janssen, National Institute of Mental Health, Merck, Pfizer, and Sunovion. M.M. has conducted clinical trials research as principal investigator for the following pharmaceutical companies over the last 12 months: Acadia, Allergan, AssureRx, Eisai, Lundbeck, Janssen, Naurex/Aptinyx, Neurim, and Suven. All clinical trial and study contracts were with and payments made to the Kansas University Medical Center Research Institute, a research institute affiliated with Kansas University School of Medicine-Wichita (KUSM-W).

Please send correspondence to: Matthew Macaluso, DO, University of Kansas Medical Center, 1010 N. Kansas, Wichita, KS 67217 (e-mail: mmacaluso@kumc.edu).

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