That means more patients, including hard-to-treat patients such as rapid metabolizers
, can benefit from once-daily controlled-release Envarsus.
Table FDA-approved drug labeling and PharmGKB information for select antidepressants Pharmacogenomics variants involved Medication in metabolism FDA-approved drug labeling Bupropion CYP2B6 (major) Although CYP2B6 is thought to be the primary metabolic pathway for bupropion, no information is included in FDA-approved drug labeling to guide dosage changes Citalopram CYP2C19 (major) In CYP2C19 poor metabolizers
, and CYP2D6 Citalopram steady state (minor) concentrations increase; therefore, 20 mg/d is the maximum recommended dose for CYP2C19 poor metabolizers
due to the risk of QT prolongation.
This was true among all coffee drinkers -- even those who were determined to be slow metabolizers
And when all causes of death were combined, even slow caffeine metabolizers
had a longevity boost.
For women who are prescribed opioids, monitoring for excessive sedation and other adverse effects is recommended in infants, given the interindividual variation of opioid metabolism and the risk of maternal and neonatal adverse effects in ultra-rapid codeine metabolizers
-- The boxed warning recommending pharmacogenomic testing of patients receiving clopidogrel to identify reduced metabolizers
seems to be playing to a largely deaf audience.
Humans exhibit genetic variations affecting the CYP2D6 gene rendering them null, poor, intermediate, or fast metabolizers
. Patients with lower levels of CYP2D6 metabolization experience recurrent malarial episodes regardless of proper treatment regimens with primaquine .
Kids with sleep apnea are considered "ultra-rapid metabolizers
" so they could encounter severe risks.
The same amount of caffeine intake causes a stronger stimulating effect on slow metabolizers
compared to rapid metabolizers
(6,9Pickering, 2017; Sachse, 1999)
Some women are ultrarapid metabolizers
of codeine because of high levels of CYP2D6, resulting in higher concentrations of morphine in their breast milk and their breast fed newborn.
There are some people--considered CYP2D6 "ultrarapid metabolizers
" --who can have levels of the drug in their breast milk that can cause excessive sleepiness and depressed breathing in infants.
This gives rise to such patient subgroups as poor metabolizers
, rapid metabolizers
and ultra-rapid metabolizers