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What is Pharmacogenetics?

Pharmacogenetics is the study of how genes affect a person’s response to drugs. This relatively new field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to develop effective, safe medications and doses that may be tailored to a person’s genetic makeup.

Many drugs that are currently available are “one size fits all,” but they don’t work the same way for everyone. It can be difficult to predict who will benefit from a medication, who will not respond at all, and who will experience negative side effects (called adverse drug reactions).

Adverse drug reactions (ADRs) are a significant cause of hospitalizations and deaths in the United States and are a long-standing and largely neglected major medical problem. ADRs, often called side effects, are not medical errors, as they occur within the FDA-approved dosage and labeling recommendations. The recently reported genetically-based problems with Plavix and codeine reported by the FDA are a prime example of specific drugs creating ADRs.

Researchers are learning how inherited differences in genes affect the body’s response to medications. These genetic differences may be used to understand whether a medication may be effective for a particular person and to help prevent adverse drug reactions.

Pharmacogenetics and Luminus Diagnostics Testing Modalities with Dr. Marion Lee

Financial Consequences of Adverse Drug Reactions

770,000

Over 770,000 people are injured or die each year in hospitals from ADRs.

$5,600,000

ADRs may cost up to $5.6 million each year per hospital depending on hospital size.

$5,600,000,000

National hospital expenses to treat patients who suffer ADRs during hospitalization range between $1.56 and $5.6 billion annually.

Additional Financial Consequences:

  • $289 billion in added health care costs per year.
  • Medication Adherence for Chronic Disease.
  • HMOs spend more treating ADRs than on drugs.
  • ADRs are the cost leader for malpractice payouts.
  • Up to one-third of drug prescriptions are not needed and therefore wasted.

Assurance of Patient Compliance is Actively Promoted Through Insurers and Government Payers

  • Adverse Drug Reactions (ADRs) are reduced by the practitioner being made aware of all medications the patient is taking both prescribed and non-prescribed ADRs cannot be predicted by patient characteristics or drug type.
  • Costs of ADRs include emergency department visits, hospitalizations and litigation.
  • Average costs for ADRs are up to $5,000 for outpatient and greater than $15,000 for inpatient occurrence.


Our Genetic Tests

What is Tested?

AMPLIS

Antidepressant Guidance


Test Description:

AMPLIS is best in class pharmacogenetic guidance for Anti-Depressant selection. RCT1 and concordance2 studies both indicate Amplis may greatly increase remission rates with first drug selected through the proprietary combinatorial algorithm based on the understanding of Auto-Binding Cassette and Uridyl-Glucuronosyltransferase systems. In addition to the power of this algorithm, AMPLIS offers LuminusLive™ for an understanding of medications, their interactions and genetic influences in addition to a portal for virtual medication changes which can be analyzed in a matter of minutes. Co-existing morbidities can be efficiently treated while reducing risk to the patient for ADRs, Anti-cholinergic burden, Life style implications and genetic influences with up to the minute recommendations based on twice-daily scraping of over 6000 entries performed by Artificial Intelligence with respect to each tested genetic pathway and over 36,000 medications, herbals and OTC products along with current live-market pricing of each medication considered.

  • Agomelatine(Valdoxan®)
  • Amitriptyline (Elavil®)
  • Bupropion (Wellbutrin®)
  • Citalopram(Celexa®)
  • Clomipramine (Anafranil®)
  • Duloxetine (Cymbalta®)
  • Desvenlaxafine (Pristiq®)
  • Escitalopram (Lexapro®)
  • Fluoxetine (Prozac®)
  • Fluvoxamine (Luvox®)
  • Levomilnacipran (Fetzima®)
  • Mirtazapine (Remeron®)
  • Nortriptyline (Pamelor®)
  • Paroxetine (Paxil®)
  • Reboxetine (Edronax®)
  • Sertraline (Zoloft®)
  • Trazadone (Desyrel®)
  • Venlafaxine (Effexor®)
  • Vilazodone (Viibryd®)
  • Vortioxetine(Trintellix®)
  1. Improved Antidepressant Remission in Major Depression via a Pharmacokinetic Pathway Polygene Pharmacogenetic Report. Clin Psychopharmacol Neurosci. 2015;13(2):150-6.
  2. Bousman, C. A., Müller, D. J., Ng, C. H., Byron, K., Berk, M., & Singh, A. B. (2016). Concordance between actual and pharmacogenetic predicted desvenlafaxine dose needed to achieve remission in major depressive disorder: a 10-week open-label study. Pharmacogenetics and genomics, 27(1), 1-6.


SSRI Antidepressants
3

Drug Class Description:

Selective serotonin reuptake inhibitors (SSRIs) are prescribed to treat various psychiatric conditions, including depression, anxiety and personality disorders. SSRIs act by blocking the serotonin (5-HT) receptors in the brain. Suboptimal responses can delay the use of effective medications and remission of symptoms. Genetic differences can play an important role in determining patient responses.

  • Citalopram
  • Escitalopram
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Sertraline
  • Vilazodone

3  Please visit http://www.pharmgkb.org for full list of pathways


SNRI Antidepressants3

Drug Class Description:

Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine, levomilnacipran and venlafaxine are primarily indicated for the treatment of major depressive disorder (MDD). Some SNRIs are also prescribed to treat anxiety disorders and neuropathic pain. SNRIs, like SSRIs, are second-generation antidepressants that are better tolerated than first-generation antidepressants such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).

  • Duloxetine
  • Levomilnacipran
  • Venlafaxine

3  Please visit http://www.pharmgkb.org for full list of pathways


TCA Antidepressants3

Drug Class Description:

Tricyclic antidepressants (TCAs) are prescribed to treat depression and various other psychiatric conditions. TCAs act by blocking the neuronal uptake of norepinephrine and serotonin; the binding of TCAs to cholinergic, alpha-adrenergic, serotonin and histamine receptors contributes to various side effects.

  • Amitriptyline
  • Clomipramine
  • Desipramine
  • Doxepin
  • Imipramine
  • Nortriptyline
  • Protriptyline
  • Trimipramine

3  Please visit http://www.pharmgkb.org for full list of pathways


Other Antidepressants3

Drug Class Description:

Other antidepressants that are used to treat depression and anxiety disorders include: Bupropion – a norepinephrine and dopamine reuptake inhibitor (NDRI) and a non-competitive antagonist of the nicotine receptors; Buspirone – an anti-anxiety medication unrelated to benzodiazepines; Mirtazapine – a commonly prescribed second-generation tetracyclic antidepressant that inhibits adrenergic alpha2-autoreceptors and serotonin 5-HT2 and 5-HT3 receptors; nefazodone – a phenylpiperazine antidepressant not related to SSRIs, TCAs and monoamine oxidase inhibitors, and blocks the serotonin 5-HT2 receptors; trazodone – a serotonin antagonist and a serotonin reuptake inhibitor (SARI) related to nefazodone; vortioxetine – a multimodal antidepressant that can be a useful alternative to serotonergic antidepressants for some patients who are partial responders or non-responders.

  • Bupropion
  • Buspirone
  • Mirtazapine
  • Nefazodone
  • Trazodone
  • Vortioxetine

3  Please visit http://www.pharmgkb.org for full list of pathways

ANTIPSYCHOTICS

Typical Antipsychotics3

Drug Class Description:

Typical antipsychotics (TAPs), also known as first generation antipsychotics, are prescribed to treat various psychiatric disorders, including schizophrenia, mania, agitated behavior and severe anxiety. This class of drugs acts by blocking dopamine D1 and D2 receptors.

  • Haloperidol
  • Perphenazine
  • Pimozide
  • Thioridazine
  • Zuclopenthixol

3  Please visit http://www.pharmgkb.org for full list of pathways


Atypical Antipsychotics3

Drug Class Description:

Atypical antipsychotics are prescribed to treat various psychiatric disorders, including schizophrenia, schizoaffective disorder and bipolar mania. These medications bind serotonin and dopamine receptors. Stimulation of serotonin receptor 2C (5-HT2C, 5-HTR2C, HTR1C) results in secretion of pro-opiomelanocortin (POMC), enhanced satiety and decreased food intake; therefore, serotonergic agents can decrease food intake and promote weight loss. Indeed, one of the major side-effects associated with atypical antipsychotics is significant weight gain.

  • Aripiprazole
  • Asenapine
  • Clozapine
  • Iloperidone
  • Lurasidone
  • Olanzapine
  • Paliperidone
  • Quetiapine
  • Risperidone
  • Ziprasidone

3  Please visit http://www.pharmgkb.org for full list of pathways


ATTENTION-DEFICIT / HYPERACTIVITY DISORDER (ADHD)

ADHD Medication (NE reuptake inhibitor)3

Drug Class Description:

Atomoxetine is indicated for the treatment of attention deficit/hyperactivity disorder (ADHD) among children, adolescents and adults. It is a potent and selective inhibitor of the pre-synaptic norepinephrine transporter with minor affinity for serotonin and dopamine transporters.

  • Atomoxetine

3  Please visit http://www.pharmgkb.org for full list of pathways


BENZODIAZEPINES

Benzodiazepines3

Drug Class Description:

Benzodiazepines (BDZ) are a class of drugs primarily used for treating seizures, but they also are effective in treating epilepsy, panic disorders and various other disorders. The exact mechanism of action of BDZs is not known, but they appear to work by affecting neurotransmitters like gamma-aminobutryic acid (GABA) in the brain.

  • Clobazam
  • Diazepam
  • Alprazolam

3  Please visit http://www.pharmgkb.org for full list of pathways


CARDIOVASCULAR HEALTH

Cardiovascular Health3

  • Caffeine Metabolism
  • Clopidogrel
  • Metoprolol
  • Statin Induced Myopathy
  • Warfarin
  • Decreased Folate
  • Thrombosis

3  Please visit http://www.pharmgkb.org for full list of pathways

HYPERTENSION

Hypertension3

  • Beta-blockers
  • Hypertension
  • Metoprolol metabolism
  • Perindopril (ACE inhibitor-therapeutic benefit)
  • Verapamil vs. atenolol (benefit of)

3  Please visit http://www.pharmgkb.org for full list of pathways

OPIOIDS

OPIODS3

Drug Class Description:

The Opioid class of compounds has been extensively used to treat acute pain as well as to alleviate severe chronic pain associated with certain terminal conditions.

  • Codeine
  • Fentanyl
  • Hydrocodone
  • Methadone
  • Oxycodone
  • Tramadol

3  Please visit http://www.pharmgkb.org for full list of pathways

NSAIDS

NSAIDS3

Drug Class Description:

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drugs widely used for their analgesic, anti-pyretic and anti-inflammatory properties.

  • Celecoxib
  • Diclofenac
  • Flurbiprofen
  • Ibuprofen
  • Meloxicam

3  Please visit http://www.pharmgkb.org for full list of pathways

PERIPHERAL ARTERIAL DISEASE

Peripheral Arterial Disease/Venous Thrombosis3

  • Clopidogrel metabolism (Plavix)
  • Estrogen supplementation (risk of venous thrombosis)
  • Peripheral arterial disease
  • Venous thrombosis
  • Warfarin

3 Please visit http://www.pharmgkb.org for full list of pathways

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