Pharmacogenetic Clinical Decision Support in Patients with Multi-Drug Regimens

We had reported our experience in a comprehensive medication management service for mental health with an algorithmic and heuristic Clinical Decision Support system (MEDtuning, Genomas Inc.) [1] based on the combinatorial genetic profile of CYP2D6, CYP2C19 and CYP2C9 [2]. This system provides a drug proscriptive warning if a patient’s CYP450 phenotype (derived from the genotypes) is functionally abnormal for an isoenzyme constituting the primary or sole metabolic pathway for a given medication. The CDS tool has previously proven very useful for diagnosing pharmacogenetic vulnerabilities of psychiatric patients and supporting drug selections to minimize risk [3-5]. Multidrug regimens (i.e., polypharmacy) have the greatest potential for bringing drug-related adverse events and harmful drug interactions in patients with cardiometabolic and neuropsychiatric co-morbidities.