What's New
How Genetic Testing Can Reduce Trial and error Prescribing
How Genetic Testing Can Reduce Trial and error Prescribing
How does Your DNA Influences Drug Response
Much like the colour of someone's eyes, DNA plays an important role in how someone may respond to many medications. In fact, specific genes have been identified that meaningfully influence the number and/or function of key proteins in the body that interact with medications. These proteins oftentimes are involved in the distribution or metabolism of medications in the body. There are also other important proteins that impact what a medication can or cannot do to the body. For example, proteins that have altered function due to genetic variations may not adequately reduce the risk of certain types of side effects in various organs and tissues in the body.
As a result of this genetic variability, someone may be at increased or decreased risk of side effect(s) and/or beneficial effects of a medication compared to the person sitting next to them. Knowing this information prior to using the medication can help health care providers personalize medication treatment decisions, oftentimes resulting in less bothersome or severe reactions, and/or improving the likelihood that the medication is effective.
What Trail-and-Error Prescribing Means
Prescribers generally consider a number of important factors when prescribing medications. The process usually involves a careful assessment of the individual, guidance from scientific studies and their professional judgement. This process is an important pillar of health care, and is a responsible and beneficial approach.
However, there is nonetheless uncertainty when selecting medications, especially when considering the number of different options available for some conditions. As a result, the tried-and-true approach may result in trial and error, whereby a medication is started (and in some cases, doses adjusted) but causes unacceptable side effects or doesn't sufficiently benefit the individual. The medication is stopped and a new one is tried. The process continues until a suitable medication is found, medications are abandoned in favour of non-medication treatments or, unfortunately in some cases, the medical condition is left unmanaged.
This process can be especially time-consuming and inefficient for medications that take a longer time to work, or whose side effect burden worsens or becomes unbearable after weeks of use. This can be highly frustrating for most. In some cases, individuals may experience harmful side effects. It should be noted, however, that these are usually not prescribing errors or medication errors. They are simply accepted downsides of established prescribing approaches.
How to Minimize Prevent Trail-and-Error Prescribing
Pharmacogenetic testing is a process involving an analysis of someone's DNA for variations known to impact effectiveness and/or side effects associated with a number of medications. This information can then be used to inform the choice of the medication selected, or the dose, monitoring, or further investigations needed when prescribers select a certain medication.
This process supplements the usual approach discussed earlier, thereby allowing prescribers to select from a narrower list of medications, or by providing precise guidance about dosing that differs from the norm. This improves the chances of finding success with a medication, and can reduce or even prevent trial and error prescribing, and the lost time and frustration that comes with it.
It's not about choosing the "prescription". It's not about "preventing medication errors", which is a separate topic. It's about individualizing medication treatment decisions by adding genetic considerations to established prescribing approaches.
Faster, More Accurate Treatment Plans for Mental Health, Pain, and Chronic Conditions
When it comes to depression and anxiety, antidepressants can often provide benefit.
However, the process can be difficult because of the amount of time it takes for antidepressants to start working. Furthermore, some side effects experienced in the first few weeks of use can resolve on their own. Unfortunately, only about 1/3rd of individuals respond favourably enough to continue use of the first antidepressant tried. The other 2/3rds unfortunately must re-start the process, but with a different medication. By having pharmacogenetic testing results in hand right at the start of the process, trial and error can be reduced, leading to better outcomes, sooner.
When it comes to cholesterol management and risk prevention, statins play an important role. However, a modest number of individuals do experience muscle-related side effects (or statin induced myopathy). Symptoms may be described as pain, aches, cramps, and/or weakness, usually in larger muscles closer to the body (e.g., thighs) and tends to occur on both sides of the body. Some individuals find that they are worse after doing physical activities. These effects usually appear after weeks to months of starting a statin, or after dose increases. In some cases, some individuals will skip doses or stop the statin prematurely to reduce the impact of side effects on their quality of life. Since statins rely on consistent, as-prescribed use to prevent heart attacks and strokes, picking the optimal medication and dose earlier in the process can be an important factor in one's health. And though we know that this side effect is meaningfully influenced by organ function, age and biological sex, we also know most statins can also be impacted by the presence of specific genetic variations. With pharmacogenetic test results, prescribers can select which statin and dose to use from the start to maximize treatment benefits as quickly as possible.
How to Get Started With Genetic Testing for Medication Optimization
Getting started with pharmacogenetic testing should involve consulting with a health care provider. It should also involve ensuring the test only uses reputable scientific guidance, uses accessible sample collection (e.g., a self-collected cheek swab), has turnaround time of about a week after samples are received and provides an easy-to-use results portal. It is also important to choose a test provider that checks for genetic variations seen in diverse groups to reduce the risk that important variations are not overlooked.
