遗传药理学、摘要和临床实践。
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嘉丁纳SJ, Begg EJ
遗传药理学、摘要和临床实践。
杂志启2006年9月,58 (3):521 - 90。doi: 10.1124 / pr.58.3.6。
- PubMed ID
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16968950 (在PubMed]
- 文摘
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药物遗传学的应用个性化治疗提供了广阔的前景。然而,它几乎没有临床现实当前,尽管许多索赔。主要问题是证据基础支持基因检测治疗前弱。药理学的药物代谢的遗传变异性往往是复杂的。很少有消除的简单或单一途径。有的活性代谢物或对映体具有不同的活动和消除的途径。药物剂量可能会影响只有在所有活动的总摩尔活动半个网站的行动是可以预见的是受基因型和表现型。药物浓度的变化必须足够大来提供“信号”,高于正常变异,并必须有一个真正的浓度效应关系。药物的治疗指数也会影响测试工具。考虑所有这些因素后,潜在的好处测试需要权衡成本和对其他端点效应。 It is not surprising that few drugs satisfy these requirements. Drugs (and enzymes) for which there is a reasonable evidence base supporting genotyping or phenotyping include suxamethonium/mivacurium (butyrylcholinesterase), and azathioprine/6-mercaptopurine (thiopurine methyltransferase). Drugs for which there is a potential case for prospective testing include warfarin (CYP2C9), perhexiline (CYP2D6), and perhaps the proton pump inhibitors (CYP2C19). No other drugs have an evidence base that is sufficient to justify prospective testing at present, although some warrant further evaluation. In this review we summarize the current evidence base for pharmacogenetics in relation to drug-metabolizing enzymes.
