Leading Cardiologists Say It’s Time to Rethink Genetic Testing for CYP2C19 and Plavix

“The thing that hit me in the face, was that virtually all the events were in those homozygotes”                                                       - Dr. C. Michael Gibson, Duke University Dr. Gibson and Dr. Kirtane from Duke University reconsider genetic testing for CYP2C19 based on the GIFT sub-study of GRAVITAS presented last week at ACC. The study clearly showed that [...]

It’s Time for Tamoxifen CYP2D6 Testing to Become the Standard of Care

JAMA released more research today that further confirms the importance of CYP2D6 testing to determine tamoxifen efficacy. Full details at http://jama.ama-assn.org/cgi/content/short/302/13/1429. The conclusion: Recurrence Rates: 14.9% for extensive metabolizers 20.9% for intermediate metabolizers 29.0% for poor metabolizers This means that Extensive Metabolizers will get the same preventative outcome from tamoxifen as much more expensive aromatase [...]

New study suggests better ROI for pretreatment CYP2D6 screening

Pharmacogenomics J. 2009 May 19. Intermediate metabolizer: increased side effects in psychoactive drug therapy. The key to cost-effectiveness of pretreatment CYP2D6 screening? Laika B, Leucht S, Heres S, Steimer W. Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar, Technische Universität München, München, Germany. The cytochrome P450 2D6 (CYP2D6) isoenzyme metabolizes about 25% of [...]

Decreased Susceptibility of the Cytochrome P450 2B6 Variant K262R to Inhibition by Several Clinically Important Drugs.

Drug Metab Dispos. 2008 Dec 12 Talakad JC, Kumar S, Halpert JR. University of California San Diego. Cytochrome P450 (CYP) 2B6 metabolizes a number of clinically relevant drugs and is one of the most highly polymorphic human P450 enzymes, with the Lys(262)–>Arg substitution being especially common in several genetic variants. Therefore, K262R (2B6*4) was created [...]

Mayo study further confirms the importance of CYP2D6 for tamoxifen effectiveness building the case for genotyping and medication management

Mayo gave a presentation yesterday at the 31st annual San Antonio Breast Cancer Symposium that further confirms the importance of the liver enzyme CYP2D6 in tamoxifen effectiveness. Tamoxifen is often prescribed to block the effects of estrogen in breast tissue to prevent breast cancer recurrence in ER+ (estrogen receptor positive) cancers which require estrogen to [...]

Comparison of two immortalized human cell lines to study nuclear receptor mediated CYP3A4 induction

Harmsen S, Koster A, Beijnen JH, Schellens JH, Meijerman I.Utrecht University. Since cytochrome P450 3A4 (CYP3A4) is responsible for the biotransformation of over 50% of all clinically used drugs, induction results in an increased clearance of many concomitantly administered drugs, thereby decreasing treatment efficacy or, in the case of pro-drugs, lead to severe intoxications. CYP3A4 [...]

Assessment of drug-drug interaction for silymarin

Dr Oesterheld’s Comment: Silymarin (aka silibinin, silybin) is an extract of milk thistle, an antioxidant herbal that is being tested in a variety of conditions, diabetes, cancer and liver injury and others was originally shown to have in vitro inhibiton against CYP3A4. Two studies, one vitro and one in vivo studies have shown that its [...]

Inhibition on human liver cytochrome P450 3A4 by constituents of fennel

Dr. Oesterheld’s Comment: Although clinicians may be well aware of the potential of grapefruit juice to be an inhibitor of CYP3A4, only a few may be aware of the possibility of other CYP-based food- drug interactions.In this study, fennel, an herb and alternate drug is shown to be a modest CYP3A4 inhibitor. Since its inhibition [...]

Cytochrome P450 testing for better psychiatric care

J Psychosoc Nurs Ment Health Serv. 2007 Oct;45(10):15-8. Link: Cytochrome P450 testing for better psychiatric care. Pestka EL, Hale AM, Johnson BL, Lee JL, Poppe KA. Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. pestka.elizabeth@mayo.edu Genotyping for CYP2D6 and CYP2C19 variations is emerging as a potentially useful clinical tool to help mental [...]

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