The role of pharmacogenomics in adverse drug reactions

ABSTRACT

Introduction: Adverse drug reactions (ADRs) are a major health concern worldwide. There are multiple causes of ADRs, some of which are preventable. Pharmacogenomics accounts for ≈80% variability in drug efficacy and safety. Over 400 genes are clinically relevant in drug metabolism, and ≈200 pharmagenes are associated with ADRs. The condition of extensive metabolizer in the Caucasian population is lower than 20%, and about 60% of patients are exposed to potential ADRs.

Areas covered: Important topics related to pharmacogenomics in drug efficacy and safety are covered, including: (i) major components of the pharmacogenomic machinery; (ii) epigenetic regulation of pharmagene expression; and (iii) pharmacogenomics-related ADRs of different drug categories.

Expert opinion: The Regulatory Agencies should make recommendations to the pharmaceutical industry in favor of the introduction of pharmacogenomics in drug development and the inclusion of pharmacogenomic information on drug labels, with specific warnings for the population at risk. Educational programs are fundamental for drug prescribers to become familiar with personalized treatments. Pharmacogenetic testing should be gradually introduced into medical practice. ADRs can be reduced not only by adherence to prescribing guidelines, suitable monitoring and regular medication review, but also by the implementation of pharmacogenomic procedures in the clinical setting.

KEYWORDS:

• ABCB1
• ADRs
• CYP2D6
• CYP2C9
• CYP2C19
• epigenetics
• metabolic genes
• pharmacogenomics
• transporter genes
• trigenic genotypes

Acknowledgments

We would like to thank our co-workers at EuroEspes Biomedical Research Center, Institute of Medical Science and Genomic Medicine, for technical support in our studies on pharmacogenomics and epigenetics of CNS disorders.

Declaration of interest

R Cacabelos is President of the World Association of Genomic Medicine and Editor-in-Chief of the World Guide for Drug Use and Pharmacogenomics. JC Carril is responsible for the EuroPharmaGenics database. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.