110-C Perimeter Park Rd.
Knoxville TN 37922
clinic has been trained and our laboratory set up for use of
a genetic probe system to
measure patients on several very important liver enzyme systems
involving the cytochrome P450 system.
now have probes, performed via buccal muscosal swabbings, that
show normal, rapid metabolizer, and slow metabolizer status on the
sub enzyme systems 2D6, 3A4, and others.
Most drugs are metabolized via these and a few other systems.
from the obvious dramatic improvement in patient care via monitoring
of drug effects, the importance of this testing includes:
can determine, at the start of treatment, or at any time during
treatment, whether a patient is a slow metabolizer for a given drug,
and, thus, likely to have side effects that can result in ER visits,
overnight hospital stays, and excess clinic visits and, thus, costs
This also allows us to dose medication at optimized levels
which may reduce or obviate the need for other medications that
would be used to target side effects.
can determine if the patient is a rapid metabolizer for a drug,
which can account for what erroneously appears to be drug seeking,
or can result in lack of effects of a drug.
The latter very often results in stopping a cheaper, generic
drug, and going to a more expensive non generic, when in fact, the
generic drug would have likely been effective had we known to start
at higher than "normal" dosing (based on the appropriate genetic
Again, this is another cost savings to the payor.
3- Many pain medications such as ultram and
hydrocodone are activated by 2D6.
Such agents are used in place of more expensive and addictive
schedule II agents such as fentanyl patches and oxycontin, If
a patient has the relatively common genetic deficiency on 2D6, then
at regular dosing, ultram and hydrocodone will be relatively
ineffective and a more expensive addictive agent will often be
substituted. Knowing that the patient is deficient on 2D6, we could start
with higher dosing of the generic agent and more likely be
successful in controlling their pain without resorting to more
expensive and addictive agents.
the genetic probes, we can more accurately predict side effects of
medications and prevent them by variable dosing or choosing another
For a striking example, most birth control agents are
metabolized by the 3A4 system.
Many agents such as lyrica, trileptal and essentially all
steroids, induce, or ramp up the 3A4 system, and in patients who are
already rapid metabolizers on 3A4, the added drug increases the
metabolism of birth control agents rendering them completely
This can result in rather serious "side effects."
this will assist our health care partners to understand our use of
these genetic probes with our patients.