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Genetics Testing Labs:


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110-C Perimeter Park Rd.
Knoxville TN 37922
Voice: 865-862-0763
Fax: 865-862-0764

  





Laboratory Medicine Clinic:  Genetic Probes

Our 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.  We 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.

Aside from the obvious dramatic improvement in patient care via monitoring of drug effects, the importance of this testing includes:

1-We 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 to you.  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.

2-We 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 probe).  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.

4-Via the genetic probes, we can more accurately predict side effects of medications and prevent them by variable dosing or choosing another medication.  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 ineffective.  This can result in rather serious "side effects."

Hopefully this will assist our health care partners to understand our use of these genetic probes with our patients.






 

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