Pharmacogenetics in Pain – Personalizing Pain Management

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As a pain management specialist, you are frequently challenged by patients with multiple health issues who are already taking several medications by the time they’re referred to your practice. YouScript can help you chart a safer, more effective course with additional medications.

Say a patient with chronic pain is referred to your practice by her primary care physician. When you perform a physical and take a history, the patient relates a background of sensitivity to medicines, but can’t tell you exactly what that sensitivity entails. The patient also relates a long history of uncontrolled pain and is already taking several other drugs and herbal supplements. There are a variety of pain medications with different pharmacokinetic properties.

How do you make the best treatment choice for your patient?

In the past, pain management specialist had little choice but to try medications without knowing in advance how such patients might genetically respond. But no more: with personalized prescribing by YouScript, you can know upfront what medications will likely prove the most effective for your patient – and which ones will not. And you’ll know precisely which medications will interact with the prescriptions and supplements your patient is already taking.

Pain Medications with Pharmacogenetic Information on the FDA Label

Drug Biomarker
Amitriptyline CYP2D6
Celecoxib CYP2C9
Codeine CYP2D6
Desipramine CYP2D6
Doxepin CYP2C19, CYP2D6
Flurbiprofen CYP2C9
Tramadol CYP2D6

 

YouScript Helps You Achieve Optimal Prescribing

Many of the opioids are metabolized into a much more active metabolite by CYP2D6 or CYP3A4 and many NSAIDs are metabolized by CYP2C9. As the table below demonstrates variations are extremely common.  This genetic variability is a critical aspect governing how an individual patient will respond to medicines.

YouScript includes testing of all clinically significant genetic variants in CYP2D6, CYP2C9, VKORC1, CYP2C19, CYP3A4 and CYP3A5 enzymes responsible for metabolizing the majority of medications.

The YouScript Personalzied Prescribing Report indicates your patient is a CYP2D6 intermediate metabolizer, CYP2C9 poor metabolizer wiht VKORC1 high sensitivity, CYP2C19 normal metabolizer, CYP3A4 normal metabolizer and CYP3A5 normal metabolizer. As the tables below demonstrate, many of your other patients may also have cytochrome variability.

The Majority of Patients Have Cytochrome P450 (CYP) Variability

Gene Poor
Metabolizer
Intermediate
Metabolizer
Normal
Metabolizer
Rapid or Ultra Rapid Metabolizer
CYP2D6 10% 35% 48% 7%
CYP2C9 2-4% >35% ~60% N/A
CYP2C19* 2-20% 24-36% 14-44% 30%

*CYP2C19 variability depends on ethnicity.

  Ethnicity
Gene Variant Activity Caucasian Asian African
CYP3A4 Decreased 5.3% 0% 0%
CYP3A5 Decreased 93% 0% 27-50%

 

YouScript Personalized Prescribing Report gives you secure web access to the patient’s cytochrome results. A comprehensive drug-gene database is at your fingertips making it easy to quickly add your patient's medication list and identify interactions. For example, your patient takes codeine, a medication you prescribed for pain. Codeine is converted to its active metabolite morphine by CYP2D6. Your patient is a CYP2D6 intermediate metabolizer. YouScript alerts you that your patient may have decreased levels of morphine and decreased analgesic effect.

YouScript Helps You with Polypharmacy Safety – Now and in the Future

Like this patient, many other pain patients are also battling other conditions such as heart disease, psychiatric issues or cancer that make multiple prescriptions necessary.  Our body’s limited capacity to process medications is easily slowed by competition between drugs, supplements, and over-the-counter medication. This is further compromised in patients with genetic variations.

Whether a patient is genetically a poor metabolizer, or has become a poor metabolizer because of other medications, it's been shown by propsective trials, population analyses, and case studies that they can experience an increase in concentration-dependent adverse events due to reduced elimination.

The clinical note in YouScript for this patient states you should be alert for insufficient pain relief or switch to an alternative other than tramadol or oxycodone. By clicking on codeine, YouScript will provide a list of medications in the same class that are not as reliant on the CYP2D6 pathway. If you select morphine instead, you’ll note in this case, there are no longer any significant interaction warnings.

YouScript is Updated with the Latest Clinical Knowledge on Drug Metabolism

To further complicate the matter, the body of knowledge on drug metabolism is constantly growing. Numerous clinical studies continue to be published on both drug metabolism and drug-gene interactions for patients on pain medications. Even the most committed physician cannot keep up with this constantly growing body of knowledge.

YouScript saves you time. Our team of pharmacists and physicians has done the research on drug metabolism and drug and gene interactions for you. YouScript is updated multiple times each month with the latest clinical information.

After navigating the YouScript software for your first patient and discovering how helpful it is in choosing safe and effective medications, you may well find that YouScript helps you treat other patients.

Which Patients Benefit Most from YouScript?

YouScript testing has significant impact for many patients, including those:

  • Taking multiple medications
  • Prescribed any of the more than 100 FDA-approved drugs with pharmacogenetic information in their labels, including the following:
    • Plavix® (clopidogrel)
    • Coumadin® (warfarin)
    • Strattera® (atomoxetine)
    • Abilify® (aripiprazole)
    • Lopressor® / Toprol® (metoprolol)
    • Clozaril® (clozapine)
  • Who complain their medications are not working
  • Wary of standard dosing based on prior negative experiences
  • On complex drug treatment plans for cancer or HIV infection
YouScript is typically covered by Medicare and most private insurers.

Call 800-TEST-DNA to ask how it works. There is no cost to you and supplies will be sent out immediately. Pharmacists and other support staff are there to help whenever you have questions

How to Integrate YouScript Into Your Practice

  1. Ask your YouScript consultant, call 800-TEST-DNA or sign up online.
  2. Receive your free YouScript test kits and supplies.
  3. Collect a buccal swab or blood sample from your patient and ship it in a prepaid mailer.
  4. Receive the YouScript Personalized Prescribing Report with recommendations from a local YouScript network pharmacist.
  5. Counsel your patient on their YouScript results and adjust treatment plan as needed

 

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How to Request
YouScript

  1. 1

    Sign up online, ask your YouScript consultant, or call 800-TEST-DNA (800-837-8362).

  2. 2

    Receive your free YouScript test kits and supplies. Alternatively, we can ship the kit directly to a patient if you complete and fax a prescription to 206-219-4000.

  3. 3

    Collect a buccal swab or blood sample from your patient and ship it in a prepaid mailer.

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