International journal of clinical pharmacy
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Introduction of the available knowledge on pharmacogenetics very likely is one of the tools to close the gap between 'population' focused evidence based and 'individual' mechanism based medicine. However, besides pharmacogenetics, other covariates like age, renal function and/or co-medication should also be considered simultaneously when aiming for a 'tailored' pharmacotherapy. To illustrate this, we further extended the tramadol example used by Wilffert et al. to illustrate the complex interplay between developmental pharmacology and pharmacogenetics.
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To assess the state of the literature concerning pharmacogenomic testing in patients requiring vitamin K antagonists, specifically warfarin. ⋯ Several studies have shown that pharmacogenomic testing for warfarin dosing is more accurate that other dosing schemes. Pharmacogenomic testing improves time to a therapeutic international normalized ratio while requiring fewer dosing adjustments. Patients who require higher or lower than usual doses seem to benefit the most. The cost-effectiveness of pharmacogenomic testing as well as preventing of outcomes such as bleeding or thrombosis are not yet elucidated. Pharmacists, especially those in a community setting can play a role in this new technology by educating prescribers and patients concerning pharmacogenomic testing, and by developing and using dosing protocols that incorporate its use.