Researchers, at Washington University School of Medicine in St. Louis and the St. Louis College of Pharmacy, found that 29 percent of patients seen at local primary-care offices had taken at least one of 16 drugs that can cause adverse reactions in genetically susceptible people.

Applying information from pharmacogenetics to primary-care practices could reduce the incidence of adverse reactions and optimize treatments, according to the study, published in the journal Pharmacogenomics.

" Until now, researchers looking at the role of genetic variation in drug effects have focused mainly on toxic drugs used by specialists treating cancer or HIV infection," says Howard L. McLeod, at the Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital.

" We knew that some of the drugs commonly used in the family practice setting can cause adverse reactions in people who have certain genetic variations, so we measured just how often these drugs are used."

The study found that of the 607 outpatients surveyed at three primary-care sites in the metropolitan St. Louis area, 174 were on a drug commonly associated with severe side effects. Among these drugs are Fluoxetine ( Prozac ), Metoprolol ( a beta-blocker ), Diltiazem ( a calcium channel blocker ), and Warfarin ( an anticoagulant ).

Each of these drugs is metabolized by genes known to vary within the population. Genetic variations that change the properties of enzymes that break down drugs or mark them for excretion can cause adverse drug reactions.

Potentially harmful reactions to the medications examined in this study include gastrointestinal bleeding, cerebrovascular hemorrhages, kidney impairment, dizziness, low blood pressure and slowed heart beat. The number and severity of adverse reactions to the drugs surveyed was not measured in this study; however, a 1998 study ranked adverse drug reactions as among the top ten leading causes of death in the United States.

Other genetic variations in the population are known to alter proteins that transport drugs or change cellular mechanisms targeted by drugs, rendering the drugs ineffective. While not leading to adverse reactions, these genetic factors can also affect health care.

" We think it's likely that using pharmacogenetics in the primary-care setting can reduce health care costs," says McLeod. " The information could help family physicians make better decisions about the right drugs and dosages to prescribe for their patients, making it possible to avoid unnecessary prescriptions and to minimize the costs of hospital treatments for adverse reactions."

Source: Washington University School of Medicine, 2006


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