From evidence based medicine to mechanism based medicine: Reviewing the role of pharmacogenetics

Wilffert, B., Swen, J., Mulder, H., Touw, D., Maitland-Van Der Zee, A-H. & Deneer, V., Jun-2013, In : International Journal of Clinical Pharmacy. 35, 3, p. 369-375 7 p.

Research output: Contribution to journalBook/Film/Article reviewProfessional

Aim of the review The translation of evidence based medicine to a specific patient presents a considerable challenge. We present by means of the examples nortriptyline, tramadol, clopidogrel, coumarins, abacavir and antipsychotics the discrepancy between available pharmacogenetic information and its implementation in daily clinical practice. Method Literature review. Results A mechanism based approach may be helpful to personalize medicine for the individual patient to which pharmacogenetics may contribute significantly. The lack of consistency in what we accept in bioequivalence and in pharmacogenetics of drug metabolising enzymes is discussed and illustrated with the example of nortriptyline. The impact of pharmacogenetics on examples like tramadol, clopidogrel, coumarins and abacavir is described. Also the present status of the polymorphisms of 5-HT2A and C receptors in antipsychotic-induced weight gain is presented as a pharmacodynamic example with until now a greater distance to clinical implementation. Conclusion The contribution of pharmacogenetics to tailor-made pharmacotherapy, which especially might be of value for patients deviating from the average, has not yet reached the position it seems to deserve. © 2010 The Author(s).
Original languageEnglish
Pages (from-to)369-375
Number of pages7
JournalInternational Journal of Clinical Pharmacy
Issue number3
Publication statusPublished - Jun-2013


  • Drug metabolising enzymes, Mechanism based medicine, Pharmacodynamics, Pharmacogenetics, Pharmacokinetics, abacavir, citalopram, clopidogrel, coumarin derivative, cytochrome P450 2C19, cytochrome P450 2C9, cytochrome P450 2D6, drug metabolizing enzyme, enzyme, escitalopram, fluoxetine, generic drug, HLA B57 antigen, neuroleptic agent, noradrenalin, nortriptyline, paroxetine, phenytoin, prasugrel, protein C, serotonin, serotonin 2A receptor, tramadol, unclassified drug, vitamin K epoxide reductase, warfarin, acute coronary syndrome, allele, area under the curve, ataxia, bioequivalence, cardiovascular risk, clinical practice, confusion, constipation, CYP2C19 gene, CYP2D6 gene, DNA polymorphism, dose response, drug antagonism, drug blood level, drug efficacy, drug elimination, drug half life, drug hypersensitivity, drug information, drug mechanism, drug metabolism, drug receptor binding, drug targeting, drug uptake, dysarthria, evidence based medicine, evidence based practice, gene, gene function, genetic analysis, genetic association, genetic variability, genotype, health care planning, heterozygote, human, iatrogenic disease, loading drug dose, maintenance drug dose, mechanism based medicine, molecular mechanics, nausea, neuropathic pain, nystagmus, percutaneous coronary intervention, personalized medicine, pharmacogenetics, phenotype, priority journal, reliability, respiration depression, review, sedation, side effect, ST segment elevation myocardial infarction, stent thrombosis, translational research, treatment response, urine retention, VKORC1 gene, vomiting, weight gain

ID: 13402978