CYP2C19 drug-drug and drug-gene interactions in ED patients

Abstract Background CYP450 polymorphisms result in variable rates of drug metabolism. CYP drug-drug interactions can contribute to altered drug effectiveness and safety. Study objectives The primary objective was to determine the percentage of emergency department (ED) patients with cytochrome 2C19...

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Bibliographic Details
Published in:The American journal of emergency medicine 2016-02, Vol.34 (2), p.245-249
Main Authors: Flaten, Hanna K, Kim, Howard S., MD, Campbell, Jenny, Hamilton, Lisa, MD, Monte, Andrew A., MD
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Adult
Antidepressants
Asian people
Cytochrome
Cytochrome P-450 CYP2C19 - genetics
Data analysis
Drug dosages
Drug Interactions - genetics
Drug therapy
Emergency
Emergency medical care
Emergency Service, Hospital
Enzymes
Female
Genes
Genotype
Genotype & phenotype
Heart attacks
Humans
Male
Medical records
Metabolism
Metabolites
Middle Aged
Nausea
Pain
Pharmacogenetics - methods
Physicians
Polymorphism, Genetic
Prescription drugs
Prevalence
Prospective Studies
Studies
United States - epidemiology
Vomiting
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Summary:Abstract Background CYP450 polymorphisms result in variable rates of drug metabolism. CYP drug-drug interactions can contribute to altered drug effectiveness and safety. Study objectives The primary objective was to determine the percentage of emergency department (ED) patients with cytochrome 2C19 (CYP2C19) drug-drug interactions. The secondary objective was to determine the prevalence of CYP2C19 polymorphisms in a US ED population. Methods We conducted a prospective observational study in an urban academic ED with 72,000 annual visits. Drug ingestion histories for the 48 hours preceding ED visit were obtained; each drug was coded as CYP2C19 substrate, inhibitor, inducer, or not CYP2C19 dependent. Ten percent of patients were randomized to undergo CYP2C19 genotyping using the Roche Amplichip. Results A total of 502 patients were included; 61% were female, 65% were white, and median age was 39 years (interquartile range, 22-53). One hundred thirty-one (26.1%) patients had taken at least 1 CYP2C19-dependent home drug. Eighteen (13.7%) patients who were already taking a CYP2C19-dependent drug were given or prescribed a CYP2C19-dependent drug while in the ED. Among the 53 patients genotyped, 52 (98%) were extensive metabolizers and 1 was a poor metabolizer. Conclusions In a population of ED patients, more than a quarter had taken a CYP2C19-dependent drug in the preceding 48 hours, but few were given or prescribed another CYP2C19-dependent drug in the ED. On genotyping analysis, CYP2C19 polymorphisms were uncommon in our cohort. We conclude that changing prescribing practice due to CYP2C19 drug-drug interaction or genotype is unlikely to be useful in most US ED populations.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2015.10.055