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Re: I need some advice regarding my medication regimen Hordak

Posted by mtom on August 6, 2019, at 20:44:26

In reply to Re: I need some advice regarding my medication regimen mtom, posted by Hordak on August 6, 2019, at 18:45:13

Hi Hordack - yes I did have genetic testing last year for medications. Citalopram & Escitalopram are metabolized by the 450 enzymes CYP 3C19 for which I am a "normal metabolizer" and CYP 3A4 which they did not test. When I inquired they said too many variations of this enzyme and insufficient data to make recommendations. Some literature also says CYP 2D6 involved and I am an "intermediate metabolizer" for this enzyme, 1 of my 2 alleles is a no activity mutation. CYP 2D6 is involved in the metabolism of Many AD's. This could be relevant to my hypersensitivity to side effects.

My CYP 2B6 showed an "increased response to Bupropion (Wellbutrin)". My Dr had already crossed this off the list before anyway as she instinctively thought it might be too activating for me. Good call.

Sertraline is metabolized by a number of enzymes including those above, and that may have contributed to my reaction. However my Genetic Report did not elaborate on Sertraline, only mentioned 1 enzyme, I got more complete data from other sources.

The Test did not include Mirtazapine (Remeron), again when I asked they said insufficient data. But my research shows it's also metabolized by 2D6 for which I have 1 non-functional allele, yet I have not experienced increased anxiety on Mirt (yet - still on low dose).

These tests are still in their infancy and except for a few drugs that they steered me away from, e.g. Wellbutrin plus "all" Antipsychotics they included in report (with the notation "increased risk of tardive dyskenesia" - don't want to risk that!), data was mostly brief and incomplete, and my subsequent follow-ups did not provide me with more information. They provided no useful information on drug interactions. And these are important as many are substrates for or inhibitors of the same enzymes (and not just AD meds). Even CBD Oil impacts some of these same enzymes and interactions are hypothesized, but the dosage required for interactions may be higher than that usually taken.

These tests will gradually get better, funding is an issue of course whenever non-pharmaceutical research is involved. But many Doctors are saying that "Personalized Medicine" based on specific genetics will be the future of medicine..... eventually.....

Additional Note: Neither of 2 Pdocs I've consulted even knew these tests existed?! Yet still questioned their veracity - a little arrogant I thought when they admitted knowing nothing about them.


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