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Posts Tagged ‘PGx’

Pharmacogenomics (PGx) & Community Pharmacies: Enabling Greater Access to Approaching Personalized Medicine. By Our Student Pharmacist, Andrew Capozzi.

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Pharmacogenomics (PGx), also known as the study of how an individual’s genetic factors can affect the body’s response to a medication, is a growing field in the healthcare industry that helps in identifying medications that would be best for a patient’s treatment.

When pharmacogenomic testing is performed, healthcare providers are able to identify how the patient’s body may respond to a particular medication or class of medications, especially with a focus on effectiveness and risk of side effects. This information helps providers to acknowledge any variations that may exist within a person’s genetic code, to make recommendations when selecting treatments, and to design a “personalized medicine” approach to care. According to research at Washington State University, variations in genetic factors that affect the human body’s response to certain medications may be more widespread than initially believed, with most of the United States population likely carrying at least one actionable pharmacogenomic variant.

According to the Food and Drug Administration (FDA), about 500 medications include pharmacogenomic information in their labeling, primarily relating to how successful the medication may be for a patient, side effects that are of greater risk or severity, or any patient-specific dose adjustments that are recommended based on genetic profile.

Of all medications that are prescribed in the United States, it’s estimated that about 20% of them have a pharmacogenomic recommendation on their label. Most notably, medications that relate to cancer, mental health, heart health, blood thinning or clot prevention, and pain are most likely to be affected by genetic factors.

In particular, clopidogrel (Plavix), a blood thinner medication, is one of the most well-known examples of a medication that is impacted by a patient’s genetic profile. Clopidogrel is broken down in the body by an enzyme known as CYP2C19, which is produced from the coding of the CYP2C19 gene. Differences that may exist in the CYP2C19 gene’s composition may increase an individual’s risk for major side effects relating to heart health when clopidogrel is taken.

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Pharmacists, often regarded as the most accessible and frequently visited of healthcare professionals, can play an important role in promoting the best treatment and medication plans for a patient. Equipped with specific knowledge, skills, and abilities to interpret and apply PGx results, pharmacists are integral in optimizing a patient’s treatment outcomes and potential long-term cost savings; additionally, providing education and counseling on the suggestions of PGx results.

Presently, pharmacists are already responsible for assessing the appropriateness of a medication and its dose with respect to a patient’s age, size, organ function, other diseases, diet, allergies, and other medications. With that in mind, PGx testing allows pharmacists to assess one additional source of response variability to individualizing drug therapy for a patient: genotype.

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With community pharmacies serving as a link between patients, prescriptions, and sometimes even multiple healthcare providers, pharmacy personnel are able to advocate in a central and unique way for patient-specific interventions that are supported by their genetic information. Currently, training, education programs, laboratory infrastructure, and guidelines are being developed for pharmacy personnel to ensure a smooth adoption of PGx services and counseling in community settings. Today, genetic testing kits are available over-the-counter (OTC), typically costing about ~$175 per kit but varying from $99 to $1000. At this time, while insurance payer coverage for testing is not universally accepted in the United States for testing that is ordered by a healthcare provider, legal advancements to support the billing of such testing services are improving and promising.

As the field of pharmacogenomics continues to grow and as genetic tests become more readily accessible and less costly to perform, patients and providers both hope to reduce healthcare costs, pick the safest and most effective medications possible for a patient, and avoid having to use the traditional, but unpredictable “trial-and-error” approach to treatment. In the near future, PGx services may be coming to a Happy Druggist Pharmacy near you!

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Resources:

Crutchley R. Personalized Medicine and the Future of Pharmacogenomics. Washington State University – College of Pharmacy Newsletter. Accessed June 23, 2022. https://pharmacy.wsu.edu/2022/02/11/personalized-medicine-and-the-future-of-pharmacogenomics/

Kennedy MJ. Personalized medicines – are pharmacists ready for the challenge? IPRP. 2018;7:113-123. doi:10.2147/IPRP.S133083

Kisor DF, Petry NJ, Bright DR. Pharmacogenomics in the United States Community Pharmacy Setting. PGPM. 2021;Volume 14:569-577. doi:10.2147/PGPM.S224894

National Community Pharmacists Association (NCPA). Pharmacogenomics. NCPA Resources. Published 2022. Accessed June 23, 2022. https://ncpa.org/pharmacogenomics

O’Connor SK, Michaels N, Ferreri S. Expansion of pharmacogenomics into the community pharmacy. Pharmacogenomics. 2015;16(3):175-180. doi:10.2217/pgs.14.183