Despite scarcity of funds, NIH announced generous awards that would allow medication testing using human tissue chips. In this unique system, human tissue is arranged on experimental framework material to mimic interplay of various organs in a body, and determine safety of drugs under development.
This represents one of many advances toward safety and tolerability of medications. At the Over 50 fair today, I gave a talk on the genetic testing for the cytochrome P450 polymorphisms. This system is responsible for processing nearly all of the drugs that are used in clinical practice. The lecture was well attended, and numerous questions at the end were reflective of the intense interest drug testing and safety generates. The test is performed by swabbing a Q tip inside a patient’s cheek. Results are available in about 2 weeks. Over 280 medications can currently be assessed for safety based on personal genetic variability of the cytochrome P 450 system.
So far, the “med-tuning” using the personalized genetic testing for common alleles of the P 450 system has exceeded my expectations. In one instance, a patient of mine on multiple medications was found to be hypotensive. I stopped one of his blood pressure drugs, and his blood pressure improved. When the genetic testing results became available, the discontinued drug was the safest one for him! I now have the opportunity to readjust his medications so that he achieves optimal blood pressure and heart rate control using the safest medications based on his genetic profile. In another instance, I stopped a water pill for a patient who became dehydrated in a hot climate. Before restarting it, I tested this patient’s P450 system. The drug appeared to be safe for him, and no substitution was needed. He was counseled to maintain his fluid intake in warm weather, and to resume this medications.
The genetic testing for medication safety is an important piece of the medications selection puzzle, and allows a truly personalized approach. Of course, it does not shed light on possible effects (and side-effects) of medications under extenuating circumstances such as diseased states, dehydration, fever. The tissue chip research supported by the NIH will add significantly to the understanding of complex organ- medication interactions.
I encourage all of my patients on at least one medication to have a genetic test for safety and side-effects profiles. All of my patients receive a color-coded hard copy of their results to use as needed during doctors appointments or hospital admissions. Over 100,000 deaths occur annually due to medication toxicity, and the annual cost exceed 182 billion. Medicare and most major carriers cover the test. I negotiated a significant discount for the test for those of our patients not covered by insurance. This simple test, performed once, may be a life-saver!