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href="#Mechanisms_of_pharmacogenetic_interactions"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Mechanisms of pharmacogenetic interactions</span> </div> </a> <button aria-controls="toc-Mechanisms_of_pharmacogenetic_interactions-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Mechanisms of pharmacogenetic interactions subsection</span> </button> <ul id="toc-Mechanisms_of_pharmacogenetic_interactions-sublist" class="vector-toc-list"> <li id="toc-Pharmacokinetics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pharmacokinetics"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>Pharmacokinetics</span> </div> </a> <ul id="toc-Pharmacokinetics-sublist" class="vector-toc-list"> <li id="toc-Drug-metabolizing_enzymes" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Drug-metabolizing_enzymes"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1.1</span> <span>Drug-metabolizing enzymes</span> </div> </a> <ul id="toc-Drug-metabolizing_enzymes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Drug_transporters" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Drug_transporters"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1.2</span> <span>Drug transporters</span> </div> </a> <ul id="toc-Drug_transporters-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Pharmacodynamics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pharmacodynamics"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>Pharmacodynamics</span> </div> </a> <ul id="toc-Pharmacodynamics-sublist" class="vector-toc-list"> <li id="toc-Drug_targets" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Drug_targets"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2.1</span> <span>Drug targets</span> </div> </a> <ul id="toc-Drug_targets-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Off-target_sites" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Off-target_sites"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2.2</span> <span>Off-target sites</span> </div> </a> <ul id="toc-Off-target_sites-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Immunologic" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Immunologic"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Immunologic</span> </div> </a> <ul id="toc-Immunologic-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Clinical_pharmacogenomics_resources" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Clinical_pharmacogenomics_resources"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Clinical pharmacogenomics resources</span> </div> </a> <button aria-controls="toc-Clinical_pharmacogenomics_resources-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Clinical pharmacogenomics resources subsection</span> </button> <ul id="toc-Clinical_pharmacogenomics_resources-sublist" class="vector-toc-list"> <li id="toc-Clinical_Pharmacogenetics_Implementation_Consortium_(CPIC)" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Clinical_Pharmacogenetics_Implementation_Consortium_(CPIC)"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Clinical Pharmacogenetics Implementation Consortium (CPIC)</span> </div> </a> <ul id="toc-Clinical_Pharmacogenetics_Implementation_Consortium_(CPIC)-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-U.S._Food_and_Drug_Administration" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#U.S._Food_and_Drug_Administration"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>U.S. Food and Drug Administration</span> </div> </a> <ul id="toc-U.S._Food_and_Drug_Administration-sublist" class="vector-toc-list"> <li id="toc-Table_of_Pharmacogenetic_Associations" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Table_of_Pharmacogenetic_Associations"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2.1</span> <span>Table of Pharmacogenetic Associations</span> </div> </a> <ul id="toc-Table_of_Pharmacogenetic_Associations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Table_of_Pharmacogenomic_Biomarkers_in_Drug_Labeling" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Table_of_Pharmacogenomic_Biomarkers_in_Drug_Labeling"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2.2</span> <span>Table of Pharmacogenomic Biomarkers in Drug Labeling</span> </div> </a> <ul id="toc-Table_of_Pharmacogenomic_Biomarkers_in_Drug_Labeling-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-PharmGKB" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#PharmGKB"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>PharmGKB</span> </div> </a> <ul id="toc-PharmGKB-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Commercial_Pharmacogenetic_Testing_Laboratories" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Commercial_Pharmacogenetic_Testing_Laboratories"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Commercial Pharmacogenetic Testing Laboratories</span> </div> </a> <button aria-controls="toc-Commercial_Pharmacogenetic_Testing_Laboratories-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Commercial Pharmacogenetic Testing Laboratories subsection</span> </button> <ul id="toc-Commercial_Pharmacogenetic_Testing_Laboratories-sublist" class="vector-toc-list"> <li id="toc-Direct-to-Consumer_Pharmacogenetic_Testing" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Direct-to-Consumer_Pharmacogenetic_Testing"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Direct-to-Consumer Pharmacogenetic Testing</span> </div> </a> <ul id="toc-Direct-to-Consumer_Pharmacogenetic_Testing-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Common_Pharmacogenomic-Specific_Nomenclature" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Common_Pharmacogenomic-Specific_Nomenclature"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Common Pharmacogenomic-Specific Nomenclature</span> </div> </a> <button aria-controls="toc-Common_Pharmacogenomic-Specific_Nomenclature-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Common Pharmacogenomic-Specific Nomenclature subsection</span> </button> <ul id="toc-Common_Pharmacogenomic-Specific_Nomenclature-sublist" class="vector-toc-list"> <li id="toc-Genotype" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Genotype"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Genotype</span> </div> </a> <ul id="toc-Genotype-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Phenotype" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Phenotype"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Phenotype</span> </div> </a> <ul id="toc-Phenotype-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Applications" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Applications"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Applications</span> </div> </a> <button aria-controls="toc-Applications-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Applications subsection</span> </button> <ul id="toc-Applications-sublist" class="vector-toc-list"> <li id="toc-Clinical_implementation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Clinical_implementation"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Clinical implementation</span> </div> </a> <ul id="toc-Clinical_implementation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Reduction_of_polypharmacy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Reduction_of_polypharmacy"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Reduction of polypharmacy</span> </div> </a> <ul id="toc-Reduction_of_polypharmacy-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Example_case_studies" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Example_case_studies"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Example case studies</span> </div> </a> <ul id="toc-Example_case_studies-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Challenges" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Challenges"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Challenges</span> </div> </a> <ul id="toc-Challenges-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Controversies" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Controversies"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>Controversies</span> </div> </a> <button aria-controls="toc-Controversies-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Controversies subsection</span> </button> <ul id="toc-Controversies-sublist" class="vector-toc-list"> <li id="toc-Race-based_medicine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Race-based_medicine"> <div class="vector-toc-text"> <span class="vector-toc-numb">9.1</span> <span>Race-based medicine</span> </div> </a> <ul id="toc-Race-based_medicine-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Genetic_exceptionalism" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Genetic_exceptionalism"> <div class="vector-toc-text"> <span class="vector-toc-numb">9.2</span> <span>Genetic exceptionalism</span> </div> </a> <ul id="toc-Genetic_exceptionalism-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>History</span> </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Future" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Future"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>Future</span> </div> </a> <ul id="toc-Future-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Ethics" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Ethics"> <div class="vector-toc-text"> <span class="vector-toc-numb">12</span> <span>Ethics</span> </div> </a> <ul id="toc-Ethics-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Web-based_resources" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Web-based_resources"> <div class="vector-toc-text"> <span class="vector-toc-numb">13</span> <span>Web-based resources</span> </div> </a> <ul id="toc-Web-based_resources-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">14</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">15</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> <span class="vector-toc-numb">16</span> <span>Further reading</span> </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">17</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Pharmacogenomics</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 21 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-21" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">21 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%B9%D9%84%D9%85_%D8%A7%D9%84%D8%B5%D9%8A%D8%AF%D9%84%D8%A9_%D8%A7%D9%84%D8%AC%D9%8A%D9%86%D9%8A" title="علم الصيدلة الجيني – Arabic" lang="ar" hreflang="ar" data-title="علم الصيدلة الجيني" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Farmacogen%C3%B2mica" title="Farmacogenòmica – Catalan" lang="ca" hreflang="ca" data-title="Farmacogenòmica" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Pharmakogenomik" title="Pharmakogenomik – German" lang="de" hreflang="de" data-title="Pharmakogenomik" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Farmakogenoomika" title="Farmakogenoomika – Estonian" lang="et" hreflang="et" data-title="Farmakogenoomika" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Farmacogen%C3%B3mica" title="Farmacogenómica – Spanish" lang="es" hreflang="es" data-title="Farmacogenómica" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%81%D8%A7%D8%B1%D9%85%D8%A7%DA%A9%D9%88%DA%98%D9%86%D9%88%D9%85%DB%8C%DA%A9" title="فارماکوژنومیک – Persian" lang="fa" hreflang="fa" data-title="فارماکوژنومیک" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Pharmacog%C3%A9nomique" title="Pharmacogénomique – French" lang="fr" hreflang="fr" data-title="Pharmacogénomique" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%95%BD%EB%AC%BC%EC%9C%A0%EC%A0%84%EC%B2%B4%ED%95%99" title="약물유전체학 – Korean" lang="ko" hreflang="ko" data-title="약물유전체학" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Farmakogenomik" title="Farmakogenomik – Indonesian" lang="id" hreflang="id" data-title="Farmakogenomik" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/Lyferf%C3%B0amengjafr%C3%A6%C3%B0i" title="Lyferfðamengjafræði – Icelandic" lang="is" hreflang="is" data-title="Lyferfðamengjafræði" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target"><span>Íslenska</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Farmacogenomica" title="Farmacogenomica – Italian" lang="it" hreflang="it" data-title="Farmacogenomica" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%A4%D0%B0%D1%80%D0%BC%D0%B0%D0%BA%D0%BE%D0%B3%D0%B5%D0%BD%D0%BE%D0%BC%D0%B8%D0%BA%D0%B0" title="Фармакогеномика – Macedonian" lang="mk" hreflang="mk" data-title="Фармакогеномика" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E3%82%B2%E3%83%8E%E3%83%A0%E8%96%AC%E7%90%86%E5%AD%A6" title="ゲノム薬理学 – Japanese" lang="ja" hreflang="ja" data-title="ゲノム薬理学" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Farmakogenomika" title="Farmakogenomika – Polish" lang="pl" hreflang="pl" data-title="Farmakogenomika" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Farmacogen%C3%B4mica" title="Farmacogenômica – Portuguese" lang="pt" hreflang="pt" data-title="Farmacogenômica" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A4%D0%B0%D1%80%D0%BC%D0%B0%D0%BA%D0%BE%D0%B3%D0%B5%D0%BD%D0%BE%D0%BC%D0%B8%D0%BA%D0%B0" title="Фармакогеномика – Russian" lang="ru" hreflang="ru" data-title="Фармакогеномика" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/Farmakogenomika" title="Farmakogenomika – Serbian" lang="sr" hreflang="sr" data-title="Farmakogenomika" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Farmakogenomika" title="Farmakogenomika – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Farmakogenomika" data-language-autonym="Srpskohrvatski / српскохрватски" 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class="mw-redirectedfrom">(Redirected from <a href="/w/index.php?title=Pharmacogenetics&redirect=no" class="mw-redirect" title="Pharmacogenetics">Pharmacogenetics</a>)</span></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Study of the role of the genome in drug response</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">For the journal, see <a href="/wiki/Pharmacogenomics_(journal)" title="Pharmacogenomics (journal)">Pharmacogenomics (journal)</a>.</div> 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href="mw-data:TemplateStyles:r1066933788"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1066933788"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1066933788"><table class="sidebar sidebar-collapse nomobile nowraplinks" style="width:17em;border:2px solid light-dark(#90db90,#024c02)"><tbody><tr><td class="sidebar-pretitle">Part of a series on</td></tr><tr><th class="sidebar-title-with-pretitle" style="background:light-dark(#90db90,#024c02) !important;color:inherit;font-size:175%;font-weight:bold"><a href="/wiki/Genetics" title="Genetics">Genetics</a></th></tr><tr><td class="sidebar-image"><span typeof="mw:File"><a href="/wiki/File:Hybridogenesis_in_water_frogs_gametes.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f0/Hybridogenesis_in_water_frogs_gametes.svg/150px-Hybridogenesis_in_water_frogs_gametes.svg.png" decoding="async" width="150" height="74" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f0/Hybridogenesis_in_water_frogs_gametes.svg/225px-Hybridogenesis_in_water_frogs_gametes.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f0/Hybridogenesis_in_water_frogs_gametes.svg/300px-Hybridogenesis_in_water_frogs_gametes.svg.png 2x" data-file-width="225" data-file-height="111" /></a></span></td></tr><tr><td class="sidebar-content" style="background:light-dark(#e7f4e7,#243124);color:inherit;padding:0.2em 0.4em 0.4em;"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="text-align:center;padding-bottom:0;background:light-dark(#90db90,#024c02) !important;color:inherit;font-size:100%;font-weight:bold;;color: var(--color-base)">Key components</div><div class="sidebar-list-content mw-collapsible-content hlist"><div class="excerpt-block"><div class="excerpt"> <ul><li><a href="/wiki/Chromosome" title="Chromosome">Chromosome</a></li> <li><a href="/wiki/DNA" title="DNA">DNA</a></li> <li><a href="/wiki/RNA" title="RNA">RNA</a></li> <li><a href="/wiki/Genome" title="Genome">Genome</a></li> <li><a href="/wiki/Heredity" title="Heredity">Heredity</a></li> <li><a href="/wiki/Nucleotide" title="Nucleotide">Nucleotide</a></li> <li><a href="/wiki/Mutation" title="Mutation">Mutation</a></li> <li><a href="/wiki/Genetic_variation" title="Genetic variation">Genetic variation</a></li> <li><a href="/wiki/Allele" title="Allele">Allele</a></li> <li><a href="/wiki/Amino_acid" title="Amino acid">Amino acid</a></li></ul></div></div> <hr /> <ul><li><a href="/wiki/Outline_of_genetics" title="Outline of genetics">Outline</a></li> <li><a href="/wiki/Index_of_genetics_articles" title="Index of genetics articles">Index</a></li></ul></div></div></td> </tr><tr><td class="sidebar-content" style="background:light-dark(#e7f4e7,#243124);color:inherit;padding:0.2em 0.4em 0.4em;"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="text-align:center;padding-bottom:0;background:light-dark(#90db90,#024c02) !important;color:inherit;font-size:100%;font-weight:bold;;color: var(--color-base)">History and topics</div><div class="sidebar-list-content mw-collapsible-content hlist"> <ul><li><a href="/wiki/Introduction_to_genetics" title="Introduction to genetics">Introduction</a></li> <li><a href="/wiki/History_of_genetics" title="History of genetics">History</a></li> <li><a href="/wiki/Evolution" title="Evolution">Evolution</a> (<a href="/wiki/Molecular_evolution" title="Molecular evolution">molecular</a>)</li> <li><a href="/wiki/Population_genetics" title="Population genetics">Population genetics</a></li> <li><a href="/wiki/Mendelian_inheritance" title="Mendelian inheritance">Mendelian inheritance</a></li> <li><a href="/wiki/Quantitative_genetics" title="Quantitative genetics">Quantitative genetics</a></li> <li><a href="/wiki/Molecular_genetics" title="Molecular genetics">Molecular genetics</a></li></ul></div></div></td> </tr><tr><td class="sidebar-content" style="background:light-dark(#e7f4e7,#243124);color:inherit;padding:0.2em 0.4em 0.4em;"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="text-align:center;padding-bottom:0;background:light-dark(#90db90,#024c02) !important;color:inherit;font-size:100%;font-weight:bold;;color: var(--color-base)">Research</div><div class="sidebar-list-content mw-collapsible-content hlist"> <ul><li><a href="/wiki/Geneticist" title="Geneticist">Geneticist</a></li> <li><a href="/wiki/DNA_sequencing" title="DNA sequencing">DNA sequencing</a></li> <li><a href="/wiki/Genetic_engineering" title="Genetic engineering">Genetic engineering</a></li> <li><span class="nowrap"><a href="/wiki/Genomics" title="Genomics">Genomics</a> (<span class="noviewer" typeof="mw:File"><span title="Template"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/8/83/Symbol_template_class_pink.svg/12px-Symbol_template_class_pink.svg.png" decoding="async" width="12" height="12" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/83/Symbol_template_class_pink.svg/18px-Symbol_template_class_pink.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/83/Symbol_template_class_pink.svg/24px-Symbol_template_class_pink.svg.png 2x" data-file-width="180" data-file-height="185" /></span></span> <a href="/wiki/Template:Genomics" title="Template:Genomics">template</a>)</span></li> <li><a href="/wiki/Medical_genetics" title="Medical genetics">Medical genetics</a></li></ul> <hr /> <ul><li><a href="/wiki/Outline_of_genetics#Branches_of_genetics" title="Outline of genetics">Branches of genetics</a></li></ul></div></div></td> </tr><tr><td class="sidebar-content" style="background:light-dark(#e7f4e7,#243124);color:inherit;padding:0.2em 0.4em 0.4em;"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="text-align:center;padding-bottom:0;background:light-dark(#90db90,#024c02) !important;color:inherit;font-size:100%;font-weight:bold;;color: var(--color-base)">Fields</div><div class="sidebar-list-content mw-collapsible-content hlist"><div class="excerpt-block"><div class="excerpt"> <ul><li><a href="/wiki/Classical_genetics" title="Classical genetics">Classical</a></li> <li><a href="/wiki/Conservation_genetics" title="Conservation genetics">Conservation</a></li> <li><a href="/wiki/Cytogenetics" title="Cytogenetics">Cytogenetics</a></li> <li><a href="/wiki/Ecological_genetics" title="Ecological genetics">Ecological</a></li> <li><a href="/wiki/Immunogenetics" title="Immunogenetics">Immunogenetics</a></li> <li><a href="/wiki/Microbial_genetics" title="Microbial genetics">Microbial</a></li> <li><a href="/wiki/Molecular_genetics" title="Molecular genetics">Molecular</a></li> <li><a href="/wiki/Population_genetics" title="Population genetics">Population</a></li> <li><a href="/wiki/Quantitative_genetics" title="Quantitative genetics">Quantitative</a></li></ul></div></div></div></div></td> </tr><tr><td class="sidebar-content" style="background:light-dark(#e7f4e7,#243124);color:inherit;padding:0.2em 0.4em 0.4em;"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="text-align:center;padding-bottom:0;background:light-dark(#90db90,#024c02) !important;color:inherit;font-size:100%;font-weight:bold;;color: var(--color-base)">Personalized medicine</div><div class="sidebar-list-content mw-collapsible-content hlist"> <ul><li><a href="/wiki/Personalized_medicine" title="Personalized medicine">Personalized medicine</a></li></ul></div></div></td> </tr><tr><td class="sidebar-below hlist"> <ul><li><span class="nowrap"><span class="noviewer" typeof="mw:File"><span title="Category"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /></span></span> <a href="/wiki/Category:Genetics" title="Category:Genetics">Category</a></span></li></ul></td></tr><tr><td class="sidebar-navbar"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Genetics_sidebar" title="Template:Genetics sidebar"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Genetics_sidebar" title="Template talk:Genetics sidebar"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Genetics_sidebar" title="Special:EditPage/Template:Genetics sidebar"><abbr title="Edit this template">e</abbr></a></li></ul></div></td></tr></tbody></table> <p><b>Pharmacogenomics</b>, often abbreviated "PGx," is the study of the role of the <a href="/wiki/Genome" title="Genome">genome</a> in <a href="/wiki/Drug" title="Drug">drug</a> response. Its name (<i><a href="https://en.wiktionary.org/wiki/pharmaco-#Prefix" class="extiw" title="wikt:pharmaco-">pharmaco-</a></i> + <i><a href="/wiki/Genomics" title="Genomics">genomics</a></i>) reflects its combining of <a href="/wiki/Pharmacology" title="Pharmacology">pharmacology</a> and <a href="/wiki/Genomics" title="Genomics">genomics</a>. Pharmacogenomics analyzes how the genetic makeup of a patient affects their response to drugs.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> It deals with the influence of <a href="/wiki/Somatic_mutation" title="Somatic mutation">acquired</a> and <a href="/wiki/Germline_mutation" title="Germline mutation">inherited</a> genetic variation on drug response, by correlating DNA <a href="/wiki/Mutation" title="Mutation">mutations</a> (including <a href="/wiki/Point_mutation" title="Point mutation">point mutations</a>, <a href="/wiki/Copy_number_variation" title="Copy number variation">copy number variations</a>, and <a href="/wiki/Structural_variation_in_the_human_genome" title="Structural variation in the human genome">structural variations</a>) with <a href="/wiki/Pharmacokinetics" title="Pharmacokinetics">pharmacokinetic</a> (drug <a href="/wiki/Absorption_(pharmacokinetics)" class="mw-redirect" title="Absorption (pharmacokinetics)">absorption</a>, <a href="/wiki/Distribution_(pharmacology)" title="Distribution (pharmacology)">distribution</a>, <a href="/wiki/Metabolism" title="Metabolism">metabolism</a>, and <a href="/wiki/Clearance_(medicine)" class="mw-redirect" title="Clearance (medicine)">elimination</a>), <a href="/wiki/Pharmacodynamics" title="Pharmacodynamics">pharmacodynamic</a> (effects mediated through a drug's <a href="/wiki/Biological_target" title="Biological target">biological targets</a>), and/or <a href="/wiki/Immunogenicity" title="Immunogenicity">immunogenic</a> endpoints.<sup id="cite_ref-pmid14585618_2-0" class="reference"><a href="#cite_note-pmid14585618-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-UNC_Center_for_Pharmacogenomics_and_Individualized_Therapy_3-0" class="reference"><a href="#cite_note-UNC_Center_for_Pharmacogenomics_and_Individualized_Therapy-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>Pharmacogenomics aims to develop rational means to optimize <a href="/wiki/Pharmacotherapy" title="Pharmacotherapy">drug therapy</a>, with regard to the patients' <a href="/wiki/Genotype" title="Genotype">genotype</a>, to achieve maximum efficiency with minimal <a href="/wiki/Adverse_effect_(medicine)" class="mw-redirect" title="Adverse effect (medicine)">adverse effects</a>.<sup id="cite_ref-pmid19530963_5-0" class="reference"><a href="#cite_note-pmid19530963-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> It is hoped that by using pharmacogenomics, <a href="/wiki/Pharmaceutical_drug" class="mw-redirect" title="Pharmaceutical drug">pharmaceutical drug</a> treatments can deviate from what is dubbed as the "one-dose-fits-all" approach. Pharmacogenomics also attempts to eliminate trial-and-error in prescribing, allowing physicians to take into consideration their patient's genes, the functionality of these genes, and how this may affect the effectiveness of the patient's current or future treatments (and where applicable, provide an explanation for the failure of past treatments).<sup id="cite_ref-pmid19565025_6-0" class="reference"><a href="#cite_note-pmid19565025-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Such approaches promise the advent of <a href="/wiki/Precision_medicine" class="mw-redirect" title="Precision medicine">precision medicine</a> and even <a href="/wiki/Personalized_medicine" title="Personalized medicine">personalized medicine</a>, in which drugs and drug combinations are optimized for narrow subsets of patients or even for each individual's unique genetic makeup.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Squassina2010_9-0" class="reference"><a href="#cite_note-Squassina2010-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>Whether used to explain a patient's response (or lack of it) to a treatment, or to act as a predictive tool, it hopes to achieve better treatment outcomes and greater efficacy, and reduce drug toxicities and adverse drug reactions (ADRs). For patients who do not respond to a treatment, alternative therapies can be prescribed that would best suit their requirements. In order to provide pharmacogenomic recommendations for a given drug, two possible types of input can be used: <a href="/wiki/Genotyping" title="Genotyping">genotyping</a>, or <a href="/wiki/Exome" title="Exome">exome</a> or whole <a href="/wiki/Genome" title="Genome">genome</a> <a href="/wiki/Sequencing" title="Sequencing">sequencing</a>.<sup id="cite_ref-eval_10-0" class="reference"><a href="#cite_note-eval-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Sequencing provides many more data points, including detection of mutations that prematurely terminate the synthesized protein (early <a href="/wiki/Stop_codon" title="Stop codon">stop codon</a>).<sup id="cite_ref-eval_10-1" class="reference"><a href="#cite_note-eval-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Pharmacogenetics_vs._pharmacogenomics">Pharmacogenetics vs. pharmacogenomics</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=1" title="Edit section: Pharmacogenetics vs. pharmacogenomics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The term <i>pharmacogenomics</i> is often used interchangeably with <i>pharmacogenetics</i>. Although both terms relate to drug response based on genetic influences, there are differences between the two. <b>Pharmacogenetics</b> is limited to <a href="/wiki/Monogenic_(genetics)" class="mw-redirect" title="Monogenic (genetics)">monogenic</a> phenotypes (i.e., single gene-drug interactions). <b>Pharmacogenomics</b> refers to polygenic drug response phenotypes and encompasses <a href="/wiki/Transcriptome" title="Transcriptome">transcriptomics</a>, <a href="/wiki/Proteomics" title="Proteomics">proteomics</a>, and <a href="/wiki/Metabolomics" title="Metabolomics">metabolomics</a>. </p> <div class="mw-heading mw-heading2"><h2 id="Mechanisms_of_pharmacogenetic_interactions">Mechanisms of pharmacogenetic interactions</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=2" title="Edit section: Mechanisms of pharmacogenetic interactions"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Pharmacokinetics">Pharmacokinetics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=3" title="Edit section: Pharmacokinetics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Pharmacokinetics" title="Pharmacokinetics">Pharmacokinetics</a> involves the absorption, distribution, metabolism, and elimination of pharmaceutics. These processes are often facilitated by enzymes such as drug transporters or drug metabolizing enzymes (discussed in-depth below). Variation in DNA loci responsible for producing these enzymes can alter their expression or activity so that their functional status changes. An increase, decrease, or loss of function for transporters or metabolizing enzymes can ultimately alter the amount of medication in the body and at the site of action. This may result in deviation from the medication's <a href="/wiki/Therapeutic_index" title="Therapeutic index">therapeutic window</a> and result in either toxicity or loss of effectiveness. </p> <div class="mw-heading mw-heading4"><h4 id="Drug-metabolizing_enzymes">Drug-metabolizing enzymes</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=4" title="Edit section: Drug-metabolizing enzymes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The majority of clinically actionable pharmacogenetic variation occurs in genes that code for drug-metabolizing enzymes, including those involved in both <a href="/wiki/Phase_I_metabolism" class="mw-redirect" title="Phase I metabolism">phase I</a> and <a href="/wiki/Phase_II_metabolism" class="mw-redirect" title="Phase II metabolism">phase II</a> metabolism. The <a href="/wiki/Cytochrome_P450" title="Cytochrome P450">cytochrome P450</a> enzyme family is responsible for metabolism of 70-80% of all medications used clinically.<sup id="cite_ref-:7_11-0" class="reference"><a href="#cite_note-:7-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> <a href="/wiki/CYP3A4" title="CYP3A4">CYP3A4</a>, <a href="/wiki/CYP2C9" title="CYP2C9">CYP2C9</a>, <a href="/wiki/CYP2C19" title="CYP2C19">CYP2C19</a>, and <a href="/wiki/CYP2D6" title="CYP2D6">CYP2D6</a> are major CYP enzymes involved in drug metabolism and are all known to be highly polymorphic.<sup id="cite_ref-:7_11-1" class="reference"><a href="#cite_note-:7-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Additional drug-metabolizing enzymes that have been implicated in pharmacogenetic interactions include <a href="/wiki/UGT1A1" class="mw-redirect" title="UGT1A1">UGT1A1</a> (a <a href="/wiki/Glucuronosyltransferase" title="Glucuronosyltransferase">UDP-glucuronosyltransferase</a>), <a href="/wiki/Dihydropyrimidine_dehydrogenase_(NADP%2B)" title="Dihydropyrimidine dehydrogenase (NADP+)">DPYD</a>, and <a href="/wiki/Thiopurine_methyltransferase" title="Thiopurine methyltransferase">TPMT</a>.<sup id="cite_ref-:0_12-0" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Drug_transporters">Drug transporters</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=5" title="Edit section: Drug transporters"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Many medications rely on <a href="/wiki/Transport_protein" title="Transport protein">transporters</a> to cross cellular membranes in order to move between body fluid compartments such as the blood, gut lumen, bile, urine, brain, and cerebrospinal fluid.<sup id="cite_ref-:1_13-0" class="reference"><a href="#cite_note-:1-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> The major transporters include the <a href="/wiki/Solute_carrier_family" title="Solute carrier family">solute carrier</a>, <a href="/wiki/ATP-binding_cassette_transporter" class="mw-redirect" title="ATP-binding cassette transporter">ATP-binding cassette</a>, and <a href="/wiki/Organo_anion_transporter_family" title="Organo anion transporter family">organic anion transporters</a>.<sup id="cite_ref-:1_13-1" class="reference"><a href="#cite_note-:1-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Transporters that have been shown to influence response to medications include <a href="/wiki/OATP1B1" class="mw-redirect" title="OATP1B1">OATP1B1</a> (<i>SLCO1B1</i>) and breast cancer resistance protein (BCRP) (<i><a href="/wiki/ABCG2" title="ABCG2">ABCG2</a>).</i><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Pharmacodynamics">Pharmacodynamics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=6" title="Edit section: Pharmacodynamics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Pharmacodynamics" title="Pharmacodynamics">Pharmacodynamics</a> refers to the impact a medication has on the body, or its mechanism of action. </p> <div class="mw-heading mw-heading4"><h4 id="Drug_targets">Drug targets</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=7" title="Edit section: Drug targets"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Drug targets are the specific sites where a medication carries out its pharmacological activity. The interaction between the drug and this site results in a modification of the target that may include inhibition or potentiation.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Most of the pharmacogenetic interactions that involve drug targets are within the field of <a href="/wiki/Oncology" title="Oncology">oncology</a> and include <a href="/wiki/Targeted_therapy" title="Targeted therapy">targeted therapeutics</a> designed to address <a href="/wiki/Somatic_mutation" title="Somatic mutation">somatic mutations</a> (see also <a href="/wiki/Cancer_pharmacogenomics" title="Cancer pharmacogenomics">Cancer Pharmacogenomics</a>). For example, <a href="/wiki/Epidermal_growth_factor_receptor" title="Epidermal growth factor receptor">EGFR</a> inhibitors like <a href="/wiki/Gefitinib" title="Gefitinib">gefitinib</a> (Iressa) or <a href="/wiki/Erlotinib" title="Erlotinib">erlotinib</a> (Tarceva) are only indicated in patients carrying specific mutations to <i>EGFR</i>.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Germline_mutation" title="Germline mutation">Germline mutations</a> in drug targets can also influence response to medications, though this is an emerging subfield within pharmacogenomics. One well-established gene-drug interaction involving a germline mutation to a drug target is <a href="/wiki/Warfarin" title="Warfarin">warfarin</a> (Coumadin) and <i><a href="/wiki/VKORC1" title="VKORC1">VKORC1</a></i>, which codes for <a href="/wiki/Vitamin_K_epoxide_reductase" title="Vitamin K epoxide reductase">vitamin K epoxide reductase (VKOR)</a>. Warfarin binds to and inhibits VKOR, which is an important enzyme in the vitamin K cycle.<sup id="cite_ref-:8_18-0" class="reference"><a href="#cite_note-:8-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Inhibition of VKOR prevents <a href="/wiki/Redox" title="Redox">reduction</a> of <a href="/wiki/Vitamin_K" title="Vitamin K">vitamin K</a>, which is a <a href="/wiki/Cofactor_(biochemistry)" title="Cofactor (biochemistry)">cofactor</a> required in the formation of <a href="/wiki/Coagulation" title="Coagulation">coagulation</a> factors <a href="/wiki/Thrombin" title="Thrombin">II</a>, <a href="/wiki/Coagulation_factor_VII" class="mw-redirect" title="Coagulation factor VII">VII</a>, <a href="/wiki/Factor_IX" title="Factor IX">IX</a> and <a href="/wiki/Factor_X" title="Factor X">X</a>, and inhibitors <a href="/wiki/Protein_C" title="Protein C">protein C</a> and <a href="/wiki/Protein_S" title="Protein S">S</a>.<sup id="cite_ref-:8_18-1" class="reference"><a href="#cite_note-:8-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Off-target_sites">Off-target sites</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=8" title="Edit section: Off-target sites"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Medications can have off-target effects (typically unfavorable) that arise from an interaction between the medication and/or its metabolites and a site other than the intended target.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Genetic variation in the off-target sites can influence this interaction. The main example of this type of pharmacogenomic interaction is <a href="/wiki/Glucose-6-phosphate_dehydrogenase" title="Glucose-6-phosphate dehydrogenase">glucose-6-phosphate-dehydrogenase (G6PD)</a>. G6PD is the enzyme involved in the first step of the <a href="/wiki/Pentose_phosphate_pathway" title="Pentose phosphate pathway">pentose phosphate pathway</a> which generates NADPH (from NADP). NADPH is required for the production of reduced <a href="/wiki/Glutathione" title="Glutathione">glutathione</a> in <a href="/wiki/Red_blood_cell" title="Red blood cell">erythrocytes</a> and it is essential for the function of <a href="/wiki/Catalase" title="Catalase">catalase</a>.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Glutathione and catalase protect cells from oxidative stress that would otherwise result in cell <a href="/wiki/Lysis" title="Lysis">lysis</a>. Certain variants in <i>G6PD</i> result in <a href="/wiki/Glucose-6-phosphate_dehydrogenase_deficiency" title="Glucose-6-phosphate dehydrogenase deficiency">G6PD deficiency</a>, in which cells are more susceptible to oxidative stress. When medications that have a significant oxidative effect are administered to individuals who are G6PD deficient, they are at an increased risk of erythrocyte lysis that presents as <a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">hemolytic anemia</a>.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Immunologic">Immunologic</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=9" title="Edit section: Immunologic"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The <a href="/wiki/Human_leukocyte_antigen" title="Human leukocyte antigen">human leukocyte antigen</a> (HLA) system, also referred to as the <a href="/wiki/Major_histocompatibility_complex" title="Major histocompatibility complex">major histocompatibility complex</a> (MHC), is a complex of genes important for the <a href="/wiki/Adaptive_immune_system" title="Adaptive immune system">adaptive immune system</a>. Mutations in the HLA complex have been associated with an increased risk of developing hypersensitivity reactions in response to certain medications.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Clinical_pharmacogenomics_resources">Clinical pharmacogenomics resources</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=10" title="Edit section: Clinical pharmacogenomics resources"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Clinical_Pharmacogenetics_Implementation_Consortium_(CPIC)"><span id="Clinical_Pharmacogenetics_Implementation_Consortium_.28CPIC.29"></span>Clinical Pharmacogenetics Implementation Consortium (CPIC)</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=11" title="Edit section: Clinical Pharmacogenetics Implementation Consortium (CPIC)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The <a href="/wiki/Clinical_Pharmacogenetics_Implementation_Consortium" title="Clinical Pharmacogenetics Implementation Consortium">Clinical Pharmacogenetics Implementation Consortium</a> (CPIC) is "an international consortium of individual volunteers and a small dedicated staff who are interested in facilitating use of pharmacogenetic tests for patient care. CPIC’s goal is to address barriers to clinical implementation of pharmacogenetic tests by creating, curating, and posting freely available, peer-reviewed, evidence-based, updatable, and detailed gene/drug clinical practice guidelines. CPIC guidelines follow standardized formats, include systematic grading of evidence and clinical recommendations, use standardized terminology, are peer-reviewed, and are published in a journal (in partnership with Clinical Pharmacology and Therapeutics) with simultaneous posting to cpicpgx.org, where they are regularly updated."<sup id="cite_ref-:0_12-1" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p><p>The CPIC guidelines are "designed to help clinicians understand HOW available genetic test results should be used to optimize drug therapy, rather than WHETHER tests should be ordered. A key assumption underlying the CPIC guidelines is that clinical high-throughput and pre-emptive (pre-prescription) genotyping will become more widespread, and that clinicians will be faced with having patients’ genotypes available even if they have not explicitly ordered a test with a specific drug in mind. CPIC's guidelines, processes and projects have been endorsed by several professional societies."<sup id="cite_ref-:0_12-2" class="reference"><a href="#cite_note-:0-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="U.S._Food_and_Drug_Administration">U.S. Food and Drug Administration</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=12" title="Edit section: U.S. Food and Drug Administration"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading4"><h4 id="Table_of_Pharmacogenetic_Associations">Table of Pharmacogenetic Associations</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=13" title="Edit section: Table of Pharmacogenetic Associations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In February 2020 the <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">FDA</a> published the Table of Pharmacogenetic Associations.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> For the gene-drug pairs included in the table, "the FDA has evaluated and believes there is sufficient scientific evidence to suggest that subgroups of patients with certain genetic variants, or genetic variant-inferred phenotypes (such as affected subgroup in the table below), are likely to have altered drug metabolism, and in certain cases, differential therapeutic effects, including differences in risks of adverse events."<sup id="cite_ref-:2_25-0" class="reference"><a href="#cite_note-:2-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p><p>"The information in this Table is intended primarily for prescribers, and patients should not adjust their medications without consulting their prescriber. This version of the table is limited to pharmacogenetic associations that are related to drug metabolizing enzyme gene variants, drug transporter gene variants, and gene variants that have been related to a predisposition for certain adverse events. The FDA recognizes that various other pharmacogenetic associations exist that are not listed here, and this table will be updated periodically with additional pharmacogenetic associations supported by sufficient scientific evidence."<sup id="cite_ref-:2_25-1" class="reference"><a href="#cite_note-:2-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Table_of_Pharmacogenomic_Biomarkers_in_Drug_Labeling">Table of Pharmacogenomic Biomarkers in Drug Labeling</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=14" title="Edit section: Table of Pharmacogenomic Biomarkers in Drug Labeling"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The FDA Table of Pharmacogenomic Biomarkers in Drug Labeling lists FDA-approved drugs with pharmacogenomic information found in the drug labeling. "Biomarkers in the table include but are not limited to germline or somatic gene variants (polymorphisms, mutations), functional deficiencies with a genetic etiology, gene expression differences, and chromosomal abnormalities; selected protein biomarkers that are used to select treatments for patients are also included."<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="PharmGKB">PharmGKB</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=15" title="Edit section: PharmGKB"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The <a href="/wiki/PharmGKB" title="PharmGKB">Pharmacogenomics Knowledgebase (PharmGKB)</a> is an "<a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">NIH</a>-funded resource that provides information about how human genetic variation affects response to medications. PharmGKB collects, curates and disseminates knowledge about clinically actionable gene-drug associations and genotype-phenotype relationships."<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Commercial_Pharmacogenetic_Testing_Laboratories">Commercial Pharmacogenetic Testing Laboratories</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=16" title="Edit section: Commercial Pharmacogenetic Testing Laboratories"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are many commercial laboratories around the world who offer pharmacogenomic testing as a <a href="/wiki/Laboratory_developed_test" title="Laboratory developed test">laboratory developed test (LDTs)</a>. The tests offered can vary significantly from one lab to another, including genes and alleles tested for, phenotype assignment, and any clinical annotations provided. With the exception of a few direct-to-consumer tests, all pharmacogenetic testing requires an order from an authorized healthcare professional. In order for the results to be used in a clinical setting in the <a href="/wiki/United_States" title="United States">United States</a>, the laboratory performing the test much be <a href="/wiki/Clinical_Laboratory_Improvement_Amendments" title="Clinical Laboratory Improvement Amendments">CLIA</a>-certified. Other regulations may vary by country and state. </p> <figure typeof="mw:File/Thumb"><a href="/wiki/File:CPIC_Term_Consensus_Table.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/87/CPIC_Term_Consensus_Table.jpg/512px-CPIC_Term_Consensus_Table.jpg" decoding="async" width="512" height="390" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/87/CPIC_Term_Consensus_Table.jpg/768px-CPIC_Term_Consensus_Table.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/87/CPIC_Term_Consensus_Table.jpg/1024px-CPIC_Term_Consensus_Table.jpg 2x" data-file-width="1200" data-file-height="913" /></a><figcaption>Final consensus terms for allele functional status and phenotype</figcaption></figure> <div class="mw-heading mw-heading3"><h3 id="Direct-to-Consumer_Pharmacogenetic_Testing">Direct-to-Consumer Pharmacogenetic Testing</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=17" title="Edit section: Direct-to-Consumer Pharmacogenetic Testing"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Direct-to-consumer_genetic_testing" class="mw-redirect" title="Direct-to-consumer genetic testing">Direct-to-consumer</a> (DTC) pharmacogenetic tests allow consumers to obtain pharmacogenetic testing without an order from a prescriber. DTC pharmacogenetic tests are generally reviewed by the FDA to determine the validity of test claims.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> The FDA maintains a <a rel="nofollow" class="external text" href="https://www.fda.gov/medical-devices/in-vitro-diagnostics/direct-consumer-tests#list">list of DTC genetic tests</a> that have been approved. </p> <div class="mw-heading mw-heading2"><h2 id="Common_Pharmacogenomic-Specific_Nomenclature">Common Pharmacogenomic-Specific Nomenclature</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=18" title="Edit section: Common Pharmacogenomic-Specific Nomenclature"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Genotype">Genotype</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=19" title="Edit section: Genotype"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are multiple ways to represent a pharmacogenomic <a href="/wiki/Genotype" title="Genotype">genotype</a>. A commonly used <a href="/wiki/Nomenclature" title="Nomenclature">nomenclature</a> system is to report <a href="/wiki/Haplotype" title="Haplotype">haplotypes</a> using a star (*) allele (e.g., <a href="/wiki/CYP2C19" title="CYP2C19">CYP2C19</a> *1/*2). <a href="/wiki/Single-nucleotide_polymorphism" title="Single-nucleotide polymorphism">Single-nucleotide polymorphisms</a> (SNPs) may be described using their assignment reference SNP cluster ID (rsID) or based on the location of the <a href="/wiki/Base_pair" title="Base pair">base pair</a> or <a href="/wiki/Amino_acid" title="Amino acid">amino acid</a> impacted.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Phenotype">Phenotype</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=20" title="Edit section: Phenotype"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 2017 CPIC published results of an expert <a href="/wiki/Survey_(human_research)" title="Survey (human research)">survey</a> to standardize terms related to clinical pharmacogenetic test results.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Consensus for terms to describe allele functional status, <a href="/wiki/Phenotype" title="Phenotype">phenotype</a> for drug metabolizing enzymes, phenotype for drug transporters, and phenotype for high-risk genotype status was reached. </p> <div class="mw-heading mw-heading2"><h2 id="Applications">Applications</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=21" title="Edit section: Applications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The list below provides a few more commonly known applications of pharmacogenomics:<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Improve drug safety, and reduce ADRs;</li> <li>Tailor treatments to meet patients' unique genetic pre-disposition, identifying optimal dosing;</li> <li>Improve drug discovery targeted to human disease; and</li> <li>Improve proof of principle for efficacy trials.</li></ul> <p>Pharmacogenomics may be applied to several areas of medicine, including <a href="/wiki/Pain_management" title="Pain management">pain management</a>, <a href="/wiki/Cardiology" title="Cardiology">cardiology</a>, <a href="/wiki/Oncology" title="Oncology">oncology</a>, and <a href="/wiki/Psychiatry" title="Psychiatry">psychiatry</a>. A place may also exist in <a href="/wiki/Forensic_pathology" title="Forensic pathology">forensic pathology</a>, in which pharmacogenomics can be used to determine the cause of death in drug-related deaths where no findings emerge using <a href="/wiki/Autopsy" title="Autopsy">autopsy</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="removed citation to predatory publisher content (December 2019)">citation needed</span></a></i>]</sup> </p><p>In <a href="/wiki/Cancer_treatment" title="Cancer treatment">cancer treatment</a>, pharmacogenomics tests are used to identify which patients are most likely to respond to certain <a href="/wiki/Cancer_drugs" class="mw-redirect" title="Cancer drugs">cancer drugs</a>. In behavioral health, pharmacogenomic tests provide tools for physicians and care givers to better manage medication selection and side effect amelioration. Pharmacogenomics is also known as companion diagnostics, meaning tests being bundled with drugs. Examples include <a href="/wiki/KRAS" title="KRAS">KRAS</a> test with <a href="/wiki/Cetuximab" title="Cetuximab">cetuximab</a> and <a href="/wiki/Epidermal_growth_factor_receptor" title="Epidermal growth factor receptor">EGFR</a> test with <a href="/wiki/Gefitinib" title="Gefitinib">gefitinib</a>. Beside efficacy, germline pharmacogenetics can help to identify patients likely to undergo severe toxicities when given cytotoxics showing impaired detoxification in relation with genetic polymorphism, such as canonical 5-FU.<sup id="cite_ref-pmid20920994_32-0" class="reference"><a href="#cite_note-pmid20920994-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> In particular, genetic deregulations affecting genes coding for <a href="/wiki/Dihydropyrimidine_dehydrogenase" class="mw-redirect" title="Dihydropyrimidine dehydrogenase">DPD</a>, <a href="/wiki/UGT1A1" class="mw-redirect" title="UGT1A1">UGT1A1</a>, <a href="/wiki/TPMT" class="mw-redirect" title="TPMT">TPMT</a>, <a href="/wiki/Cytidine_deaminase" title="Cytidine deaminase">CDA</a> and <a href="/wiki/CYP2D6" title="CYP2D6">CYP2D6</a> are now considered as critical issues for patients treated with 5-FU/capecitabine, irinotecan, mercaptopurine/azathioprine, gemcitabine/capecitabine/AraC and tamoxifen, respectively.<sup id="cite_ref-pmid202043652_33-0" class="reference"><a href="#cite_note-pmid202043652-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p><p>In <a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">cardiovascular disorders</a>, the main concern is response to drugs including <a href="/wiki/Warfarin" title="Warfarin">warfarin</a>, <a href="/wiki/Clopidogrel" title="Clopidogrel">clopidogrel</a>, <a href="/wiki/Beta_blocker" title="Beta blocker">beta blockers</a>, and <a href="/wiki/Statin" title="Statin">statins</a>.<sup id="cite_ref-eval_10-2" class="reference"><a href="#cite_note-eval-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> In patients with CYP2C19, who take clopidogrel, cardiovascular risk is elevated, leading to <a href="/wiki/Medication_package_insert" title="Medication package insert">medication package insert</a> updates by regulators.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> In patients with <a href="/wiki/Type_2_diabetes" title="Type 2 diabetes">type 2 diabetes</a>, <a href="/wiki/Haptoglobin" title="Haptoglobin">haptoglobin</a> (Hp) genotyping shows an effect on cardiovascular disease, with Hp2-2 at higher risk and supplemental vitamin E reducing risk by affecting <a href="/wiki/High-density_lipoprotein" title="High-density lipoprotein">HDL</a>.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p><p>In psychiatry, as of 2010, research has focused particularly on <a href="/wiki/5-HTTLPR" title="5-HTTLPR">5-HTTLPR</a> and <a href="/wiki/Dopamine_receptor_D2" title="Dopamine receptor D2">DRD2</a>.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Clinical_implementation">Clinical implementation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=22" title="Edit section: Clinical implementation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Education_in_personalized_medicine" title="Education in personalized medicine">Education in personalized medicine</a></div> <p>Initiatives to spur adoption by clinicians include the <a rel="nofollow" class="external text" href="https://upgx.eu/">Ubiquitous Pharmacogenomics (U-PGx)</a> program in <a href="/wiki/Europe" title="Europe">Europe</a> and the Clinical Pharmacogenetics Implementation Consortium (CPIC) in the United States.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> In a 2017 survey of European clinicians, in the prior year two-thirds had not ordered a pharmacogenetic test.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p><p>In 2010, <a href="/wiki/Vanderbilt_University_Medical_Center" title="Vanderbilt University Medical Center">Vanderbilt University Medical Center</a> launched Pharmacogenomic Resource for Enhanced Decisions in Care and Treatment (PREDICT);<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> in 2015 survey, two-thirds of the clinicians had ordered a pharmacogenetic test.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p>In 2019, the largest private health insurer, <a href="/wiki/UnitedHealth_Group" title="UnitedHealth Group">UnitedHealthcare</a>, announced that it would pay for genetic testing to predict response to psychiatric drugs.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p><p>In 2020, <a href="/wiki/Canada" title="Canada">Canada's</a> 4th largest health and dental insurer, <a href="/wiki/Green_Shield_Canada" title="Green Shield Canada">Green Shield Canada</a>, announced that it would pay for pharmacogenetic testing and its associated clinical decision support software to optimize and personalize mental health prescriptions.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Reduction_of_polypharmacy">Reduction of polypharmacy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=23" title="Edit section: Reduction of polypharmacy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A potential role for pharmacogenomics is to reduce the occurrence of <a href="/wiki/Polypharmacy" title="Polypharmacy">polypharmacy</a>: it is theorized that with tailored drug treatments, patients will not need to take several medications to treat the same condition. Thus they could potentially reduce the occurrence of <a href="/wiki/Adverse_drug_reaction" title="Adverse drug reaction">adverse drug reactions</a>, improve treatment outcomes, and save costs by avoiding purchase of some medications. For example, maybe due to inappropriate prescribing, <a href="/wiki/Psychiatry" title="Psychiatry">psychiatric</a> patients tend to receive more medications than age-matched non-psychiatric patients.<sup id="cite_ref-polypharmacy_book_43-0" class="reference"><a href="#cite_note-polypharmacy_book-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> </p><p>The need for pharmacogenomically tailored drug therapies may be most evident in a survey conducted by the Slone Epidemiology Center at <a href="/wiki/Boston_University" title="Boston University">Boston University</a> from February 1998 to April 2007. The study elucidated that an average of 82% of adults in the United States are taking at least one medication (prescription or nonprescription drug, vitamin/mineral, herbal/natural supplement), and 29% are taking five or more. The study suggested that those aged 65 years or older continue to be the biggest consumers of medications, with 17-19% in this age group taking at least ten medications in a given week. Polypharmacy has also shown to have increased since 2000 from 23% to 29%.<sup id="cite_ref-Slone_Study_44-0" class="reference"><a href="#cite_note-Slone_Study-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Example_case_studies">Example case studies</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=24" title="Edit section: Example case studies"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><i>Case A – Antipsychotic adverse reaction</i><sup id="cite_ref-PMC2656342_45-0" class="reference"><a href="#cite_note-PMC2656342-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p><p>Patient A has schizophrenia. Their treatment included a combination of ziprasidone, olanzapine, trazodone and <a href="/wiki/Benzatropine" title="Benzatropine">benztropine</a>. The patient experienced dizziness and sedation, so they were tapered off ziprasidone and olanzapine, and transitioned to quetiapine. Trazodone was discontinued. The patient then experienced excessive sweating, tachycardia and neck pain, gained considerable weight and had hallucinations. Five months later, quetiapine was tapered and discontinued, with ziprasidone re-introduced into their treatment, due to the excessive weight gain. Although the patient lost the excessive weight they had gained, they then developed muscle stiffness, <a href="/wiki/Cogwheeling" class="mw-redirect" title="Cogwheeling">cogwheeling</a>, tremors and night sweats. When benztropine was added they experienced blurry vision. After an additional five months, the patient was switched from ziprasidone to aripiprazole. Over the course of 8 months, patient A gradually experienced more weight gain and sedation, and developed difficulty with their gait, stiffness, cogwheeling and dyskinetic ocular movements. A pharmacogenomics test later proved the patient had a CYP2D6 *1/*41, which has a predicted phenotype of IM and CYP2C19 *1/*2 with a predicted phenotype of IM as well. </p><p><i>Case B – Pain Management</i><sup id="cite_ref-url_AMA_Pharmacogenomic_Factsheet_46-0" class="reference"><a href="#cite_note-url_AMA_Pharmacogenomic_Factsheet-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p><p>Patient B is a woman who gave birth by caesarian section. Her physician prescribed codeine for post-caesarian pain. She took the standard prescribed dose, but she experienced nausea and dizziness while she was taking codeine. She also noticed that her breastfed infant was lethargic and feeding poorly. When the patient mentioned these symptoms to her physician, they recommended that she discontinue codeine use. Within a few days, both the patient's and her infant's symptoms were no longer present. It is assumed that if the patient had undergone a pharmacogenomic test, it would have revealed she may have had a duplication of the gene CYP2D6, placing her in the Ultra-rapid metabolizer (UM) category, explaining her reactions to codeine use. </p><p><i>Case C – FDA Warning on Codeine Overdose for Infants</i><sup id="cite_ref-url_FDA_Codeine_Warning_47-0" class="reference"><a href="#cite_note-url_FDA_Codeine_Warning-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> </p><p>On February 20, 2013, the <a href="/wiki/FDA" class="mw-redirect" title="FDA">FDA</a> released a statement addressing a serious concern regarding the connection between children who are known as CYP2D6 UM, and fatal reactions to codeine following <a href="/wiki/Tonsillectomy" title="Tonsillectomy">tonsillectomy</a> and/or <a href="/wiki/Adenoidectomy" title="Adenoidectomy">adenoidectomy</a> (surgery to remove the tonsils and/or adenoids). They released their strongest Boxed Warning to elucidate the dangers of CYP2D6 UMs consuming codeine. Codeine is converted to morphine by CYP2D6, and those who have UM phenotypes are in danger of producing large amounts of morphine due to the increased function of the gene. The morphine can elevate to life-threatening or fatal amounts, as became evident with the death of three children in August 2012. </p> <div class="mw-heading mw-heading2"><h2 id="Challenges">Challenges</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=25" title="Edit section: Challenges"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Pharmacogenomics_challenges_from_research_to_practice.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/74/Pharmacogenomics_challenges_from_research_to_practice.jpg/440px-Pharmacogenomics_challenges_from_research_to_practice.jpg" decoding="async" width="440" height="476" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/7/74/Pharmacogenomics_challenges_from_research_to_practice.jpg 1.5x" data-file-width="453" data-file-height="490" /></a><figcaption> Consecutive phases and associated challenges in Pharmacogenomics.<sup id="cite_ref-sven2007_48-0" class="reference"><a href="#cite_note-sven2007-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p>Although there appears to be a general acceptance of the basic tenet of pharmacogenomics amongst physicians and healthcare professionals,<sup id="cite_ref-pmid22278335_49-0" class="reference"><a href="#cite_note-pmid22278335-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> several challenges exist that slow the uptake, implementation, and standardization of pharmacogenomics. Some of the concerns raised by physicians include:<sup id="cite_ref-Pharmacogenetics_and_Pharmacogenomics_Factsheet._50-0" class="reference"><a href="#cite_note-Pharmacogenetics_and_Pharmacogenomics_Factsheet.-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid22278335_49-1" class="reference"><a href="#cite_note-pmid22278335-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid22689709_51-0" class="reference"><a href="#cite_note-pmid22689709-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Limitation on how to apply the test into clinical practices and treatment;</li> <li>A general feeling of lack of availability of the test;</li> <li>The understanding and interpretation of evidence-based research;</li> <li>Combining test results with other patient data for prescription optimization; and</li> <li>Ethical, legal and social issues.</li></ul> <p>Issues surrounding the availability of the test include:<sup id="cite_ref-sven2007_48-1" class="reference"><a href="#cite_note-sven2007-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> </p> <ul><li><i>The lack of availability of scientific data</i>: Although there are a considerable number of drug-metabolizing enzymes involved in the metabolic pathways of drugs, only a fraction have sufficient scientific data to validate their use within a clinical setting; and</li> <li><i>Demonstrating the cost-effectiveness of pharmacogenomics</i>: Publications for the <a href="/wiki/Pharmacoeconomics" title="Pharmacoeconomics">pharmacoeconomics</a> of pharmacogenomics are scarce, therefore sufficient evidence does not at this time exist to validate the cost-effectiveness and cost-consequences of the test.</li></ul> <p>Although other factors contribute to the slow progression of pharmacogenomics (such as developing guidelines for clinical use), the above factors appear to be the most prevalent. Increasingly substantial evidence and industry body guidelines for clinical use of pharmacogenetics have made it a population wide approach to precision medicine. Cost, reimbursement, education, and easy use at the point of care remain significant barriers to widescale adoption. </p> <div class="mw-heading mw-heading2"><h2 id="Controversies">Controversies</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=26" title="Edit section: Controversies"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Race-based_medicine">Race-based medicine</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=27" title="Edit section: Race-based medicine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There has been call to move away from race and ethnicity in medicine and instead use genetic ancestry as a way to categorize patients.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> Some <a href="/wiki/Allele" title="Allele">alleles</a> that vary in frequency between specific populations have been shown to be associated with differential responses to specific <a href="/wiki/Drugs" class="mw-redirect" title="Drugs">drugs</a>. As a result, some disease-specific guidelines only recommend pharmacogenetic testing for populations where high-risk alleles are more common<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> and, similarly, certain insurance companies will only pay for pharmacogenetic testing for beneficiaries of high-risk populations.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Genetic_exceptionalism">Genetic exceptionalism</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=28" title="Edit section: Genetic exceptionalism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In the early 2000s, handling genetic information as exceptional, including legal or regulatory protections, garnered strong support. It was argued that genomic information may need special policy and practice protections within the context of electronic health records (EHRs).<sup id="cite_ref-:4_55-0" class="reference"><a href="#cite_note-:4-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> In 2008, the <a href="/wiki/Genetic_Information_Nondiscrimination_Act" title="Genetic Information Nondiscrimination Act">Genetic Information Nondiscrimination Act (GINA)</a> was enacted to protect patients from health insurance companies discriminating against an individual based on genetic information.<sup id="cite_ref-56" class="reference"><a href="#cite_note-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> </p><p>More recently it has been argued that <a href="/wiki/Genetic_exceptionalism" title="Genetic exceptionalism">genetic exceptionalism</a> is past its expiration date as we move into a blended genomic/big data era of medicine, yet exceptionalism practices continue to permeate clinical healthcare today.<sup id="cite_ref-:5_58-0" class="reference"><a href="#cite_note-:5-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> Garrison et al. recently relayed a call to action to update verbiage from genetic exceptionalism to genomic contextualism in that we recognize a fundamental duality of genetic information.<sup id="cite_ref-:6_60-0" class="reference"><a href="#cite_note-:6-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> This allows room in the argument for different types of genetic information to be handled differently while acknowledging that genomic information is similar and yet distinct from other health-related information.<sup id="cite_ref-:6_60-1" class="reference"><a href="#cite_note-:6-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> Genomic contextualism would allow for a case-by-case analysis of the technology and the context of its use (e.g., clinical practice, research, secondary findings). </p><p>Others argue that genetic information is indeed distinct from other health-related information but not to the extent of requiring legal/regulatory protections, similar to other sensitive health-related data such as HIV status.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> Additionally, Evans et al. argue that the EHR has sufficient privacy standards to hold other sensitive information such as social security numbers and that the fundamental nature of an EHR is to house highly personal information.<sup id="cite_ref-:5_58-1" class="reference"><a href="#cite_note-:5-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> Similarly, a systematic review reported that the public had concern over privacy of genetic information, with 60% agreeing that maintaining privacy was not possible; however, 96% agreed that a direct-to-consumer testing company had protected their privacy, with 74% saying their information would be similarly or better protected in an EHR. With increasing technological capabilities in EHRs, it is possible to mask or hide genetic data from subsets of providers and there is not consensus on how, when, or from whom genetic information should be masked.<sup id="cite_ref-:4_55-1" class="reference"><a href="#cite_note-:4-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> Rigorous protection and masking of genetic information is argued to impede further scientific progress and clinical translation into routine clinical practices.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=29" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Pharmacogenomics was first recognized by <a href="/wiki/Pythagoras" title="Pythagoras">Pythagoras</a> around 510 BC when he made a connection between the dangers of <a href="/wiki/Fava_bean" class="mw-redirect" title="Fava bean">fava bean</a> ingestion with <a href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">hemolytic anemia</a> and <a href="/wiki/Oxidative_stress" title="Oxidative stress">oxidative stress</a>. In the <a href="/wiki/1950s" title="1950s">1950s</a>, this identification was validated and attributed to deficiency of <a href="/wiki/G6PD" class="mw-redirect" title="G6PD">G6PD</a> and is called <a href="/wiki/Favism" class="mw-redirect" title="Favism">favism</a>.<sup id="cite_ref-pmid11678777_64-0" class="reference"><a href="#cite_note-pmid11678777-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid22461095_65-0" class="reference"><a href="#cite_note-pmid22461095-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> Although the first official publication was not until 1961,<sup id="cite_ref-Evans_1961_66-0" class="reference"><a href="#cite_note-Evans_1961-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> the unofficial beginnings of this science were around the 1950s. Reports of prolonged paralysis and fatal reactions linked to genetic variants in patients who lacked <a href="/wiki/Butyrylcholinesterase" title="Butyrylcholinesterase">butyrylcholinesterase</a> ('pseudocholinesterase') following succinylcholine injection during anesthesia were first reported in 1956.<sup id="cite_ref-pmid14585618_2-1" class="reference"><a href="#cite_note-pmid14585618-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid16415920_67-0" class="reference"><a href="#cite_note-pmid16415920-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> The term pharmacogenetics was first coined in 1959 by <a href="/wiki/Friedrich_Vogel_(human_geneticist)" title="Friedrich Vogel (human geneticist)">Friedrich Vogel</a> of <a href="/wiki/Heidelberg" title="Heidelberg">Heidelberg</a>, <a href="/wiki/Germany" title="Germany">Germany</a> (although some papers suggest it was 1957 or 1958).<sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> In the late 1960s, <a href="/wiki/Twin_study" title="Twin study">twin studies</a> supported the inference of genetic involvement in drug metabolism, with identical twins sharing remarkable similarities in drug response compared to fraternal twins.<sup id="cite_ref-pmid16421980_69-0" class="reference"><a href="#cite_note-pmid16421980-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup> The term pharmacogenomics first began appearing around the 1990s.<sup id="cite_ref-pmid11678777_64-1" class="reference"><a href="#cite_note-pmid11678777-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> </p><p>The first FDA approval of a pharmacogenetic test was in 2005<sup id="cite_ref-Squassina2010_9-1" class="reference"><a href="#cite_note-Squassina2010-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> (for <a href="/wiki/Allele" title="Allele">alleles</a> in <i>CYP2D6</i> and <i>CYP2C19</i>) </p> <div class="mw-heading mw-heading2"><h2 id="Future">Future</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=30" title="Edit section: Future"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Computational advances have enabled cheaper and faster sequencing.<sup id="cite_ref-pharmacogenomic_example_book_70-0" class="reference"><a href="#cite_note-pharmacogenomic_example_book-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup> Research has focused on <a href="/wiki/Combinatorial_chemistry" title="Combinatorial chemistry">combinatorial chemistry</a>,<sup id="cite_ref-pmid11908762_71-0" class="reference"><a href="#cite_note-pmid11908762-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup> genomic mining, omic technologies, and <a href="/wiki/High-throughput_screening" title="High-throughput screening">high throughput screening</a>. </p><p>As the cost per genetic test decreases, the development of personalized drug therapies will increase.<sup id="cite_ref-pmid17168846_72-0" class="reference"><a href="#cite_note-pmid17168846-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> Technology now allows for genetic analysis of hundreds of target genes involved in medication metabolism and response in less than 24 hours for under $1,000. This a huge step towards bringing pharmacogenetic technology into everyday medical decisions. Likewise, companies like <a href="/wiki/DeCODE_genetics" title="DeCODE genetics">deCODE genetics</a>, MD Labs Pharmacogenetics, <a href="/wiki/Navigenics" title="Navigenics">Navigenics</a> and <a href="/wiki/23andMe" title="23andMe">23andMe</a> offer genome scans. The companies use the same <a href="/wiki/Genotyping" title="Genotyping">genotyping</a> chips that are used in GWAS studies and provide customers with a write-up of individual risk for various traits and diseases and testing for 500,000 known SNPs. Costs range from $995 to $2500 and include updates with new data from studies as they become available. The more expensive packages even included a telephone session with a genetics counselor to discuss the results.<sup id="cite_ref-isbn0-465-02550-1_73-0" class="reference"><a href="#cite_note-isbn0-465-02550-1-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Ethics">Ethics</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=31" title="Edit section: Ethics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Pharmacogenetics has become a controversial issue in the area of <a href="/wiki/Bioethics" title="Bioethics">bioethics</a>. Privacy and confidentiality are major concerns.<sup id="cite_ref-Corrigan_74-0" class="reference"><a href="#cite_note-Corrigan-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> The evidence of benefit or risk from a genetic test may only be suggestive, which could cause dilemmas for providers.<sup id="cite_ref-Corrigan_74-1" class="reference"><a href="#cite_note-Corrigan-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 145">: 145 </span></sup> Drug development may be affected, with rare genetic variants possibly receiving less research.<sup id="cite_ref-Corrigan_74-2" class="reference"><a href="#cite_note-Corrigan-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> Access and patient autonomy are also open to discussion.<sup id="cite_ref-Breckenridge_75-0" class="reference"><a href="#cite_note-Breckenridge-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 680">: 680 </span></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Web-based_resources">Web-based resources</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=32" title="Edit section: Web-based resources"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <table class="wikitable"> <caption>Web Resources for Pharmacogenomics<sup id="cite_ref-barh_book_76-0" class="reference"><a href="#cite_note-barh_book-76"><span class="cite-bracket">[</span>76<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-stram_book_77-0" class="reference"><a href="#cite_note-stram_book-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup> </caption> <tbody><tr> <th>Data source</th> <th>Main use</th> <th>Citation </th></tr> <tr> <td><i>PharmVar</i></td> <td>A central repository for pharmacogene variation that focuses on haplotype structure and allelic variation</td> <td><sup id="cite_ref-pmid29134625_78-0" class="reference"><a href="#cite_note-pmid29134625-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><i>SuperCYP Bioinformatics Tool</i></td> <td>Containing 1170 drugs with more than 3800 interactions, and approximately 2000 known SNPs. These SNPs are listed and ordered according to their effect on expression and/or activity.</td> <td><sup id="cite_ref-pmid19934256_79-0" class="reference"><a href="#cite_note-pmid19934256-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><i>PharmGKB</i></td> <td>The Pharmacogenomics Knowledge Base (PharmGKB) is an interactive tool for researchers investigating how genetic variation affects drug response.</td> <td><sup id="cite_ref-pmid23824865_80-0" class="reference"><a href="#cite_note-pmid23824865-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><i>dbSNP database</i></td> <td>A repository of <a href="/wiki/Single_nucleotide_polymorphism" class="mw-redirect" title="Single nucleotide polymorphism">SNPs</a> and other variants that have been reported after discovery, compiled and officially named. These are SNPs across the board.</td> <td><sup id="cite_ref-81" class="reference"><a href="#cite_note-81"><span class="cite-bracket">[</span>81<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid10592272_82-0" class="reference"><a href="#cite_note-pmid10592272-82"><span class="cite-bracket">[</span>82<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><i>FINDbase</i></td> <td>Repository of allele frequencies of pharmacogenetic markers in different populations</td> <td><sup id="cite_ref-pmid24234438_83-0" class="reference"><a href="#cite_note-pmid24234438-83"><span class="cite-bracket">[</span>83<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><i>Pharmacogenomics Biomarkers in Drug Labelling</i></td> <td>A table that identifies which FDA-approved drugs have pharmacogenomics-related warning labels</td> <td><sup id="cite_ref-84" class="reference"><a href="#cite_note-84"><span class="cite-bracket">[</span>84<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><i>SNPedia</i></td> <td>A wiki-based bioinformatics database of SNPs</td> <td><sup id="cite_ref-85" class="reference"><a href="#cite_note-85"><span class="cite-bracket">[</span>85<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid22140107_86-0" class="reference"><a href="#cite_note-pmid22140107-86"><span class="cite-bracket">[</span>86<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><i>Pharmacogenomics Research Network (PGRN)</i> </td> <td>The PGRN hosts resources and information to stimulate collaborative research in pharmacogenomics and precision medicine. </td> <td><sup id="cite_ref-87" class="reference"><a href="#cite_note-87"><span class="cite-bracket">[</span>87<span class="cite-bracket">]</span></a></sup> </td></tr></tbody></table> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=33" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Genomics" title="Genomics">Genomics</a> <ul><li><a href="/wiki/Chemogenomics" title="Chemogenomics">Chemogenomics</a></li> <li><a href="/wiki/Clinomics" title="Clinomics">Clinomics</a></li> <li><a href="/wiki/Genetic_engineering" title="Genetic engineering">Genetic engineering</a></li> <li><a href="/wiki/Toxicogenomics" title="Toxicogenomics">Toxicogenomics</a></li> <li><a href="/wiki/Cancer_pharmacogenomics" title="Cancer pharmacogenomics">Cancer pharmacogenomics</a></li></ul></li> <li><a href="/wiki/Metabolomics" title="Metabolomics">Metabolomics</a></li> <li><a href="/wiki/Pharmacovigilance" title="Pharmacovigilance">Pharmacovigilance</a></li> <li><a href="/wiki/Race_and_health" title="Race and health">Population groups in biomedicine</a></li> <li><a href="/wiki/Toxgnostics" 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class="mw-file-description"><img alt="icon" src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2d/Issoria_lathonia.jpg/21px-Issoria_lathonia.jpg" decoding="async" width="21" height="15" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/2d/Issoria_lathonia.jpg/32px-Issoria_lathonia.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/2d/Issoria_lathonia.jpg/42px-Issoria_lathonia.jpg 2x" data-file-width="629" data-file-height="445" /></a></span> </span><a href="/wiki/Portal:Biology" title="Portal:Biology">Biology</a></li><li class="portal-bar-item"><span class="nowrap"><span typeof="mw:File"><a href="/wiki/File:Noun-technology.svg" class="mw-file-description"><img alt="icon" src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a9/Noun-technology.svg/19px-Noun-technology.svg.png" decoding="async" width="19" height="19" class="mw-file-element" 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title="Genetic testing">Genetic testing</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=34" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFErmak2015" class="citation book cs1">Ermak G (2015). <i>Emerging Medical Technologies</i>. 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annotation, interpretation and analysis"</a>. <i>Nucleic Acids Research</i>. <b>40</b> (Database issue): <span class="nowrap">D1308 –</span> <span class="nowrap">D1312</span>. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fnar%2Fgkr798">10.1093/nar/gkr798</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245045">3245045</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/22140107">22140107</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nucleic+Acids+Research&rft.atitle=SNPedia%3A+a+wiki+supporting+personal+genome+annotation%2C+interpretation+and+analysis&rft.volume=40&rft.issue=Database+issue&rft.pages=%3Cspan+class%3D%22nowrap%22%3ED1308+-%3C%2Fspan%3E+%3Cspan+class%3D%22nowrap%22%3ED1312%3C%2Fspan%3E&rft.date=2012-01&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3245045%23id-name%3DPMC&rft_id=info%3Apmid%2F22140107&rft_id=info%3Adoi%2F10.1093%2Fnar%2Fgkr798&rft.aulast=Cariaso&rft.aufirst=M&rft.au=Lennon%2C+G&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3245045&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></span> </li> <li id="cite_note-87"><span class="mw-cite-backlink"><b><a href="#cite_ref-87">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.pgrn.org">"Pharmacogenomics Research Network PGRN"</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pharmacogenomics+Research+Network+PGRN&rft_id=https%3A%2F%2Fwww.pgrn.org&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></span> </li> </ol></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=35" title="Edit section: Further reading"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin" style=""> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKatsnelson2005" class="citation journal cs1">Katsnelson A (August 2005). <a rel="nofollow" class="external text" href="http://www.scientificamerican.com/article.cfm?id=a-drug-to-call-ones-own">"A Drug to Call One's Own: Will medicine finally get personal?"</a>. <i>Scientific American</i>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scientific+American&rft.atitle=A+Drug+to+Call+One%27s+Own%3A+Will+medicine+finally+get+personal%3F&rft.date=2005-08&rft.aulast=Katsnelson&rft.aufirst=A&rft_id=http%3A%2F%2Fwww.scientificamerican.com%2Farticle.cfm%3Fid%3Da-drug-to-call-ones-own&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKarczewskiDaneshjouAltman2012" class="citation journal cs1">Karczewski KJ, Daneshjou R, Altman RB (2012). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531317">"Chapter 7: Pharmacogenomics"</a>. <i>PLOS Computational Biology</i>. <b>8</b> (12): e1002817. <a href="/wiki/Bibcode_(identifier)" class="mw-redirect" title="Bibcode (identifier)">Bibcode</a>:<a rel="nofollow" class="external text" href="https://ui.adsabs.harvard.edu/abs/2012PLSCB...8E2817K">2012PLSCB...8E2817K</a>. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1371%2Fjournal.pcbi.1002817">10.1371/journal.pcbi.1002817</a></span>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531317">3531317</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23300409">23300409</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLOS+Computational+Biology&rft.atitle=Chapter+7%3A+Pharmacogenomics&rft.volume=8&rft.issue=12&rft.pages=e1002817&rft.date=2012&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3531317%23id-name%3DPMC&rft_id=info%3Apmid%2F23300409&rft_id=info%3Adoi%2F10.1371%2Fjournal.pcbi.1002817&rft_id=info%3Abibcode%2F2012PLSCB...8E2817K&rft.aulast=Karczewski&rft.aufirst=KJ&rft.au=Daneshjou%2C+R&rft.au=Altman%2C+RB&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3531317&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Pharmacogenomics&action=edit&section=36" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/About/primer/pharm.html">"Pharmacogenomics Factsheet"</a>. National Center for Biotechnology Information (NCBI), U.S. National Library of Medicine<span class="reference-accessdate">. Retrieved <span class="nowrap">2011-07-11</span></span>. <q>a quick introduction to customised drugs</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pharmacogenomics+Factsheet&rft.pub=National+Center+for+Biotechnology+Information+%28NCBI%29%2C+U.S.+National+Library+of+Medicine&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2FAbout%2Fprimer%2Fpharm.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.fda.gov/Drugs/ScienceResearch/ResearchAreas/Pharmacogenetics/ucm085325.htm">"Pharmacogenomics Education Initiatives"</a>. U.S. Food and Drug Administration. 2010-09-24<span class="reference-accessdate">. Retrieved <span class="nowrap">2011-07-11</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pharmacogenomics+Education+Initiatives&rft.pub=U.S.+Food+and+Drug+Administration&rft.date=2010-09-24&rft_id=https%3A%2F%2Fwww.fda.gov%2FDrugs%2FScienceResearch%2FResearchAreas%2FPharmacogenetics%2Fucm085325.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20110519160500/http://learn.genetics.utah.edu/content/health/pharma/">"Personalized Medicine (Pharmacogenetics)"</a>. University of Utah's Genetic Science Learning Center. Archived from <a rel="nofollow" class="external text" href="http://learn.genetics.utah.edu/content/health/pharma/">the original</a> on 2011-05-19<span class="reference-accessdate">. Retrieved <span class="nowrap">2011-07-11</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Personalized+Medicine+%28Pharmacogenetics%29&rft.pub=University+of+Utah%27s+Genetic+Science+Learning+Center&rft_id=http%3A%2F%2Flearn.genetics.utah.edu%2Fcontent%2Fhealth%2Fpharma%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20140806192211/https://pharmacy.unc.edu/research/centers/center-for-pharmacogenomics-and-individualized-therapy">"Center for Pharmacogenomics and Individualized Therapy"</a>. University of North Carolina at Chapel Hill Center for Pharmacogenomics and Individualized Therapy. Archived from <a rel="nofollow" class="external text" href="https://pharmacy.unc.edu/research/centers/center-for-pharmacogenomics-and-individualized-therapy">the original</a> on 2014-08-06<span class="reference-accessdate">. Retrieved <span class="nowrap">2014-06-25</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Center+for+Pharmacogenomics+and+Individualized+Therapy&rft.pub=University+of+North+Carolina+at+Chapel+Hill+Center+for+Pharmacogenomics+and+Individualized+Therapy&rft_id=https%3A%2F%2Fpharmacy.unc.edu%2Fresearch%2Fcenters%2Fcenter-for-pharmacogenomics-and-individualized-therapy&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></li></ul> <p>Journals: </p> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.futuremedicine.com/loi/pgs">"Pharmacogenomics"</a>. Future Medicine Ltd. 24 August 2023.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pharmacogenomics&rft.pub=Future+Medicine+Ltd&rft.date=2023-08-24&rft_id=http%3A%2F%2Fwww.futuremedicine.com%2Floi%2Fpgs&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.jpharmacogenetics.com/">"Pharmacogenetics and Genomics"</a>. Lippincott Williams & Wilkins. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1744-6872">1744-6872</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Pharmacogenetics+and+Genomics&rft.pub=Lippincott+Williams+%26+Wilkins&rft.issn=1744-6872&rft_id=http%3A%2F%2Fwww.jpharmacogenetics.com%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation journal cs1"><a rel="nofollow" class="external text" href="http://www.nature.com/tpj/index.html">"The Pharmacogenomics Journal"</a>. <i>The Pharmacogenomics Journal</i>. Nature Publishing Group. 20 October 2021. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1470-269X">1470-269X</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Pharmacogenomics+Journal&rft.atitle=The+Pharmacogenomics+Journal&rft.date=2021-10-20&rft.issn=1470-269X&rft_id=http%3A%2F%2Fwww.nature.com%2Ftpj%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3APharmacogenomics" class="Z3988"></span></li></ul> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output 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navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Genomics" title="Template:Genomics"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Genomics" title="Template talk:Genomics"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Genomics" title="Special:EditPage/Template:Genomics"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Genomics334" style="font-size:114%;margin:0 4em"><a href="/wiki/Genomics" title="Genomics">Genomics</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Fields</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cognitive_genomics" title="Cognitive genomics">Cognitive genomics</a></li> <li><a href="/wiki/Computational_genomics" title="Computational genomics">Computational genomics</a></li> <li><a href="/wiki/Comparative_genomics" title="Comparative genomics">Comparative genomics</a></li> <li><a href="/wiki/Functional_genomics" title="Functional genomics">Functional genomics</a></li> <li><a href="/wiki/Genome_project" title="Genome project">Genome project</a> <ul><li><a href="/wiki/Human_Genome_Project" title="Human Genome Project">Human Genome Project</a></li></ul></li> <li><a href="/wiki/Metagenomics" title="Metagenomics">Metagenomics</a> <ul><li><a href="/wiki/Human_Microbiome_Project" title="Human Microbiome Project">Human Microbiome Project</a></li></ul></li> <li><a href="/wiki/Oncogenomics" title="Oncogenomics">Oncogenomics</a></li> <li><a href="/wiki/Pangenomics" class="mw-redirect" title="Pangenomics">Pangenomics</a></li> <li><a href="/wiki/Personal_genomics" title="Personal genomics">Personal genomics</a></li> <li><a href="/wiki/Population_genomics" title="Population genomics">Population genomics</a></li> <li><a href="/wiki/Sociogenomics" title="Sociogenomics"><i>Socio</i>genomics</a></li> <li><a href="/wiki/Structural_genomics" title="Structural genomics">Structural genomics</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bioinformatics" title="Bioinformatics">Bioinformatics</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Biochip" title="Biochip">Biochip</a></li> <li><a href="/wiki/Cheminformatics" title="Cheminformatics">Cheminformatics</a></li> <li><a href="/wiki/Chemogenomics" title="Chemogenomics">Chemogenomics</a></li> <li><a href="/wiki/Connectomics" title="Connectomics">Connectomics</a> <ul><li><a href="/wiki/Human_Connectome_Project" title="Human Connectome Project">Human Connectome Project</a></li></ul></li> <li><a href="/wiki/Epigenomics" title="Epigenomics">Epigenomics</a> <ul><li><a href="/wiki/Human_Epigenome_Project" title="Human Epigenome Project">Human Epigenome Project</a></li></ul></li> <li><a href="/wiki/Glycomics" title="Glycomics">Glycomics</a></li> <li><a href="/wiki/Immunomics" title="Immunomics">Immunomics</a></li> <li><a href="/wiki/Lipidomics" title="Lipidomics">Lipidomics</a></li> <li><a href="/wiki/Metabolomics" title="Metabolomics">Metabolomics</a></li> <li><a href="/wiki/Microbiome" title="Microbiome">Microbiomics</a></li> <li><a href="/wiki/Nutrigenomics" class="mw-redirect" title="Nutrigenomics">Nutrigenomics</a></li> <li><a href="/wiki/Paleopolyploidy" title="Paleopolyploidy">Paleopolyploidy</a></li> <li><a href="/wiki/Pharmacogenetics" class="mw-redirect" title="Pharmacogenetics">Pharmacogenetics</a></li> <li><a class="mw-selflink selflink">Pharmacogenomics</a></li> <li><a href="/wiki/Systems_biology" title="Systems biology">Systems biology</a></li> <li><a href="/wiki/Toxicogenomics" title="Toxicogenomics">Toxicogenomics</a></li> <li><a href="/wiki/Transcriptomics" class="mw-redirect" title="Transcriptomics">Transcriptomics</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Structural_biology" title="Structural biology">Structural biology</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Proteomics" title="Proteomics">Proteomics</a> <ul><li><a href="/wiki/Human_proteome_project" class="mw-redirect" title="Human proteome project">Human proteome project</a></li></ul></li> <li><a href="/wiki/Call-map_proteomics" class="mw-redirect" title="Call-map proteomics">Call-map proteomics</a></li> <li><a href="/wiki/Structure-based_drug_design" class="mw-redirect" title="Structure-based drug design">Structure-based drug design</a></li> <li><a href="/wiki/Expression_proteomics" class="mw-redirect" title="Expression proteomics">Expression proteomics</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Research tools</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/2-D_electrophoresis" class="mw-redirect" title="2-D electrophoresis">2-D electrophoresis</a></li> <li><a href="/wiki/Mass_spectrometer" class="mw-redirect" title="Mass spectrometer">Mass spectrometer</a></li> <li><a href="/wiki/Electrospray_ionization" title="Electrospray ionization">Electrospray ionization</a></li> <li><a href="/wiki/Matrix-assisted_laser_desorption_ionization" class="mw-redirect" title="Matrix-assisted laser desorption ionization">Matrix-assisted laser desorption ionization</a></li> <li><a href="/wiki/Matrix-assisted_laser_desorption_ionization-time_of_flight_mass_spectrometer" class="mw-redirect" title="Matrix-assisted laser desorption ionization-time of flight mass spectrometer">Matrix-assisted laser desorption ionization-time of flight mass spectrometer</a></li> <li><a href="/wiki/Microfluidic-based_tools" class="mw-redirect" title="Microfluidic-based tools">Microfluidic-based tools</a></li> <li><a href="/wiki/Isotope_affinity_tags" class="mw-redirect" title="Isotope affinity tags">Isotope affinity tags</a></li> <li><a href="/wiki/Chromosome_conformation_capture" title="Chromosome conformation capture">Chromosome conformation capture</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Organizations</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/DNA_Data_Bank_of_Japan" title="DNA Data Bank of Japan">DNA Data Bank of Japan</a> (JP)</li> <li><a href="/wiki/European_Molecular_Biology_Laboratory" title="European Molecular Biology Laboratory">European Molecular Biology Laboratory</a> (EU)</li> <li><a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">National Institutes of Health</a> (USA)</li> <li><a href="/wiki/Wellcome_Sanger_Institute" title="Wellcome Sanger Institute">Wellcome Sanger Institute</a> (UK)</li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><span class="noviewer" typeof="mw:File"><span title="List-Class article"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/d/db/Symbol_list_class.svg/16px-Symbol_list_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/d/db/Symbol_list_class.svg/23px-Symbol_list_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/d/db/Symbol_list_class.svg/31px-Symbol_list_class.svg.png 2x" data-file-width="180" data-file-height="185" /></span></span> <b><a href="/wiki/List_of_omics_topics_in_biology" title="List of omics topics in biology">List</a> </b></li> <li><span class="noviewer" typeof="mw:File"><span title="Category"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /></span></span> <b><a href="/wiki/Category:Omics" title="Category:Omics">Category</a></b></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Pharmacology105" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Pharmacology" title="Template:Pharmacology"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Pharmacology" title="Template talk:Pharmacology"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Pharmacology" title="Special:EditPage/Template:Pharmacology"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Pharmacology105" style="font-size:114%;margin:0 4em"><a href="/wiki/Pharmacology" title="Pharmacology">Pharmacology</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align: center;"><a href="/wiki/Ligand_(biochemistry)" title="Ligand (biochemistry)">Ligand (biochemistry)</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Excitatory10" scope="row" class="navbox-group" style="width:1%;text-align: center;">Excitatory</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Agonist" title="Agonist">Agonist</a></li> <li><a href="/wiki/Endogenous_agonist" title="Endogenous agonist">Endogenous agonist</a></li> <li><a href="/wiki/Irreversible_agonist" title="Irreversible agonist">Irreversible agonist</a></li> <li><a href="/wiki/Partial_agonist" title="Partial agonist">Partial agonist</a></li> <li><a href="/wiki/Superagonist" title="Superagonist">Superagonist</a></li> <li><a href="/wiki/Physiological_agonism_and_antagonism" title="Physiological agonism and antagonism">Physiological agonist</a></li></ul> </div></td></tr></tbody></table><div> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Inhibitory10" scope="row" class="navbox-group" style="width:1%;text-align: center;">Inhibitory</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Receptor_antagonist" title="Receptor antagonist">Antagonist</a></li> <li><a href="/wiki/Competitive_antagonist" class="mw-redirect" title="Competitive antagonist">Competitive antagonist</a></li> <li><a href="/wiki/Irreversible_antagonist" title="Irreversible antagonist">Irreversible antagonist</a></li> <li><a href="/wiki/Physiological_agonism_and_antagonism" title="Physiological agonism and antagonism">Physiological antagonist</a></li> <li><a href="/wiki/Inverse_agonist" title="Inverse agonist">Inverse agonist</a></li> <li><a href="/wiki/Enzyme_inhibitor" title="Enzyme inhibitor">Enzyme inhibitor</a></li></ul> </div></td></tr></tbody></table><div> <ul><li><a href="/wiki/Drug" title="Drug">Drug</a></li> <li><a href="/wiki/Neurotransmitter" title="Neurotransmitter">Neurotransmitter</a></li> <li><a href="/wiki/Agonist-antagonist" title="Agonist-antagonist">Agonist-antagonist</a></li> <li><a href="/wiki/Pharmacophore" title="Pharmacophore">Pharmacophore</a></li></ul></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align: center;"><a href="/wiki/Pharmacodynamics" title="Pharmacodynamics">Pharmacodynamics</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Activity_at_receptor20" scope="row" class="navbox-group" style="width:1%;text-align: center;">Activity at receptor</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <li><a href="/wiki/Mechanism_of_action" title="Mechanism of action">Mechanism of action</a></li> <li><a href="/wiki/Mode_of_action" title="Mode of action">Mode of action</a></li> <li><a href="/wiki/Molecular_binding" title="Molecular binding">Binding</a></li> <li><a href="/wiki/Receptor_(biochemistry)" title="Receptor (biochemistry)">Receptor (biochemistry)</a></li> <li><a href="/wiki/Desensitization_(medicine)" title="Desensitization (medicine)">Desensitization (medicine)</a></li> </div></td></tr></tbody></table><div> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Other_effects_of_ligand23" scope="row" class="navbox-group" style="width:1%;text-align: center;">Other effects of ligand</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Selectivity (<a href="/wiki/Binding_selectivity" title="Binding selectivity">Binding</a>, <a href="/wiki/Functional_selectivity" title="Functional selectivity">Functional</a>)</li> <li><a href="/wiki/Pleiotropy_(drugs)" title="Pleiotropy (drugs)">Pleiotropy (drugs)</a></li> <li><a href="/wiki/Non-specific_effect_of_vaccines" title="Non-specific effect of vaccines">Non-specific effect of vaccines</a></li> <li><a href="/wiki/Adverse_effect" title="Adverse effect">Adverse effect</a></li> <li><a href="/wiki/Toxicity" title="Toxicity">Toxicity</a> (<a href="/wiki/Neurotoxicity" title="Neurotoxicity">Neurotoxicity</a>)</li></ul> </div></td></tr></tbody></table><div> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Analysis8" scope="row" class="navbox-group" style="width:1%;text-align: center;">Analysis</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dose%E2%80%93response_relationship" title="Dose–response relationship">Dose–response relationship</a></li> <li><a href="/wiki/Hill_equation_(biochemistry)" title="Hill equation (biochemistry)">Hill equation (biochemistry)</a></li> <li><a href="/wiki/Schild_plot" class="mw-redirect" title="Schild plot">Schild plot</a></li> <li><a href="/wiki/Del_Castillo_Katz_model" class="mw-redirect" title="Del Castillo Katz model">Del Castillo Katz model</a></li> <li><a href="/wiki/Cheng-Prussoff_Equation" class="mw-redirect" title="Cheng-Prussoff Equation">Cheng-Prussoff Equation</a></li> <li>Methods (<a href="/wiki/Organ_bath" title="Organ bath">Organ bath</a>, <a href="/wiki/Ligand_binding_assay" title="Ligand binding assay">Ligand binding assay</a>, <a href="/wiki/Patch_clamp" title="Patch clamp">Patch clamp</a>)</li></ul> </div></td></tr></tbody></table><div> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Metrics7" scope="row" class="navbox-group" style="width:1%;text-align: center;">Metrics</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Efficacy#Pharmacology" title="Efficacy">Efficacy</a></li> <li><a href="/wiki/Intrinsic_activity" title="Intrinsic activity">Intrinsic activity</a></li> <li><a href="/wiki/Potency_(pharmacology)" title="Potency (pharmacology)">Potency</a> (<a href="/wiki/EC50" title="EC50">EC50</a>, <a href="/wiki/IC50" title="IC50">IC50</a>, <a href="/wiki/Effective_dose_(pharmacology)" title="Effective dose (pharmacology)">ED50</a>, <a href="/wiki/Median_lethal_dose" title="Median lethal dose">LD50</a>, <a href="/wiki/Median_toxic_dose" title="Median toxic dose">TD50</a>)</li> <li><a href="/wiki/Therapeutic_index" title="Therapeutic index">Therapeutic index</a></li> <li><a href="/wiki/Dissociation_constant#Protein-ligand_binding" title="Dissociation constant">Affinity</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align: center;"><a href="/wiki/Pharmacokinetics" title="Pharmacokinetics">Pharmacokinetics</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Metrics7" scope="row" class="navbox-group" style="width:1%;text-align: center;">Metrics</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Loading_dose" title="Loading dose">Loading dose</a></li> <li><a href="/wiki/Volume_of_distribution" title="Volume of distribution">Volume of distribution</a> (<a href="/wiki/Initial_volume_of_distribution" title="Initial volume of distribution">Initial</a>)</li> <li><a href="/wiki/Rate_of_infusion" title="Rate of infusion">Rate of infusion</a></li> <li><a href="/wiki/Onset_of_action" title="Onset of action">Onset of action</a></li> <li><a href="/wiki/Biological_half-life" title="Biological half-life">Biological half-life</a></li> <li><a href="/wiki/Plasma_protein_binding" title="Plasma protein binding">Plasma protein binding</a></li> <li><a href="/wiki/Bioavailability" title="Bioavailability">Bioavailability</a></li></ul> </div></td></tr></tbody></table><div> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="LADME5" scope="row" class="navbox-group" style="width:1%;text-align: center;">LADME</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/ADME" title="ADME">(L)ADME</a>: (<a href="/wiki/Liberation_(pharmacology)" title="Liberation (pharmacology)">Liberation</a>)</li> <li><a href="/wiki/Absorption_(pharmacology)" title="Absorption (pharmacology)">Absorption</a></li> <li><a href="/wiki/Distribution_(pharmacology)" title="Distribution (pharmacology)">Distribution</a></li> <li><a href="/wiki/Drug_metabolism" title="Drug metabolism">Metabolism</a></li> <li><a href="/wiki/Excretion" title="Excretion">Excretion</a> (<a href="/wiki/Clearance_(pharmacology)" title="Clearance (pharmacology)">Clearance</a>)</li></ul> </div></td></tr></tbody></table><div> <ul><li><a href="/wiki/Compartment_(pharmacokinetics)" title="Compartment (pharmacokinetics)">Compartment</a></li> <li><a href="/wiki/Bioequivalence" title="Bioequivalence">Bioequivalence</a></li></ul></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align: center;">Related<br /> fields</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Neuroscience_and_psychology35" scope="row" class="navbox-group" style="width:1%;text-align: center;"><a href="/wiki/Neuroscience" title="Neuroscience">Neuroscience</a> and <a href="/wiki/Psychology" title="Psychology">psychology</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <li><a href="/wiki/Neuropsychopharmacology" title="Neuropsychopharmacology">Neuropsychopharmacology</a></li> <li><a href="/wiki/Neuropharmacology" title="Neuropharmacology">Neuropharmacology</a></li> <li><a href="/wiki/Psychopharmacology" title="Psychopharmacology">Psychopharmacology</a></li> <li><a href="/wiki/Electrophysiology" title="Electrophysiology">Electrophysiology</a></li> </div></td></tr></tbody></table><div> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Medicine12" scope="row" class="navbox-group" style="width:1%;text-align: center;"><a href="/wiki/Medicine" title="Medicine">Medicine</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Clinical_pharmacology" title="Clinical pharmacology">Clinical pharmacology</a></li> <li><a href="/wiki/Pharmacy" title="Pharmacy">Pharmacy</a></li> <li><a href="/wiki/Medicinal_chemistry" title="Medicinal chemistry">Medicinal chemistry</a></li> <li><a href="/wiki/Pharmacoepidemiology" title="Pharmacoepidemiology">Pharmacoepidemiology</a></li></ul> </div></td></tr></tbody></table><div> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Biochemistry_and_genetics33" scope="row" class="navbox-group" style="width:1%;text-align: center;"><a href="/wiki/Biochemistry" title="Biochemistry">Biochemistry</a> and <a href="/wiki/Genetics" title="Genetics">genetics</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pharmacoinformatics" title="Pharmacoinformatics">Pharmacoinformatics</a></li> <li><a href="/wiki/Pharmacogenetics" class="mw-redirect" title="Pharmacogenetics">Pharmacogenetics</a></li> <li><a class="mw-selflink selflink">Pharmacogenomics</a></li></ul> </div></td></tr></tbody></table><div> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Toxicology14" scope="row" class="navbox-group" style="width:1%;text-align: center;"><a href="/wiki/Toxicology" title="Toxicology">Toxicology</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pharmacotoxicology" title="Pharmacotoxicology">Pharmacotoxicology</a></li> <li><a href="/wiki/Neurotoxicology" class="mw-redirect" title="Neurotoxicology">Neurotoxicology</a></li></ul> </div></td></tr></tbody></table><div> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Drug_discovery18" scope="row" class="navbox-group" style="width:1%;text-align: center;"><a href="/wiki/Drug_discovery" title="Drug discovery">Drug discovery</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Classical_pharmacology" title="Classical pharmacology">Classical pharmacology</a></li> <li><a href="/wiki/Reverse_pharmacology" title="Reverse pharmacology">Reverse pharmacology</a></li></ul> </div></td></tr></tbody></table><div> <ul><li><a href="/wiki/Photopharmacology" title="Photopharmacology">Photopharmacology</a></li> <li><a href="/wiki/Immunopharmacology" class="mw-redirect" title="Immunopharmacology">Immunopharmacology</a></li> <li><a href="/wiki/Cell_biology" title="Cell biology">Cell biology</a></li> <li><a href="/wiki/Physiology" title="Physiology">Physiology</a></li></ul></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align: center;">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <li><a href="/wiki/Coinduction_(anesthetics)" title="Coinduction (anesthetics)">Coinduction (anesthetics)</a></li> <li><a href="/wiki/Combination_therapy" title="Combination therapy">Combination therapy</a></li> <li><a href="/wiki/Functional_analog_(chemistry)" title="Functional analog (chemistry)">Functional analog (chemistry)</a></li> <li><a href="/wiki/Polypharmacology" title="Polypharmacology">Polypharmacology</a></li> <li><a href="/wiki/Chemotherapy" title="Chemotherapy">Chemotherapy</a></li> <li><a href="/wiki/Lists_of_drugs" title="Lists of drugs">Lists of drugs</a></li> <li><a href="/wiki/WHO_list_of_essential_medicines" class="mw-redirect" title="WHO list of essential medicines">WHO list of essential medicines</a></li> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Tolerance_and_resistance24" scope="row" class="navbox-group" style="width:1%;text-align: center;">Tolerance and resistance</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Drug_tolerance" title="Drug tolerance">Drug tolerance</a></li> <li><a href="/wiki/Tachyphylaxis" title="Tachyphylaxis">Tachyphylaxis</a></li> <li><a href="/wiki/Drug_resistance" title="Drug resistance">Drug resistance</a></li> <li><a href="/wiki/Antibiotic_resistance" class="mw-redirect" title="Antibiotic resistance">Antibiotic resistance</a></li> <li><a href="/wiki/Multiple_drug_resistance" title="Multiple drug resistance">Multiple drug resistance</a></li></ul> </div></td></tr></tbody></table><div> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Antimicrobial_pharmacology26" scope="row" class="navbox-group" style="width:1%;text-align: center;">Antimicrobial pharmacology</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antimicrobial_pharmacodynamics" title="Antimicrobial pharmacodynamics">Antimicrobial pharmacodynamics</a></li> <li><a href="/wiki/Minimum_inhibitory_concentration" title="Minimum inhibitory concentration">Minimum inhibitory concentration</a></li> <li><a href="/wiki/Bacteriostatic_agent" title="Bacteriostatic agent">Bacteriostatic</a></li> <li><a href="/wiki/Minimum_bactericidal_concentration" title="Minimum bactericidal concentration">Minimum bactericidal concentration</a></li> <li><a href="/wiki/Bactericide" title="Bactericide">Bactericide</a></li></ul> </div></td></tr></tbody></table><div> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Pharmacy178" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Pharmacy" title="Template:Pharmacy"><abbr title="View this 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title="Medication">Medication</a></li> <li><a href="/wiki/Prescription_drug" title="Prescription drug">Prescription drug</a></li> <li><a href="/wiki/Pharmacy" title="Pharmacy">Pharmacy</a></li> <li><a href="/wiki/Biological_activity" title="Biological activity">Pharmacological activity</a></li> <li><a href="/wiki/Separation_of_prescribing_and_dispensing" title="Separation of prescribing and dispensing">Separation of prescribing and dispensing</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Pharmaceutical sciences</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pharmacology" title="Pharmacology">Pharmacology</a> <ul><li><a href="/wiki/Pharmacokinetics" title="Pharmacokinetics">Pharmacokinetics</a> & <a href="/wiki/Pharmacodynamics" title="Pharmacodynamics">Pharmacodynamics</a> <ul><li><a href="/wiki/Pharmacometrics" 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