Role of Pharmacogenomics in Reducing the Risk of Drug-Related Iatrogenesis

Purpose of ReviewDrug-related iatrogenesis includes medication errors, adverse drug events, and adverse drug reactions and is among the most prevalent causes of death in the USA. Accessibility of pharmacogenetic testing and better understanding of mechanisms associated with drug-related iatrogenesis offer clinicians greater opportunities to establish tailored and precise pharmacological treatments to improve efficacy and decrease the risk of drug-related severe side effects.Recent FindingsThree conditions associated with drug-related iatrogenesis that could be prevented by pre-emptive pharmacogenomic testing are discussed with three relevant drug examples for each condition. Conditions discussed are (1) N-acetyltransferase (NAT) polymorphisms, N-oxidation, and drug-related toxicity; (2) glucose-6-phosphate dehydrogenase (G6PD) and drug-related toxicity; and (3) HLA and drug-related hypersensitivity. The three specific drugs discussed under these conditions are (1) for NAT, isoniazid, hydralazine, and procainamide; (2) for G6PD, primaquine, rasburicase, and nitrofurantoin; and (3) for HLA, abacavir, carbamazepine, and allopurinol.SummaryDetailed information is presented and supported by an exhaustive literature search. An introduction to each condition is provided to review the most important elements associated with the drug-related iatrogenic condition. In each case, a summary of drug action and metabolism, whenever relevant, is presented. The inter-relationship between the associated conditions with each drug is described in detail with a special attention given to the genetic component of this drug-related iatrogenic condition. Comments are provided by the authors at the end of each subsection on the value of pharmacogenomic testing to prevent drug-related iatrogenic events.