Genetically Based Adverse Medication Reactions – Genetically Guided Prescribing by A/Prof Ajeet Singh

Posted on: August 20, 2019
Last Updated: August 25, 2019

A/Prof Ajeet Singh is an academic private psychiatrist whose research has focused on genetically guided prescribing (pharmacogenetics) of antidepressants, particularly the role of the blood-brain-barrier. Dr Singh is the Founder of CNSDose, an academic member of the Clinical Pharmacogenetics Implementation Consortium (CPIC), and member of the Genetic Tests in Psychiatry Taskforce, International Society of Psychiatric Genetics (ISPG).

Author Quotes  

One of the areas which I think we need to know today, and I think there’s a hazard if you don’t think about it today, is HLA-genotyping for carbamazepine.

When you look at the literature and you see glaring deficiencies, sometimes it’s because of ethical issues.

Summary  

In this video, Dr Singh presents an overview of adverse reactions to drugs. Beginning with the anticoagulant Plavix, the FDA has issued a boxed warning regarding its effectiveness in people unable to metabolise the drug.

He discusses how carbamazepine and other anticonvulsant agents cause the skin condition, Steven Johnson Syndrome, and how patients with a severe immunological reaction can die from toxic epidermal necrolysis. 

He discusses the importance of future HLA-genotyping of carbamazepine and possibly lamotrigine, particularly in those with an Asian background. Dr Singh addresses several audience questions on psychotropic pharmacogenetics and provides advice for clinicians when prescribing anticonvulsants. 

 Concluding this presentation, Dr Singh discusses a serotonin transporter gene methylation study that revealed a large difference in the percentage of improvement within the depression rating scale. 

Take-Home Points  

  • Affordable, genetic testing is available for HLAgenotyping for carbamazepine. 
  • Methylation studies are important in determining impaired antidepressant treatment response. 
  • The relationship between methylation and psychotropic use is unknown.
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