The effectiveness of drugs and their potential for both benefit and side effects are not only the result of drug selection and dose but also the rate of drug metabolism and target interaction.  For many drugs, this metabolism is accomplished by the Cytochrome P450 (CYP450) enzyme system located in the liver.



The CYP450 system


Variability in the CYP450 system, accumulated in humans since prehistoric times, results in strikingly different drug levels, drug effectiveness and drug safety among individuals when the recommended dose is designed to treat the "average" person. These variances, particularly relevant to drugs used in mental health, cardio-metabolic disease, and pain control, can now be measured by DNA typing before treatment.  Drug doses can then be tailored to provide safe and effective therapy for individual patients (DNA-Guided Medicine).

Enzyme Induction of P450


Induction can cause marked increases in P450 composition and chemical clearance or bioactivation.   As a result of this induction, there is an exhibited delta in tolerance to various toxicants.  Additionally, there can be a corresponding decrease in the therapeutic effect of some drugs through the increased rate and pattern of metabolism.  Multiple xenobiotics are known to produce enzymes that can either play no role or a significant role in their biotransformation (examples: omeprazole vs ethanol).



Certainty Health Diagnostics


Certainty Health Diagnostics analyzes the CYP2C9, CYP2C19, and CYP2D6 genes simply from a cheek swab from the patient.  CHD then assists in the interpretation of these results for DNA-guided medical management of serious side effects and individualized optimization of therapy.  The genotype results and guidance delivered by CHD markedly improve the safety and efficacy of drug therapy.

Assessment of Patient Innate Functional Status

Assessment of the patient's innate functional status for the 3 key CYP450 isoenzymes relevant to the metabolism of neuro-psychiatric and cardio-metabolic drugs: CYP2D6, CYP2C9, and CYP2C19.

High-resolution genotyping of a total of 37 variants in the genes coding for these isoenzymes: CYP2D6 (20 alleles), CYP2C9 (7 alleles), CYP2C19 (10 alleles).

Well-characterized ultra-rapid promoter alleles for genes CYP2D6 and CYP2C19 (*2a and *17, respectively) conferring gain of metabolic function in carriers

Objective Indices for Metabolic Reserve and Alteration, Allele and Gene Alteration

Analysis of the VKOR gene coding for Vitamin K Epoxide Reductase, the target for the anticoagulant drug warfarin, and interpretation for gene-guided warfarin dosing