Methods for Selecting Medications

Abstract

The invention provides a computer program product for selecting and administering a psychotropic medication for a patient. The computer program product utilizes a combination of genotype and phenotype information to provide the user with accurate guidance regarding the appropriate medication and its use.

1 - 47 . (canceled) 
     
     
         48 . A computer program product containing executable instructions that when executed cause a processor to perform operations comprising:
 (1) receiving a plurality of genotypes for a panel of genes, wherein said panel of genes comprises the following:
 (a) a cytochrome P450 CYP2D6 gene consisting of two alleles independently selected from the group consisting of fully functional alleles 2D6*1A, *2, *2N, and *35, partially functional alleles 2D6*10 and *17, and non-functional alleles 2D6*3, *4, *5, *6, *7, *8, and *12, 
 (b) a cytochrome P450 CYP2C19 gene consisting of two alleles independently selected from the group consisting of fully functional alleles 2C19*1A and *1B, and non-functional alleles 2C19*2A, *2B, *3, *4, *5A, *5B, *6, *7 and *8, and 
 (c) a serotonin transporter gene 5HTTR consisting of two alleles independently selected from the short (s) and long (l) forms of the 5HTTR gene; 
   (2) receiving a plurality of metabolic phenotypes based on the genotypes of the cytochrome P450 genes in (1), wherein the metabolic phenotype is selected from poor (P), intermediate (I), and extensive (E), and   said phenotypes are assigned based upon the number of functional alleles for each cytochrome P450 gene as follows: P=no fully functional alleles and either one or no partially functional alleles, I=either one fully functional allele and a non-functional allele or two partially functional alleles, and E=either one fully functional allele and one partially functional allele or two fully functional alleles;   (3) receiving a plurality of medication profiles, wherein said profiles are specified based on the genotypes and phenotypes in (1) and (2) and wherein said plurality of medication profiles comprises the following profiles (medication:: composite phenotype (2D612C19); and 5HTTR genotype:: instruction):   amitriptyline:: P/P or P/E; s/s, s/l or l/l:: avoid or use with caution and close monitoring   amitriptyline:: I/P, E/P or I/E; s/s, s/l or l/l:: use with caution   amitriptyline:: E/E; s/s, s/l or l/l:: acceptable for use as directed;   bupropion:: P/P, P/E, I/P, E/P, I/E, or E/E; s/s, s/l or l/l:: acceptable for use as directed;   citalopram:: P/P or I/P; s/s, s/l, or l/l:: avoid or use with caution and close monitoring   citalopram:: E/P; s/s:: avoid or use with caution and close monitoring   citalopram:: P/E, I/E or E/E; s/s:: use with caution   citalopram:: E/P; s/l or l/l:: use with caution   citalopram:: P/E, I/E or E/E; s/l or l/l:: acceptable for use as directed;   escitalopram:: P/P or I/P; s/s, s/l or l/l:: avoid or use with caution and close monitoring   escitalopram:: E/P; s/s:: avoid or use with caution and close monitoring   escitalopram:: P/E, I/E or E/E; s/s:: use with caution   escitalopram:: E/P; s/l or l/l:: use with caution   escitalopram:: P/E, I/E or E/E; s/l or l/l:: acceptable for use as directed;   fluoxetine:: P/P, P/E or I/P; s/s, s/l or l/l:: avoid or use with caution and close monitoring   fluoxetine:: I/E; s/s:: avoid or use with caution and close monitoring   fluoxetine:: E/P or E/E; s/s:: use with caution   fluoxetine:: I/E; s/l or l/l use with caution   fluoxetine:: E/P or E/E; s/l or l/l:: acceptable for use as directed;   fluvoxamine:: E/P; s/s:: avoid or use with caution and close monitoring   fluvoxamine:: P/P, P/E, I/P, I/E or E/E; s/s:: use with caution   fluvoxamine:: E/P; s/l or l/l:: use with caution   fluvoxamine:: P/P, P/E, I/P, I/E or E/E; s/l or l/l:: acceptable for use as directed;   imipramine:: P/P, P/E or I/P; s/s s/l or l/l:: avoid or use with caution and close monitoring   imipramine:: E/P or I/E; s/s, or l/l:: use with, caution   imipramine:: E/E, s/s, s/l or l/l:: acceptable for use as directed;   mirtazapine:: P/P, P/E, I/P or E/P; s/s, s/l or l/l:: use with caution   mirtazapine:: I/E or E/E; s/s s/l or l/l:: acceptable for use as directed;   nortriptyline:: P/P or P/E; s/s, s/l or l/l:: avoid or use with caution and close monitoring   nortriptyline:: I/P, E/P or I/E; s/s, s/l or l/l:: use with caution   nortriptyline:: E/E; s/s, or l/l:: acceptable for use as directed;   paroxetine:: P/P or P/E; s/s, s/l or l/l:: avoid or use with caution and close monitoring   paroxetine:: IP or I/E; s/s:: avoid or use with caution and close monitoring   paroxetine:: I/P or I/E; s/l or l/l:: use with caution   paroxetine:: E/P or E/E; s/s:: use with caution   paroxetine:: E/P of E/E; s/l or l/l:: acceptable for use as directed;   sertraline:: P/P or P/E; s/s:: avoid or use with caution and close monitoring   sertraline:: P/P or P/E; or l/l:: use with caution   sertraline:: I/P, E/P, I/E or E/E; s/s:: use with caution   sertraline:: I/P, E/P, I/E or E/E; s/l or l/l:: acceptable for use as directed;   venlafaxine:: P/P or P/E; s/s, s/l or l/l:: avoid or use with caution and close monitoring   venlafaxine:: I/P or I/E; s/s, s/l or l/l:: use with caution   venlafaxine:: E/P or E/E; s/s, s/l or l/l:: acceptable for use as directed;   ; and   (4) storing the genotypes, phenotypes, and medication profiles such that each medication profile is associated with a specific combination genotype and phenotype.   
     
     
         49 . A computer program product containing executable instructions that when executed cause a processor to perform operations comprising:
 (1) receiving a plurality of genotypes for a panel of genes, wherein said panel of genes comprises the following:
 (a) a cytochrome P450 CYP3A4 gene consisting of two alleles independently selected from the group consisting of fully functional alleles 3A4*1A, *1B, *2, *5, *6, and *15A, partially functional alleles 3A4*12, *13 and *17, and increased functional alleles 3A4*18A, 
 (b) a cytochrome P450 CYP1A2 gene consisting of two alleles independently selected from the group consisting of fully functional alleles 1A2*1A, partially functional alleles 1A2*3, and increased functional alleles 1A2*1F, 
 (c) a cytochrome P450 CYP21)6 gene consisting of two alleles independently selected from the group consisting of fully functional alleles 2D6*1A, *2, *2N, and *35, partially functional alleles 2D6*10 and *17 and non-functional alleles 2D6*3, *4, *5, *6, *7, *8, and *12, 
 (d) a cytochrome P450 CYP2C19 gene consisting of two alleles independently selected from the group consisting of fully functional alleles 2C19*1A and *1B, and non-functional alleles 2C1.9*2A, *2B, *3, *4, *5A, *5B, *6, *7 and *8, 
 (e) as serotonin transporter gene 5HTTR consisting of two alleles independently selected from the short (s) and long (l) forms of the HTTR gene, and 
 (f) a serotonin receptor gene HTR2A T102C polymorphism consisting of two alleles independently selected from the normal (T) and mutant (C) forms of the HTR2A gene; 
   (2) receiving a plurality of metabolic phenotypes based on the genotypes of the cytochrome P450 genes in (1), wherein the metabolic phenotype is selected from poor (P), intermediate (I), and extensive (E), and   said phenotypes are assigned based upon the number of functional alleles for each cytochrome P450 gene as P=two non-functional alleles, one non-functional allele and one partially functional allele, two partially functional alleles or two increased functional alleles, I=one non-functional allele and one fully functional allele, one non-functional allele and one increased functional allele, one fully functional allele and a partially functional allele or one fully functional allele and an increased functional allele, and E=either one partially functional allele and one increased functional allele or two fully functional alleles;   (3) receiving a plurality of medication profiles, wherein said profiles are specified based on the genotypes and phenotypes in (1) and (2) and wherein said plurality of medication profiles comprises the following profiles (medication:: composite phenotype (2D6/2C19); 5HTTR genotype; composite phenotype (3A4/1 A2); and HTR2A genotype):: instruction):   amitriptyline:: P/P or P/E; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   amitriptyline:: I/P, E/P or I/E; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: use with caution   amitriptyline:: E/E; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: acceptable for use as directed;   bupropion:: P/P, P/E, I/P, E/P, I/E, or E/E; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: acceptable for use as directed;   citalopram:: P/P or I/P; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   citalopram:: E/P; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   citalopram:: P/E, I/E or E/E; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: use with caution   citalopram:: E/P: s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: use with caution   citalopram:: P/E, I/E or E/E: s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: acceptable for use as directed;   escitalopram:: P/P or I/P; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   escitalopram:: E/P; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   escitalopram:: P/E, I/E or E/E; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: use with caution   escitalopram:: E/P; s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: use with caution   escitalopram:: P/E, I/E or E/E; s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: acceptable for use as directed;   fluoxetine:: P/P, P/E or I/P; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/:: C avoid or use with caution and close monitoring   fluoxetine:: I/E; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   fluoxetine:: E/P or E/E; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: use with caution   fluoxetine:: I/E; s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: use with caution   fluoxetine:: E/P or E/E; s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: acceptable for use as directed;   fluvoxamine:: E/P; s/s; P/E, I/E or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   fluvoxamine:: P/P, P/E, I/P, E/P, I/E or E/E; s/s; P/I, I/I or E/I; T/T, T/C or C/C:: avoid or use with caution and close monitoring   fluvoxamine:: E/P; s/l or l/l; P/I, I/I or E/I; T/T, T/C or C/C:: avoid or use with caution and close monitoring   fluvoxamine:: P/P, P/E, I/P, E/P, I/E or E/E; s/s, s/l or l/l; P/P, I/P or E/P; T/T, T/C or C/C:: avoid or use with caution and close monitoring   fluvoxamine:: P/P, P/E, I/P, I/E or E/E; s/s; P/E, I/E or E/E; T/T, T/C or C/C:: use with caution   fluvoxamine:: E/P; s/l or l/l; P/E, I/E or E/E; T/T, T/C or C/C:: use with caution   fluvoxamine:: P/P, P/E, I/P, I/E or E/E; s/l or l/l; P/I, I/I or E/I; T/T, T/C or C/C:: use with caution   fluvoxamine:: P/P, P/E, I/P, I/E or E/E; s/l or l/l; P/E, I/E or E/E; T/T, T/C or C/C:: acceptable for use as directed;   imipramine:: P/P, P/E or I/P; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   imipramine:: E/P or I/E; s/s, s/l, or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: use with caution   imipramine:: E/E; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: acceptable for use as directed;   mirtazapine:: P/P, P/E, I/P or E/P; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: use with caution   mirtazapine:: I/E or E/E; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: acceptable for use as directed;   nortriptyline:: P/P or P/E; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   nortriptyline:: I/P, E/P or I/E; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C, or C/C:: use with caution   nortriptyline:: E/E; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: acceptable for use as directed;   paroxetine:: P/P or P/E; s/s, s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   paroxetine:: I/P or I/E; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   paroxetine:: I/P or I/E; s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; C/C:: avoid or use with caution and close monitoring,   paroxetine:: E/P or E/E; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; C/C:: avoid or use with caution and close monitoring   paroxetine:: I/P or I/E; s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T or T/C:: use with caution   paroxetine:: E/P or E/E; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I ear E/E; T/T or T/C:: use with caution   paroxetine:: E/P or E/E; s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; C/C:: use with caution   paroxetine:: E/P or E/E; s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T or T/C:: acceptable for use as directed;   sertraline:: P/P or P/E; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or CC:: avoid or use with caution and close monitoring   sertraline:: P/P or P/E; s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P or E/E; T/T, T/C or CC:: use with caution   sertraline:: I/P, E/P, I/E or E/E; s/s; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or CC:: use with caution   sertraline:: I/P, E/P, I/E or E/E; s/l or l/l; P/P, P/I, P/E, I/P, I/I, I/E, E/P, E/I or E/E; T/T, T/C or CC:: acceptable for use as directed;   venlafaxine:: P/P or P/E; s/s, s/l or l/l; E/P, E/I or E/E; T/T, T/C or C/C:: avoid or use with caution and dose monitoring   venlafaxine:: P/P, P/E, I/P or I/E; s/s, s/l or l/l; I/P, I/I or I/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   venlafaxine:: P/P, P/E, I/P, E/P, I/E or E/E; s/s, s/l or l/l; P/P, P/I or P/E; T/T, T/C or C/C:: avoid or use with caution and close monitoring   venlafaxine:: I/P or I/E; s/s, s/l or l/l; E/P, E/I or E/E; T/T, T/C or C/C:: use with caution   venlafaxine:: E/P or E/E; s/s, s/l or l/l; I/P, I/I or I/E; T/T, T/C or C/C:: use with caution   venlafaxine:: E/P or E/E; s/s, s/l or l/l; E/P, E/I or E/E; T/T, T/C or C/C:: acceptable for use as directed;   
     
     
         50 . The computer program product of  claim 48  or  49 , further comprising executable instructions for querying a database of genotypes. 
     
     
         51 . The computer program product of  claim 48  or  49 , further comprising executable instructions for querying a database of electronic health records. 
     
     
         52 . The computer program product of  claim 48  or  49 , further comprising executable instructions for synthesizing the genotypes, phenotypes, and medication profiles into an individualized composite report.