Methods for Selecting Medications

Abstract

The invention provides computer assisted methods for selecting an antidepressant medication for a patient. The methods utilize a combination genotype comprising at least three genes to guide medication selection.

1 - 47 . (canceled) 
     
     
         48 . A computer-implemented method for selecting an antidepressant medication for a patient in need thereof, the method comprising
 identifying the patient's clinical phenotype as depression based on data received by the computer system,   receiving a set of medications used to treat depression,   associating each of the medications with a combination genotype and a category of use to create at least one medication profile for each medication, the combination genotype comprising the genotypes of a panel of at least three genes, a cytochrome P450 CYP2D6 gene, a cytochrome P450 CYP2C19 gene, and a serotonin transporter gene 5HTTR,   storing the medication profiles and genotypes such that a medication profile associated with a specific genotype can be identified,   receiving the patient's combination genotype for the panel of at least three genes,   identifying from the stored medication profiles at least one identified medication profile associated with the patient's combination genotype, and   outputting a patient-specific report comprising the at least one identified medication profile associated with the patient's genotype.   
     
     
         49 . The method of  claim 48 , wherein the medications are selected from citalopram, fluvoxamine, bupropion, escitalopram, sertraline, mirtazapine, fluoxetine, venlafaxine, amitriptyline, imipramine, paroxetine, and nortriptyline. 
     
     
         50 . The method of  claim 49 , wherein the panel of at least three genes comprises
 (i) 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,   (ii) 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   (iii) a serotonin transporter gene 5HTTR consisting of two alleles independently selected from the short (s) and long (1) forms of the 5HTTR gene.   
     
     
         51 . The method of  claim 50 , further comprising assigning a metabolic phenotype to each cytochrome P450 gene according to the number of functional alleles in the genotype, the metabolic phenotype selected from poor (P), intermediate (I), and extensive (E). 
     
     
         52 . The method of  claim 51 , wherein the at least one medication profile has a data structure comprising<medication::2D6/2C19 metabolic phenotype; 5HTTR genotype::use category>and is selected from the group consisting of:
 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, s/l 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, s/l 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::I/P 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 or 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; s/l 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;     
     
     
         53 . The method of  claim 48 , wherein the category of use is selected from acceptable for use as directed, use with caution, avoid or use with caution and close monitoring. 
     
     
         54 . The method of  claim 48 , further comprising querying a database of genotypes. 
     
     
         55 . The method of  claim 48 , further comprising querying a database of electronic health records. 
     
     
         56 . The method of  claim 48 , further comprising synthesizing the genotypes, phenotypes, and medication profiles into an individualized composite report. 
     
     
         57 . The method of  claim 48 , wherein the patient's genotype is received directly from equipment used in determining the patient's genotype. 
     
     
         58 . The method of  claim 48 , wherein the medication profile for the patient includes a ranking of several medications. 
     
     
         59 . The method of  claim 48 , wherein the ranking is based on patient-specific co-factors.