Optimization and Individualization of Medication Selection and Dosing

Abstract

Described are methods for treating a patient with a therapeutic drug using a combination of genetic and non-genetic information to tailor the dose of the drug to the patient.

1 - 39 . (canceled) 
     
     
         40 . A method for treating a patient with a therapeutic drug, the method comprising
 receiving a drug profile comprising the drug's therapeutic range;   receiving patient data comprising demographic data and clinical data;   determining the patient's genotype at one or more genetic loci encoding a cytochrome P450 gene selected from the group consisting of CYP2D6, CYP1A2, CYP2C19, CYP2C9, and CYP2E1, each genetic loci containing one or more genetic variants;   generating a first pharmacokinetic (PK) model of the area under the time concentration curve (AUC) based on the patient data, genotype, and drug profile, wherein the model is a Bayesian model and incorporates the one or more genetic variations, a population frequency for each genetic variation, and AUC data for each genetic variation;   administering a first dosing regimen of the drug to the patient based upon the first PK model;   determining a blood level of the drug in the patient;   generating a second PK model incorporating the blood level of the drug;   administering a second dosing regimen of the drug to the patient based upon the second PK model.   
     
     
         41 . The method of  claim 40 , wherein the step of determining the blood level of the drug comprises determining a pre-dose blood level of the drug in the patient before administering the first dosing regimen. 
     
     
         42 . The method of  claim 41 , wherein the method further comprises incorporating the pre-dose blood level into the PK model. 
     
     
         43 . The method of  claim 40 , wherein the therapeutic drug is a neuropsychiatric medication. 
     
     
         44 . The method of  claim 43 , wherein the neuropsychiatric medication is a selective serotonin reuptake inhibitor or a tricyclic antidepressant. 
     
     
         45 . The method of  claim 43 , wherein the neuropsychiatric medication is a substrate of CYP2D6. 
     
     
         46 . The method of  claim 45 , wherein the medication is selected from the group consisting of amitriptyline, nortriptyline, haloperidol, and desipramine. 
     
     
         47 . The method of  claim 43 , wherein the neuropsychiatric medication is a substrate of CYP1A2. 
     
     
         48 . The method of  claim 47 , wherein the medication is selected from clozapine and imipramine. 
     
     
         49 . The method of  claim 43 , wherein the neuropsychiatric medication is a substrate of CYP2C19. 
     
     
         50 . The method of  claim 49 , wherein the medication is selected from imipramine, citalopram, and diazepam. 
     
     
         51 . The method of  claim 43 , wherein the neuropsychiatric medication is a substrate of CYP2C9. 
     
     
         52 . The method of  claim 51 , wherein the medication is selected from acetaminophen and antabuse (disulfiram). 
     
     
         53 . The method of  claim 43 , wherein the neuropsychiatric medication is a substrate of CYP2E1. 
     
     
         54 . The method of  claim 53 , wherein the medication is selected from phenytoin and carbamazepine.