Pharmacogenomics and adverse drug reactions in diagnostic and clinical practice.

Pharmacogenetics and pharmacogenomics deal with genetically determined variations in how individuals respond to drugs. They hold the potential to revolutionize drug therapy. The clinical need for novel approaches to improve pharmacotherapy stems from the high rate of adverse reactions to drugs and their lack of effectiveness in many individuals. Despite the accumulation of research findings showing the potential for clinical benefit for several drug-metabolizing enzymes and some receptors that constitute drug targets, the translation of these findings into tangible clinical applications occurs very slowly. The main steps for clinical implementation of pharmacogenomics include: a) education of clinicians and all other parties involved in the use and benefits of pharmacogenomics; b) execution of large prospective clinical and pharmacoeconomic studies showing the benefit of pharmacogenomic genotyping; c) provision of incentives to develop tests; d) development of specific clinical guidelines; and e) creation of a solid regulatory and ethical framework. Furthermore, the potential should be explored to use existing therapeutic drug monitoring laboratories to introduce pharmacogenomic testing into hospitals. Overall, our thesis is that pharmacogenomics is already a reality in clinical practice and is bound to continue gaining acceptance by clinicians in the coming years.