Case Vignettes

Gerald, age 58, Asian male

Recent heart attack, depression

Gerald had been taking carisoprodol, as needed, for his chronic back pain for many years. Six months ago, Gerald suffered a heart attack and was prescribed aspirin, clopidogrel, metoprolol, and simvastatin. He did not report any adverse effects from these new medications.

Later, Gerald began to experience symptoms of depression and was prescribed fluoxetine. After three weeks, Gerald returned to his doctor complaining of nausea, dizziness, and a heartbeat that was racing for short periods of time. His doctor determined he was not having another heart attack, but because he was uncertain why the symptoms occurred, he ordered DNA testing and utilized the Youscript Precision Prescribing System.

Gerald’s DNA testing and YouScript results revealed that he is an intermediate metabolizer of CYP2C19 and CYP2D6. The combination of his genetics and the fluoxetine made his body unable to respond to clopidogrel and he became more sensitive to metoprolol and carisoprodol as the levels increased. As a result of the report, Gerald’s doctor changed his prescriptions from fluoxetine to vilazodone and from clopidogrel to ticagrelor. This helped to avoid a potentially fatal interaction with clopidogrel and reduced the possible side effects of metoprolol and carisoprodol. Now that his medications have been tailored to his metabolizing abilities, Gerald is feeling much better.

Betty, age 68, White female

Breast cancer, chronic back pain

Betty was prescribed tamoxifen for her cancer and hydrocodone for her pain. Despite the powerful narcotic, she reported no pain relief. Betty decided to try goldenseal. Her friend told her that it makes her prescription medicines work better.

Betty’s doctor ordered a DNA test and utilized the YouScript Precision Prescribing Software. The test revealed that her body makes half of the typical amount of the CYP2D6 enzyme which is necessary for the body to respond to the pain medicine. In addition, this enzyme is also necessary for her breast cancer medicine to work. The goldenseal she was taking was contributing to her problems with both medications as well.

Betty’s medications were changed. She stopped using goldenseal and is taking alternatives for the hydrocodone and tamoxifen. She found pain relief and her breast cancer was treated successfully, without recurrence.

Ashton, age 13, White male

Attention deficit hyperactivity disorder (ADHD)

Ashton was prescribed Adderall® and had a seizure one week later. His psychiatrist ordered YouScript for the child. The test revealed he is genetically incapable of producing CYP2D6, an enzyme on which Adderall® is 100 percent dependent.

Ashton’s DNA testing and YouScript report contained a red warning about Adderall®. The warning suggested that Adderall® concentration could increase 200 percent or greater in Ashton’s bloodstream. This type of increase could lead to seizures. It also showed that Ritalin®, an alternative ADHD medication, does not use the 2D6 enzyme. Based on this report, Ashton’s doctor switched him to Ritalin®. The new medication effectively manages his condition without compromising his safety.