Genetics of tailored medicine: Focus on CNS drugs

The genetics of tailored medicine (TM), a medicine in which drug types and dosages are tailored to the clinical needs of each patient, greatly overlap cytochrome P450 (CYP) genetics, probably the most active area of multidisciplinary research interrelating the interest of medicine, biology, biochemistry, and pharmacology, and potentially crossing all medical disciplines. The great genetics variability showed by the CYP gene superfamily permitted on one side to encode a series of enzyme capable to metabolize almost all drugs, and on the other side to have specific genetic profiles for each individual, resulting in inter-individual difference in drug efficacy also responsible of severe clinical consequences such as therapeutic failures (TFs) and adverse drug reactions (ADRs), worldwide primary causes of morbidity and mortality in Western countries. Among medical disciplines, neurology, psychiatry and geriatrics resulted the most interesting for TM since the administration of concomitant treatment is a common practice, raising the prevalence of TFs and ADRs in the treatment of neurological and psychiatric diseases. i.e. in older patients with in treatment with acetylcholinesterase inhibitors, antidepressants, and antipsychotics, all substrate of CYPs. Thus, in these clinical settings the genetic analysis of CYPs may be pivotal for the identification of patients to be addressed toward alternative treatments, and tailor drug types and dosages to the individual patient's clinical needs.