Journal
PHARMACOTHERAPY
Volume 43, Issue 7, Pages 691-704Publisher
WILEY
DOI: 10.1002/phar.2751
Keywords
clinical decision support; pediatric; personalized medicine; pharmacogenetics; pharmacogenomics; precision medicine; selective serotonin reuptake inhibitors
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Pharmacogenetic testing for psychiatry is rapidly expanding and being utilized for clinical decision-making. Vanderbilt University Medical Center has implemented genotype-guided dosing and drug selection for selective serotonin reuptake inhibitors in both adult and pediatric patients. Effective implementation of pharmacogenetic-based clinical decision support for the pediatric population requires consideration of evidence, medication indications, and alternative therapies when contraindications are identified.
Pharmacogenetic testing for psychiatry is growing at a rapid pace, with multiple sites utilizing results to help clinical decision-making. Genotype-guided dosing and drug selection have been implemented at several sites, including Vanderbilt University Medical Center, where clinical decision support (CDS) based on pharmacogenetic results went live for selective serotonin reuptake inhibitors in 2020 for both adult and pediatric patients. Effective and appropriate implementation of CYP2D6- and CYP2C19-guided CDS for the pediatric population requires consideration of the evidence for the pharmacogenetic associations, medication indications, and appropriate alternative therapies to be used when a pharmacogenetic contraindication is identified. In this article, we review these pediatric pharmacogenetic considerations for selective serotonin reuptake inhibitor CDS. We include a case study, the current literature supporting clinical recommendations, considerations when designing pediatric CDS, future implications, and examples of sertraline, (es)citalopram, paroxetine, and fluvoxamine alerts.
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