Pharmacogenomics: what pharmacists should know

Case Scenario

Kiet, a 45-year-old man of Thai ethnicity, presents to your pharmacy with a prescription for allopurinol. He has been prescribed this to treat his frequent gout flares, for which he usually takes ibuprofen. Kiet is worried, as he recalls his brother having a ‘bad reaction’ to a gout medicine in the past, and because he has never had to take any regular medicines before. You look in the Australian Medicines Handbook and note that Kiet’s ethnicity may increase his risk of having the HLA-B*58:01 allele, which significantly increases the risk of hypersensitivity reactions with allopurinol. You ask Kiet, but he does not recall having had any genetic tests in relation to this.

Introduction

Medication-related problems have a significant impact on individuals and Australia’s healthcare system, costing $1.4 billion annually and causing 250,000 annual hospital admissions.¹ Half of medication-related harm is believed to be preventable.¹ Consequently, medicines safety is Australia’s 10th National Health Priority Area, and the work of pharmacists is integral to its achievement.²

Pharmacogenomic testing is a tool that can be used to personalise medicine management. It has been shown to reduce adverse events, healthcare utilisation and healthcare costs.^3-6