Pharmacogenetics of the antiepileptic drugs phenytoin and lamotrigine

Drug Metabol Drug Interact. 2011;26(1):5-12. doi: 10.1515/DMDI.2011.008.

Abstract

Patients treated with antiepileptic drugs can exhibit large interindividual variability in clinical efficacy or adverse effects. This could be partially due to genetic variants in genes coding for proteins that function as drug metabolizing enzymes, drug transporters or drug targets. The purpose of this article is to provide an overview of the current knowledge on the pharmacogenetics of two commonly prescribed antiepileptic drugs with similar mechanisms of action; phenytoin (PHT) and lamotrigine (LTG). These two drugs have been selected in order to model the pharmacogenetics of Phase I and Phase II metabolism for PHT and LTG, respectively. In light of the present evidence, patients treated with PHT could benefit from CYP2C9 and CYP2C19 genotyping/phenotyping. For those under treatment with LTG, UGT1A4 and UGT2B7 genotyping might be of clinical use and could contribute to the interindividual variability in LTG concentration to dose ratio in epileptic patients.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anticonvulsants / adverse effects
  • Anticonvulsants / metabolism*
  • Anticonvulsants / therapeutic use
  • Aryl Hydrocarbon Hydroxylases / genetics
  • Aryl Hydrocarbon Hydroxylases / metabolism
  • Cytochrome P-450 CYP2C19
  • Cytochrome P-450 CYP2C9
  • Epilepsy / drug therapy
  • Genotype
  • Glucuronosyltransferase / genetics
  • Glucuronosyltransferase / metabolism
  • Humans
  • Lamotrigine
  • Pharmacogenetics
  • Phenytoin / adverse effects
  • Phenytoin / metabolism*
  • Phenytoin / therapeutic use
  • Polymorphism, Single Nucleotide
  • Triazines / adverse effects
  • Triazines / metabolism*
  • Triazines / therapeutic use

Substances

  • Anticonvulsants
  • Triazines
  • Phenytoin
  • CYP2C9 protein, human
  • Cytochrome P-450 CYP2C9
  • Aryl Hydrocarbon Hydroxylases
  • CYP2C19 protein, human
  • Cytochrome P-450 CYP2C19
  • Glucuronosyltransferase
  • Lamotrigine