Pharmacogenetic guided drug therapy - how to deal with phenoconversion in polypharmacy

Introduction: The prevalence of polypharmacy and the increasing availability of pharmacogenetic information in clinical practice have raised the prospect of data-driven clinical decision-making when addressing the issues of drug-drug interactions and genetic polymorphisms in metabolizing enzymes. Inhibition of metabolizing enzymes in drug interactions can lead to genotype-phenotype discrepancies (phenoconversion) that reduce the relevance of individual pharmacogenetic information.

Areas covered: The aim of this review is to provide an overview of existing models of phenoconversion, and we discuss how phenoconversion models may be developed to estimate joint drug-interactions and genetic effects. Based on a literature search in PubMed, Google Scholar, and reference lists from review articles, we provide an overview of the current models of phenoconversion. The currently applied phenoconversion models are presented and discussed to predict the effects of drug-drug interactions while accounting for the pharmacogenetic status of patients.

Expert opinion: While pharmacogenetic-dose recommendations alone are most relevant for rare and extreme genotypes, phenoconversion may increase the prevalence of these phenotypes. Therefore, in polypharmacy conditions, phenoconversion assessment is especially important for personalized drug therapy.