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Liver
Other.
Lungs
Plasma
Mixed function oxidases (monooxygenases)
Cytochrome P450s or CYPs)
Reduction
Hydrolysis
Acetylation
Glucuronidation
Glutathione conjugation
Sulfation
Potentially lifesaving
Particularly important anytime dosage is changed
or drugs are added or withdrawn
Expensive
For some drugs, there is no simple relationship
between plasma level and therapeutic effect
GeneChip* CYP450 Assay
(applied pharmacogenomics)
A matrix on a chip (high density miniaturized
array of oligonucleotides) that can identify the
CYP phenotype of a patient. By the year 2000
enabled rapid detection of 18 known mutations of
CYP2D6 and CYP2C19. Could easily do
hundreds.
In 2005 Roche AmpliChip CYP 450 Test was
approved. Cost estimated at that time was about
$950 - cost will come down significantly
Something like this is likely to become a part of
initial patient screening in the near future.
*http://www.affymetrix.com/
Patient Case