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Cordinated global efforts to prevent and control malaria have been a tour-de-force for public health, but success appears to have reached a plateau in many parts of the world. While this is a multifaceted problem, policy strategies have largely ignored genetic variations in humans as a factor that influences both selection and dosing of antimalarial drugs. This includes attempts to decrease toxicity, increase effectiveness and reduce the development of drug resistance, thereby lowering health care costs. We review the potential hurdles to developing and implementing pharmacogenetic-guided policies at a national or regional scale for the treatment of uncomplicated falciparum malaria. We also consider current knowledge on some component drugs of artemisinin combination therapies and ways to increase our understanding of host genetics, with the goal of guiding policy decisions for drug selection. Les efforts mondiaux coordonnes de prevention et de lutte contre le paludisme ont ete un veritable tour de force pour la sante publique, mais le succes semble avoir atteint un plateau dans de nombreuses regions du monde. Bien que ce soit un probleme a multiples facettes, les strategies politiques ont largement ignore les variations genetiques chez l'homme en tant que facteur influencant a la fois la selection et le dosage des medicaments antipaludiques. Cela inclut des tentatives pour diminuer la toxicite, augmenter l'efficacite et reduire le developpement de la resistance aux medicaments, reduisant ainsi les couts des soins de sante. Nous passons en revue les obstacles potentiels au developpement et a la mise en ceuvre des politiques guidees par la pharmacogenetique a l'echelle nationale ou regionale pour le traitement du paludisme non complique a falciparum. Nous examinons egalement les connaissances actuelles sur certains medicaments qui composent les combinaisons therapeutiques a base d'artemisinine et les moyens d'accroitre notre comprehension de la genetique de l'hote, dans l'objectif dbrienter les decisions politiques de selection des medicaments. Los esfuerzos coordinados que se estan realizando en todo el mundo para prevenir y controlar la malaria han sido una autentica hazafla para la salud publica, pero parece que el exito conseguido se ha estabilizado en muchas partes dei mundo. Debido a que se trata de un problema multifacetico, muchas de las estrategias de las politicas han ignorado las variaciones geneticas en humanos como un factor que influye tanto en la seleccion como en las dosis de farmacos antimalaricos. Estu incluye los intentos de reducir la toxicidad, de aumentar la eficacia y de disminuir el desarrollo de resistencia a los farmacos. De esta manera, tambien se reducirian los costes de la asistencia sanitaria. Revisamos los posibles obstaculos para el desarrollo e implementacion de las politicas orientadas a la farmacogenetica a nivel nacional o regional para el tratamiento de la malaria por Plasmodium falciparum sin complicaciones. Con el objetivo de conseguir orientacion para las decisiones sobre la seleccion de farmacos, tambien tenemos en cuenta los conocimientos disponibles sobre algunas terapias de combinacion de farmacos componentes de artemisinina y las maneras de aumentar nuestros conocimientos sobre genetica dei huesped., Introduction Renewed efforts to control and eliminate malaria are making advances using the current generation of tools: long-lasting insecticide treated nets, artemisinin combination therapies (ACTs) and indoor residual spraying. Despite [...]

Background: The pharmacokinetics (PKs) and pharmacodynamics (PDs) of telmisartan varies among the individuals, and the main causes remain unknown. The aim of this study was to evaluate the impact of ORM1, as well as ABCC2, ABCB1, ABCG2 and SLCO1B3 polymorphisms, on the disposition of the drug and BP change after taking 40 mg telmisartan in 48 healthy Chinese males. Method: A total of 48 healthy males were included in this trial. Every volunteer ingested a single dose of 40 mg telmisartan, and the plasma drug concentration and blood pressure (BP) were measured up to 48 h. Result: In this study, the area under the plasma concentration-time curve (AUC) in the heterozygotes of ORM1 113AG was higher than that in the wild-type homozygotes, AUC(0–48) (113AA vs. 113AG, 1,549.18±859.84 ng·h/ml vs. 2,313.54±1,257.71 ng·h/ml, P = 0.033), AUC(0–∞) (113AA vs. 113AG, 1,753.13±1,060.60 ng·h/ml vs. 2,686.90±1,401.87 ng·h/ml, P = 0.016), and the change(%) of the diastolic blood pressure (DBP) from the baseline BP value also showed a significant difference between the ORM1 113AG and 113AA genotypes at 5 h after taking telmisartan (P = 0.026). This study also showed that the allele of ABCC2 C3972T would affected the disposition of telmsiartan and the DBP change significantly after taking the drug. However, the common SNPs of ABCG2 C421, ABCB1 C3435T, and SLCO1B3 T334G showed no impacts on the PKs of telmisartan or BP change(%) in our trial. Conclusion: The ORM1 A113G polymorphism was associated with the PKs variability after taking telmsiartan, as well as ABCC2 C3972T. The heterozygotes of ORM1 113AG showed a larger AUC and a notable BP change(%) from the baseline compared with the wild-type. Trial Registration: Chinese Clinical Trial Registry ChiCTR-TNC-10000898 [ABSTRACT FROM AUTHOR]

The article highlights the risks and benefits of oral combination contraceptives. Among the risks include a three- to sixfold increase of venous thromboembolism and a possible ischemic stroke among women with a history of migraine. Meanwhile, its benefits include a lower risk of colorectal cancer and a decrease in primary dysmenorrheal pain.

This article identifies patient-centered reasons that contribute to the changes in contraception patterns. Nonlactating women are choosing progestin-only contraceptives less often than previously. Patient-centered, not evidence-based, reasons contribute to this shift in prescribing patterns. Many women who chose injectable progestin-only contraceptives have changed to patch-delivered or intravaginal estrogen-progestins due to concerns over potential weight gain and increased bone loss with progestin-only contraceptives.

Aim: To describe the exploratory planning and implementation of a pilot pharmacogenetic program in a community pharmacy. An institutional review board-approved protocol for a clopidogrel pharmacogenetic program in a community pharmacy was developed to address feasibility and evaluate the pilot program., Study Concept: Subjects taking clopidogrel are asked to participate at the point of medication dispensing. A pharmacist schedules an appointment with subjects to discuss the study and collects a buccal swab sample for CYP2C19 testing. When the results are available, the pharmacist consults with the subject's prescriber regarding test result interpretation and associated recommendations, and schedules a second appointment with the participant to discuss results and review any physician-approved therapeutic changes. The intervention-associated consultation is then billed to the subject's insurance., Results: Subject enrollment has begun., Conclusion: Community pharmacists may be valuable partners in pharmacogenetics.

The cytochome P450 enzyme system is responsible for the metabolism of xenobiotics, including > 75% of commonly prescribed medications. Many of the cytochrome enzymes exhibit polymorphic genotypes, partly accounting for the variations observed in individual drug responses. Recent advances in the understanding of functional alleles of cytochrome P450 enzymes have changed the use of medications. Improvements in drug efficacy and the prevention of toxicity, as well as improvements in clinical drug dosing, have enhanced pharmacotherapy decisions in medical practice. In addition to personalizing medicine, the identification and quantification of genotypic differences in cytochrome P450 metabolism has the potential to facilitate population-based personalized medicine in countries without the resources to perform genotypic tests at the point of care. This review provides an update on the utility of genotype-guided therapy when treating breast cancer, malaria and coagulation disorders. Also discussed are advancements made in diagnostic tests for cytochrome genotypes and the need for future research in the area of diagnostic tests.