November 2004 – Commentary on BiDil, the CHF medication for blacks:
Now, let’s look at BiDil a little closer. This is merely a combination of two cheap generic medications – hydralazine and isosorbide dinitrate. In fact, you can simply prescribe these medications separately at BiDil’s dosages for only pennies. This combination has been tested before in the pre ace-inhibitor era and was the standard of care for CHF before the emergence of ace-inhibitors. However, the data showed that blacks had a lesser response to ace-inhibitors, and that the older standard of hydralazine and nitrates had a more pronounced effects in blacks. The drug company, NitroMed, shrewdly pounced on this fact, leading to the results of today’s study.
Related posts:
- BiDil smoke and mirrors
- Classic post: Cut Medicare payments for doctors, you’ll have fewer doctors
- Racist not to cover BiDil?
- Medication reconciliation
- Does e-prescribing save prescription drug costs?
- Medication reconciliation
- Do we really need brand name amoxicillin?
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This is from my own blog. It seems apropos:
Ethnicity and Drug Metabolism
Geneticists are uncomfortable with the idea of “race”. The more we learn about genetic variation the more we realize that there really are no genetic markers that define a particular race. Further, in many parts of the world human beings have so thoroughly mixed their gene pools over time that it is often impossible to predict whether or not an individual identified with a particular ethnic group actually possesses a gene known to be unique to his or her ethnic group.
Nevertheless population studies continue to yield some interesting data about response to medications. African Americans, for example, include a greater proportion of individuals who have poor responses to beta-blocker blood pressure medications. East Asians appear to have a much higher proportion of individuals who develop a nagging, dry cough in response to angiotensin-1 converting enzyme inhibitor (ACE-1) medications than do other groups. The prevalence rate for the CYP2D6 poor metabolizer (PM) phenotype is almost seven times higher in Sweden that in China. Any textbook of genetics is replete with these sorts of observations.
Although different ethnic groups may differ in their frequencies of genes affecting drug metabolism, to adopt a prescribing practice that treated every member of that group exactly the same would be a mistake. What is true for the group is not always true for the individual. A one-size-fits-all prescribing practice for members of a defined ethnic group runs the risk of prescribing the wrong drug to an individual with a poor result.
A much better prescribing practice—and one that will likely become a standard of care in the not-too-distant future—is to directly determine an individual’s genotype. If a physician is aware of genetically determined responses to a particular drug, and if there is a test for a marker of the genes involved, he or she can simply order the test and use the result to guide the optimum prescription. There are actually more of these tests currently available than most physicians suspect and many more in the development pipeline.
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