Therapeutic Drug Monitoring to Support Clinical Pharmacogenomics

  • Alan H. B. WuEmail author
  • Kara L. Lynch


The implementation of pharmacogenomics can improve the efficacy of therapeutic drugs while reducing the incidence of side effects and drug toxicity. Therapeutic drug monitoring is well accepted and widely practiced for many drugs and is also relevant for drugs for which pharmacogenomic testing is needed. Tamoxefin is metabolized by CYP 2D6 to endoxifen, clopidogrel by CYP 2C19 to thiol-containing active metabolite, and opioid drugs by 2D6 to morphine and other metabolites. For these drugs, genetic testing can be used to predict efficacy for breast cancer outcomes, freedom from cardiovascular events, and adequate pain control, respectively. Therapeutic drug monitoring (TDM) can be used to determine drug compliance, especially for the opioids which have street value and can be diverted as a drug of abuse. Drug levels can be used to titrate drug dosage for individuals who are shown to be sub-therapeutic. TDM can also improve efficacy for tamoxifen for patients taking drug inhibitors, and be useful for determining the mechanism of clopidogrel resistance (i.e., pharmacokinetics vs. pharmacodynamics). Since there are no specific immunoassays for these drugs and metabolites for serum measurements, liquid chromatography/mass spectrometric methods will be necessary to implement TDM.


Therapeutic Drug Monitoring Stent Thrombosis Clopidogrel Resistance Morphine Formation Nongenetic Factor 
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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Laboratory MedicineUniversity of California-San FranciscoSan FranciscoUSA
  2. 2.San Francisco General HospitalSan FranciscoUSA

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