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Antipsychotic Medications in Schizophrenia

By | Antipsychotics, Pharmacogenetic Testing, Pharmacogenomics, Precision Medicine, Psychiatric Medications | No Comments

Medications are central to the treatment of schizophrenia and a number of drugs are used to treat this serious mental condition. Schizophrenia is a long-term mental disorder marked by psychosis- a breakdown in the relation between thought, emotion, and behavior, leading to errors in perception, inappropriate actions and feelings, withdrawal from reality, and a sense of mental fragmentation.


Most patients are now treated with antipsychotics that are thought to control symptoms through the brain chemical, dopamine. There are two types of antipsychotics used: first generation and second generation.


First Generation Antipsychotics

The first generation antipsychotics have more serious side effects and are used only when necessary. They include haloperidol (Haldol), chlorpromazine (Thorazine), and Fluphenazine (Prolixin). Side effects of first-generation antipsychotics include extrapyramidal side effects which is marked by rigidity, bradykinesia, dystonias, tremor, and akathisia. Tardive dyskinesia (TD)— a disorder marked by permanent involuntary movements in the limbs and face such as grimacing and lip-smacking – is another adverse effect that can occur with first-generation antipsychotics. Additionally. first-generation antipsychotics are known to cause cardiac rhythm abnormalities.


Second Generation Antipsychotics and Side Effects

The newer second generation antipsychotics have less side effects than the older drugs, and are preferred for treatment of schizophrenia. They include: aripiprazole (Abilify), asenapine (Saphris), brexipiprazole (Rexulti), clozapine (Clozaril), Iloperidone (Fanapt), Lurasidone (Latuda), Olanzapine (Zyprexa), Paliperidone (Invega), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon).

Abilify side effects include akathisia (agitation), restlessness, insomnia, constipation, fatigue and blurred vision. Most of the second-generation antipsychotics have similar side effects, as they are similar chemically. Geodon is one of the newer antipsychotics with extra-pyramidal side effects reported (drug induced movement disorders).

During initial phases of treatment with the second generation antipsychotics patients may experience side effects such as dry mouth, drowsiness, restlessness, muscle spasms, tremor or blurring of vision. The second generation antipsychotics have a much lower risk of tardive dyskinesia, a serious side effect of the older antipsychotics. It is possible to lessen side effects by either lowering the dose or by changing medications.


Antipsychotic Pharmacogenetics

Patients and physicians often work together to find a dose that results in the fewest side effects. Patients will often change medications if the side effects are severe and side effects lessen over time. One way to potentially avoid side effects for new medications and for newly prescribed schizophrenia medications is to have your drug metabolism genes tested. After the human genome was sequenced back in 2003, genome wide association studies showed that there is variation among the population in the genes that process medications. As a result, if there’s a drug-processing gene with variation, it may have trouble processing medications that are metabolized by that gene product.


Know Your Risks with the Rxight® DNA Test

The most state-of-the-art way to determine genetic variations is with the Rxight® pharmacogenetics test from MD Labs. This advance in pharmacogenetics means that a physician can determine beforehand what drugs may be safe to take and what drugs to avoid or require different doses than recommended. All that is required is a prescription from a physician and a cheek swab at a participating pharmacy.

You could benefit from this advance in precision medicine with the knowledge of your gene variations with your physician or other healthcare services. The Rxight® pharmacogenetics test determines your genetic susceptibilities for over 200 drugs on the market. You could also benefit from knowing how you might respond to drugs you may have to take in the future. Most importantly, you could get information that may change your current dosing and medication for fewer harmful side effects from your antipsychotic medication.

Uses, Side Effects and Pharmacogenetics of Antihypertensive Drugs

By | Adverse Drug Reactions, Antihypertensives | No Comments

An antihypertensive drug is any agent that reduces blood pressure. There are many different classes and are used in certain situations. They are prescribed for hypertension and help prevent events like transient ischemic attacks (TIAs), strokes, and myocardial infarction.
Classes of antihypertensive drugs include:

  • Diuretics
  • Calcium channel blockers
  • ACE inhibitors – used to treat hypertension but act by inhibiting angiotensin converting enzyme. This reduces activity of the renin angiotensin aldosterone system and reduces blood pressure. One example is ramipril.
  • Angiotensin II receptor antagonists
  • Adrenergic antagonists
  • Benzodiazepines
  • Renin inhibitors
  • Aldosterone receptor antagonists
  • Endothelin receptor blockers
  • Thiazide diuretics – used to treat hypertension and edema. They work by inhibiting the sodium chloride symporter. The increase in fluid loss decreases blood volume and reduced blood pressure. An example is bendroflumethiazide.


Antihypertensive Drugs Side Effects

Thiazide diuretics like bendroflumethiazide cause a number of side effects. These include:

  • Syncope (fainting)
  • Hypotension (low blood pressure)
  • Glaucoma
  • Gastric irritation
  • Nausea/vomiting
  • Diarrhea
  • Constipation
  • Abdominal pain
  • Rash

Calcium Channel Blockers include drugs like isradipine and verapamil. Side effects include:

  • Headache
  • Dizziness
  • Lethargy
  • Hypotension (low blood pressure)
  • Edema (swelling)
  • Pharyngitis (sore throat)
  • Fatigue
  • Malaise
  • Rash
  • Scalp irritation
  • Sleep disturbance
  • Myalgia (muscle pain)
  • Allergic reactions
  • Hypersensitivity
    ACE inhibitors are also associated with a number of side effects. These include:

    • Hypotension
    • Angina pectoris (chest pain)
    • Postural hypotension
    • Nausea/vomiting
    • Diarrhea
    • Abdominal discomfort
    • Dyspepsia
    • Fatigue
    • Asthenia
    • Vertigo
    • Bronchitis
    • Cough
    • Depression
    • Anxiety
    • Nervousness
    • Restlessness
    • Headache
    • Dizziness
    • Syncope (fainting)
    • Muscle spasm
    • Myalgia (muscle pain)

    Angiotensin II receptor antagonists include drugs like losartan (Cozaar). Common side effects include:

    • Nasal congestion
    • Sinusitis
    • Abdominal pain
    • Nausea
    • Diarrhea
    • Dyspepsia (indigestion)
    • Back pain
    • Myalgia (muscle pain)
    • Dizziness
    • Headache
    • Vertigo
    • Chest pain
    • Hyperkalemia (high blood concentration of potassium)
    • Insomnia
    • Anemia

    Adrenergic receptor antagonists are also used as antihypertensives. Common side effects include (these occur in more than 1% of patients):

    • Hypotension (low blood pressure)
    • Raynaud’s syndrome (can result in cold extremities)
    • Fatigue
    • Sleep disturbances
    • Nightmares
    • Sleep disorder
    • Agitation
    • Somnolence (lack of energy)
    • Irritability

    Antianxiety medications such as benzodiazepines can be used to lower blood pressure. Side effects can include:

    • Irritability (33% more)
    • Anxiety
    • Depression
    • Confusion
    • Disinhibition
    • Derealization
    • Dream abnormalities
    • Fear
    • Drowsiness (77%)
    • Impaired coordination
    • Memory impairment
    • Lightheadedness
    • Insomnia
    • Headache
    • Cognitive disorder
    • Dysarthria
    • Abnormal involuntary movement
    • Somnolence
    • Ataxia (loss of control of body)
    • Balance disorder
    • Nervousness
    • Syncope (fainting)
    • Agitation
    • Paresthesia (pins and needles)
    • Tinnitus
    • Hypersomnia
    • Lethargy
    • Fatigue
    • Blurred vision
    • Decreased libido
    • Micturition difficulties (issues urinating)
    • Menstrual disorders
    • Increased libido
    • Decreased salivation
    • Constipation
    • Allergies
    • Tachycardia (increased heart rate)
    • Chest pains
    • Rigidity
    • Tremor
    • Muscular twitching
    • Increased/decreased appetite
    • Weight gain/loss


    Know Your Risks for Side Effects from Anihypertensive Medications with the Rxight® Genetic Test

    Most patients do not suffer adverse reactions when taking antihypertensives. However some patients may suffer from many side effects. This inter patient variability is explained by pharmacogenetics. Polymorphisms (variations) in the enzymes and receptors that interact with antihypertensives can increase the probability of patients developing side effects.
    Most antihypertensives are metabolized by the cytochrome P450 superfamily of enzymes (the specific isoenzymes will vary on class and drug). Polymorphisms in these enzymes have been shown in studies to increase the probability of developing side effects (Clinical Biochemist Reviews, “The Influence of Cytochrome P450 Pharmacogenetics on Disposition of Common Antidepressant and Antipsychotic Medications,” Feb 2006).
    Identifying these alleles can aid clinicians in prescribing antihypertensives and could reduce the risk of developing adverse reactions. MD Labs provides a genetic testing service, Rxight®, which sequences a number of genes to establish how patients are likely to respond to hundreds of medications, including most antihypertensives.

    side effects of opioids

    Pharmacogenomic Data May Help Guide Opioid Pharmacotherapy in Patients with Cancer-related Pain

    By | Cancer Treatments, Other, Pain Medications, Pharmacogenomics, Provider | No Comments

    Opioids are the most potent analgesics and are used to treat severe pain, specifically pain associated with cancer – a significant factor in reducing quality of life and clinical outcomes in such patients as detailed in Cancer Control “Clinical Implications of Opioid Pharmacogenomics in Patients with Cancer” (October 2015).


    Inter-individual Differences in Genetically Modulated Opioid Response

    The study reviewed clinical studies involving the pharmacodynamics and pharmacokinetics of opioids. It examined the opioid agents morphine, codeine, tramadol, oxycodone, fentanyl, and hydrocodone and the relationship to single nucleotide polymorphisms (SNPs): OPRM1, COMT (specifically COMT Val Met), CYP2D6, CYP3A4/5, and ABCB1, which the study claimed are responsible for the inter-individual differences in opioid response.

    The authors specifically found that OPRM1, COMT Val Met, and ABCB1 are most strongly correlated with morphine response. One study combined OPRM1 and ABCB1 and found that patients with both of these genetic variants were the best responders as indicated in patients’ measures of pain intensity. In another study, patients with OPRM1 and COMT Val Met needed the lowest morphine dose compared to other genotypes. All three together demonstrated no difference in morphine dose requirements.


    CYP2D6 Variants Correlate with Drug Efficacy

    Similarly, the presence of CYP2D6 variants correlated positively with variations in codeine and tramadol efficacy. CYP2D6 is responsible in converting the analgesic properties of codeine and tramadol. In studies investigating codeine pharmacotherapy in cancer patients, analgesic differences and adverse effects were found for CYP2D6 poor, intermediate, and extensive metabolizers.

    The authors concluded CYP2D6 testing helps in finding which patients respond positively to codeine. Studies with tramadol focusing on non-cancer pain populations identified CYP2D6 poor metabolizers as having a decreased analgesic response compared to extensive metabolizers. However, the authors noted there has been no specific study relating to tramadol’s analgesic efficacy in cancer populations, arguing tramadol will likely have decreased clinical benefit in patients who are poor CYP2D6 metabolizers.


    Call for Preemptive Genotyping in Clinical Practice

    The authors assert that these findings “suggest genotyping patients for some of these genetic variants may help predict responses to pain treatments with good rates of sensitivity and specificity and with greater benefits for patients and decreased health care utilization.” Furthermore, the authors assert that utilizing pharmacogenomics data combined with a preemptive genotyping be a “key element” in guiding treatment decisions for cancer patients.

    Overview of the Dangers and Side Effects of Psychotropic Medications

    By | ADHD Medications, Antianxiety Medications, Antidepressants, Antipsychotics, Pharmacogenetic Testing, Precision Medicine, Psychiatric Medications | No Comments

    Get the Rxight® Genetic Test to Know Your Risks

    Psychiatric medications (often called “psychotropics”) are routinely used to treat a variety of psychiatric disorders – ranging from ADHD (attention deficit hyperactive disorder) and depression to bipolar disorder and anxiety to schizophrenia – Psychiatric medications are generally jused as an adjunct to psychotherapy.

    It is estimated that 17 percent (some 80 million people) in the United States are taking some form of psychiatric medication (Scientific American, “1 in 6 Americans Takes a Psychiatric Drug,”  Dec 13 2016) According to the article, an earlier government report, from 2011, found that just over 10% of adults are taking prescription drugs for “problems with emotions, nerves or mental health,” published in the journal JAMA Internal Medicine.

    While the potential benefits of psychotropic medications have been demonstrated in research and clinical practice for decades, patients are cautioned to remain vigilant of the many side effects of psychiatric medications.

    This article presents a detailed summary of the major types of mental health medications and their associated risks for side effects as reported by the U.S. Food and Drug Administration (FDA) and the National Institute of Mental Health (NIMH) and an overview of the benefits of the Rxight® genetic test for psychiatric medications in identifying your unique genetically determined risk for developing side effects or non-response to dozens of these psychiatric medications along with hundreds of other medications across 50 pharmacological classes.

    Antidepressant Side Effects

    What are antidepressants?
    Antidepressants are commonly used to treat depressive disorders. They also are used for other conditions, such as pain, anxiety and insomnia. Although antidepressants are not FDA-approved specifically to treat ADHD, they are sometimes used “off-label” for ADHD treatment.

    The most commonly prescribed types of antidepressants today are called . Examples of SSRIs include:

    Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs) .These are chemically similar to SSRIs and include and duloxetine (Cymbalta)  and venlafaxine (Effexor).

    Another antidepressant that is commonly used is bupropion – a third sub-class of antidepressant which acts differently than either SSRIs or SNRIs.  Bupropion is also used to treat seasonal affective disorder (SAD) and for smoking cessation treatment.

    SSRIs, SNRIs, and bupropion are commonly used today because they do not cause as many side effects as the older (“first generation”) classes of antidepressants, and moreover are effective in treating a broader range of depressive and anxiety disorders.

    Older antidepressant medications include tricyclic antidepressants, tetracyclic antidepressants, and monoamine oxidase inhibitors (MAOIs).  These are less commonly prescribed since the development of the newer generation antidepressants.
    What are the possible side effects of antidepressants?
    Some antidepressants may cause more side effects than others. The most common side effects listed by the FDA include:

    • Sexual problems (impotence or inability to orgasm)
    • Nausea and vomiting
    • Weight gain
    • Sleepiness or fatigue
    • Diarrhea

    In 2004, the FDA ordered a “black box” label – the most serious warning it issues – on all antidepressants to caution of psychiatric drugs’ increasing suicide risk in children and adolescents. In 2006, the FDA increased the age to include young adults up to age of 25. (FDA, Revision to Product Labeling, 2004)

    Call your doctor immediately if you have any of the following symptoms, especially if they are new, worsening, or worry you (U.S. Food and Drug Administration, 2011):

    • Suicidal thoughts or actions
    • New or worsening depression
    • New or worsening anxiety
    • Feeling restless or agitated or
    • Panic attacks
    • Insomnia
    • New or worsening irritability
    • Acting aggressively, being angry, or violent
    • Acting on dangerous impulses
    • An increase in activity and talking (mania)

    Additionally, drug interactions can occur.  Specifically, combining the newer SSRI or SNRI antidepressants with one of the commonly-used “triptan” medications for treating migraines can cause a life-threatening condition called “serotonin syndrome.” Serotonin syndrome is marked by agitation, hallucinations, high temperature, or unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well.

    Antidepressants may cause other side effects that were not included in this list, as determined by individual genetics and ability to metabolize the drug in the liver.

    How do patients respond to antidepressants?
    Some people respond better to some antidepressant medications than to others.  It is critical to know that some people may not feel better with the first medicine they try. Additionally, sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return.

    These inter-individual differences are based in genetics, and the Rxight® genetic test will indicate which antidepressants may not work for you right from the start instead of having to go through trial and error with your doctor  With Rxight results, you your doctor can work together to find the best and most effective antidepressant treatment tailored to your unique genetics.


    Antipsychotic Side Effects

    What are antipsychotics?
    Antipsychotic medicines are primarily used to manage psychosis, a condition that affects the mind. Psychosis is characterized by some loss of contact with reality, often including or hallucinations (hearing or seeing things that are not really there), or delusions (false, fixed beliefs). It can also be a symptom of a physical condition such as drug abuse or a mental disorder such as schizophrenia, very severe depression (also known as “psychotic depression”), or bipolar disorder.

    Antipsychotic medications are frequently used in combination with other drugs to treat delirium, dementia, and mental health conditions, including:

    The older antipsychotic medications are conventionally referred to as “typical” antipsychotics or “neuroleptics”. Some of the common typical antipsychotics include:

    Second generation antipsychotic medications are also called “atypical” antipsychotics. Some of the most common atypical antipsychotics are:

    According to a 2013 research review by the Agency for Healthcare Research and Quality , typical and atypical antipsychotics both work to treat of bipolar disorder (preventing mania) and symptoms of schizophrenia Additionally, some atypical antipsychotics have wider applications and are used for treating bipolar depression or general depression.

    What are the possible side effects of antipsychotics?

    Antipsychotics are known to have a large number of side effects (also called adverse events) and risks, including potentially fatal complications.

    The FDA lists the following side effects of antipsychotic medicines:

    • Constipation
    • Nausea
    • Vomiting
    • Uncontrollable movements, such as tics and tremors (the risk is higher with typical antipsychotic medicines)
    • Seizures Drowsiness
    • Blurred vision
    • Low blood pressure
    • Dizziness
    • Restlessness
    • Weight gain (the risk is higher with some atypical antipsychotic medicines)
    • Dry mouth
    • A low number of white blood cells, which fight infections

    Typical antipsychotic medications can also cause additional side effects related to physical movement, such as:

    • Tremors
    • Restlessness
    • Rigidity
    • Muscle spasms

    Long-term use of antipsychotic medications may lead to a condition called tardive dyskinesia (TD). Tardive dyskinesia causes uncontrolled muscle movements, commonly around the mouth. TD can range from mild to very severe, and in some people, the problem cannot be cured and becomes disfiguring.

    Avoid the Risk of Antipsychotic Side Effects with Rxight®

    The Rxight® medication panel includes 18 popular antipsychotics on the market. Because the potential side effects of both typical and atypical antipsychotics can be very serious and potentially fatal, knowing your risks ahead of time with Rxight® can be an invaluable test for you and your prescriber.


    Mood Stabilizer Side Effects

    What are mood stabilizers?
    Mood stabilizers work by decreasing abnormal brain activity. They are used mainly to treat bipolar disorder and the mood swings associated with other mental conditions including:

    • Depression (usually in conjunction with an antidepressant)
    • Disorders of impulse control
    • Schizoaffective Disorder

    Anticonvulsant (anti-seizure) medications are most frequently used as mood stabilizers. They were originally developed for treatment of seizures, but they were found to help control mood swings as well. One anticonvulsant commonly used as a mood stabilizer especially in patients with symptoms of both mania and depression, or those with rapid-cycling bipolar disorder, is valproic acid (sold as Depakote). Anticonvulsants used as mood stabilizers include:

    Lithium is a non-anticonvulsant mood stabilizer approved for the treatment of mania and the maintenance treatment of bipolar disorder.

    What are the potential side effects of mood stabilizers?

    Mood stabilizers can cause several side effects, some of which may be serious, especially at high dosages. These side effects include:

    • Potentially fatal rash (Stevens-Johnson Syndrome)
    • Itching
    • Extreme thirst
    • Tremor
    • Nausea and vomiting
    • Fast, slow, or irregular heartbeat
    • Slurred speech
    • Blackouts
    • Changes in vision
    • Hallucinations
    • Loss of coordination
    • Swelling

    Mood stabilizers may cause other side effects that are not included in this list. Your unique reaction to anticonvulsants is based in genetics, and the Rxight® genetic test will indicate which mood stabilizer not work for you may right from the start instead of having to go through trial and error with your doctor – a process which can be expensive, lengthy and dangerous.  With Rxight® results, you your doctor can work together to find the best and most effective antidepressant treatment tailored to your genotype, preferably before treatment begins.


    Anti-Anxiety Medication Side Effects

    What are anti-anxiety medications?
    Anti-anxiety medications (also called “anxiolytics”) work by reducing the symptoms of anxiety, such as that seen in panic attacks, or extreme worry and fear. The most commonly prescribed anti-anxiety medications are called “benzodiazepines.” Benzodiazepines are most frequently used to treat a condition called generalized anxiety disorder, while in cases of social phobia (social anxiety disorder) or panic disorder (panic attacks). Benzodiazepines are usually second-line treatments, behind antidepressants such as SSRIS.

    Benzodiazepines used to treat anxiety disorders – all of which are tested in the Rxight® panel – include:

    Short-acting benzodiazepines such as Lorazepam and another class of medication known as beta-blockers are used to treat non-persistent symptoms of anxiety. Beta-blockers are used primarily to manage physical symptoms of anxiety (e.g., shaking, rapid heartrate, and sweating).

    Buspirone  (which is chemically unrelated to the benzodiazepine family) is sometimes indicated for the long-term treatment of chronic anxiety. It is not effective to use on an “as-needed” basis like the benzodiazepines.

    How common is addiction to benzodiazepines?
    One of the serious risks of anti-anxiety medications is that you can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need increasingly higher doses to get the same effect. There is a serious risk of addiction and dependence. To avoid these problems, doctors usually prescribe benzodiazepines for short periods, particularly in the elderly (NIMH, “Despite Risks, Benzodiazepine Use Highest in Older People”), and people with addiction tendencies. If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms or their anxiety may return.

    What are the possible side effects of anti-anxiety medications?
    Like other medications, anti-anxiety medications may cause side effects, many of which are serious. The most common side effects of benzodiazepines are sleepiness and dizziness. Other possible side effects include:

    • Headache
    • Confusion
    • Tiredness
    • Nausea
    • Blurred vision
    • Nightmares

    Tell your doctor immediately if any of these symptoms are severe or do not go away:

    • Drowsiness
    • Difficulty thinking or remembering
    • Increased saliva
    • Dizziness
    • Unsteadiness
    • Problems with coordination
    • Blurred vision

    If you experience any of the symptoms below, call your doctor immediately:

    • Swelling of the eyes, face, lips, tongue, or throat
    • Difficulty breathing or swallowing
    • Rash
    • Hives
    • Hoarseness
    • Seizures
    • Yellowing of the skin or eyes (jaundice)
    • Depression
    • Difficulty speaking
    • Difficulty breathing

    Common side effects of beta-blockers include:

    • Fatigue
    • Dizziness
    • Weakness
    • Cold hands


    Stimulant Side Effects

    What are Stimulants?
    Stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. Stimulant medications are generally prescribed to treat individuals diagnosed with ADHD (attention-deficit hyperactivity disorder). People with ADHD who take prescription stimulants describe a calming and “focusing” effect from the medication.  This is due to its effects on the brain chemical dopamine.

    Stimulants used to treat ADHD – all of which are analyzed in the Rxight® DNA test – include:

    In 2002, the FDA approved non-stimulant medication atomoxetine (Strattera) for use as a treatment for ADHD. Additional non-stimulant antihypertensive medications, clonidine  and guanfacine, are also approved for treatment of ADHD.

    In addition to treating ADHD, stimulants are prescribed to treat other health conditions, including narcolepsy, and occasionally depression.

    What are the possible side effects of stimulants?
    Stimulants may cause side effects, most of which are relatively minor and disappear when dosage levels are lowered. The most common side effects include:

    • Loss of appetite
    • Insomnia
    • Stomach pain
    • Headache

    Less common side effects include:

    • Motor tics or verbal tics
    • Personality changes

    What are serious side effects of stimulant medications?
    While side effects of stimulant medications tend to be minimal, patients and parents of patients are cautioned that serious adverse effects may occur, as reported by the FDA Drug Safety Communication in 2013. Also see
    FDA Warns of Psychiatric Adverse Events from ADHD Medications

    Heart-related problems:

    • Sudden death in patients who have heart problems or heart defects
    • Stroke
    • Myocardial infarction (heart attack)
    • Increased blood pressure and heart rate

    Mental (Psychiatric) problems:

    • Behavior and thought problems
    • New or worse aggressive behavior or hostility
    • New or worse bipolar illness
    • New psychotic symptoms (or new manic symptoms)
    • Physical or psychological dependence

    For additional details on the FDA warnings and manufacturer labeling for medications covered in the Rxight® panel, please refer to our list of medications covered.


    About Rxight® Pharmacogenetic Testing

    The Rxight® genetic test analyzes your risks based on your unique genetic makeup through a process called “SNP genotyping.” The report which will be shared with you in a personal consultation with a pharmacist. The report “red-flags” medications which may cause you to have issues, or conversely highlight medications which may not be effective for you.

    Rxight® is based on pharmacogenetics — the study of how genes affect a person’s response to medicines. Our panel of over 200 clinically significant medications includes dozens of commonly prescribed psychiatric medications, including antidepressants across five sub-classes, mood stabilizers used in bipolar disorder and schizoaffective disorder, antipsychotics, ADHD medications (stimulant and non-stimulant), and anti-anxiety medications.

    Based on how well you metabolize those particular medications, which is determined by your genes that encode liver enzymes that break down drugs, you will be at risk for developing side effects or the medication not working well or at all. With the results of the Rxight® test you and your prescriber can find the right medication for you, preferably before treatment begins.

    Contact us today by phone 1 (888) 888-1932 or email to learn more about how Rxight® pharmacogenetic testing can help you find the right medication, right from the start.

    Glipizide (Glucotrol) Uses and Side Effects

    By | Diabetes, Sulfonylureas | No Comments

    Glipizide is an antidiabetic drug of the chemical sulfonylurea class.  It is an oral and short acting drug that is classified as a second generation sulfonylurea.  It is marketed by Pfizer under the name Glucotrol in the United States. 

    How Does Glipizide Work?

    Like other sulfonylurea antidiabetic medicines, glipizide induces insulin release from pancreatic beta cells, but only when there is some beta-cell activity remaining in the pancreas.  This helps control blood sugar to maintain it at normal levels.  Glipizide is used with diet and exercise to have a healthy lifestyle with your type II diabetes diagnosis.  Some patients cannot take glipizide: If you have blockage in your intestines, kidney or liver disease, or a history of heart disease.  Tell your doctor if you have a glucose-6-phosphate deficiency (G6PD), a disorder of the pituitary or adrenal glands.

    Warnings and Side Effects

    Some oral diabetes drugs can increase your risk of serious heart issues.  Not taking your diabetes drugs have damage your heart and other organs, so you should talk to your physician about your risks. Other side effects of the sulfonylurea class of diabetes drugs include: low blood sugar symptoms such as dizziness, confusion, sweating, nervousness, weight gain, upset stomach, hunger, skin reactions, and dark urine.

    How Do Genetics Determine Drug Metabolism?

    Since the human genome was completed, many genome wide association studies have revealed that there are variations in the many genes that are responsible for processing drugs. processing in your body is also called drug metabolism.  Genes provide ‘instructions’ for the production of the actual enzymes responsible for drug metabolism.  Thus, variations in the genes transfer to the enzyme, which will have variations from the genetic instructions.  Variations in the enzyme may mean that the drug metabolism function is altered.  That could mean that the enzyme responsible for metabolizing several or a number of drugs isn’t working properly, resulting in side effects. 

    Genetic Testing with Rxight®

    One important way to know beforehand if you have any drug metabolism variations is to get the Rxight® pharmacogenetics test from MD Labs.  With one simple cheek swab, you and your physician can have at hand the results of this state-of-the-art platform that reveals your genetic disposition to any of the 200 drugs and over-the-counter products on the market.


    To avoid side effects or medication inefficacy, ask your physician to prescribe the Rxight® pharmacogenetics test from MD Labs.  All that is required is a participating pharmacy and your physician’s prescription.  It also brings precision medicine to you and your physician, utilizing more individualized medical care. 

    Drug Sensitivity and Your Genetics

    By | Adverse Drug Reactions, Drug Metabolism | No Comments

    Drug sensitivity is broadly defined as an exaggerated response to a drug in a patient in comparison to the expected response in the general population. Drug sensitivity can range from increased side effects to complete drug intolerance, whereby patients exhibit severe side effects or death. These side effects are often irreversible, as in aspirin induced Tinnitus.


    Why Do Some People Suffer from Drug Sensitivity?

    Drug sensitivity should not be confused with drug hypersensitivity. Drug hypersensitivities are caused by a patient’s body mounting an immune response to a drug. These can also be severe, but are different to drug sensitivities. Drug sensitivity results solely from genetic differences in a patient. How can your genetics impact drug metabolism and action? Through polymorphisms of genes coding for enzymes or receptors that directly affect how the body responds to the drug.
    For instance, an article in Pharmacogenetics and Genomics “VKORC1 Pharmacogenomics Summary” (Oct 2011) states that polymorphisms in the gene VKORC1, which codes for the enzyme Vitamin K epoxide reductase, regulates a patient’s sensitivity to the common anti-coagulant drug Warfarin. The enzyme is the limiting step in the vitamin K cycle and Warfarin acts to inhibit this enzyme, inhibiting Vitamin K’s downstream coagulation effects. Variants 1639A and 1173T require a lower Warfarin dose whereas patients with allele 9041A need a higher dose.

    Drug Intolerance and Severe Side Effects 

    Drug intolerance can cause severe side effects in a patient. These are usually rare but in some instances are reasonably common. For instance, Tinnitus is a drug intolerant side effect to the drug Aspirin. At higher doses, aspirin is nown to cause tinnitus according to a study Frontiers in Systems Neuroscience “Salicylate toxicity model of tinnitus” (April 2012), but some patients experience the symptom after a normal dose of the drug.
    Other examples of drug intolerance include liver failure to Paracetamol, fatal poisoning in infants who breastfeed on mothers who are taking the pain relief drug codeine, hypotension (low blood pressure) in patients taking heart drug Enalapril and hallucinations in patients taking codeine, according to research in Australian Family Physician, “Adverse drug reactions” (Feb 2013).
    The number of genes that might cause drug sensitivity is massive and many are still not known. At Rxight® we sequence VKORC1 and a panel of other genes to identify how patients will react to more than 200 clinically relevant medications. Genetic testing for drug sensitivity is a faster, cheaper and far safer alternative than watching patients undergo adverse drug reactions and adjusting the dose accordingly.

    Drug Metabolism Testing with Rxight®

    By | Drug Metabolism | No Comments


    Both clinicians and patients know that drugs can cause side effects. However, not all patients experience side effects. Variability in drug response is due to many factors including age, weight, number of medications taken and overall health. Genetic variation is also a reason that a patient may experience an adverse reaction to a drug. Pharmacogenetics studies the way that variations in a patient’s genetic makeup affect the metabolism of drugs. Rxight® genetic testing examines specific genes associated with drug metabolism to determine whether an individual’s inherited characteristics may cause side effects, toxicity or result in no therapeutic value.


    Drug Metabolism and Adverse Reactions


    To avoid adverse reactions, doctors often use a trial and error method to find appropriate medications for patients. Pharmacogenetic testing provides important information about which medicines may cause unpleasant side effects. Testing also helps clinicians find doses of medications that are appropriate for a patient’s genetic characteristics.


    Genetic variants affect the rate of assimilation of a drug by the body. Poor metabolism of a drug can cause adverse effects because the drug stays in the body too long. Ultra-rapid metabolism may result in no benefit from the drug because it is eliminated too quickly.


    The cytochrome P450 enzymes are responsible for approximately 70 percent of drug metabolism. Of the approximately 60 cytochrome P450 genes, six are known to affect drug metabolism and drug-drug interactions. The most significant are CYP2C19, CYP2C9 and CYP2D6.


    CYP2D6 is responsible for the metabolism of approximately 25 percent of prescription medications. Drugs metabolized by this gene include many antidepressants, beta-blockers, opioids and anti-cancer medicines. Codeine, a pro-drug, is inactive until it is converted by gene CYP2D6 to morphine. Poor metabolizers of codeine do not get any pain relief. Ultra-rapid metabolizers of codeine convert the drug into morphine too rapidly, which may result in side effects or toxicity. The Food and Drug Administration recommends that codeine not be prescribed to nursing mothers who are ultra-rapid metabolizers of CYP2D6 because large amounts of morphine passed through breastmilk can result in infant respiratory failure or death.


    Approximately 30 variants have been identified for gene CYP2C19. This gene is responsible for the metabolism of clopidogrel, a commonly prescribed antiplatelet medication used by patients with heart disease. Extensive and poor metabolizers have a higher incidence of adverse reactions to this drug. The FDA recommends use of another medication for patients with genetic variants that affect the metabolism of this drug.


    Rxight® Pharmacogenetic Testing

    Rxight® pharmacogenetic testing examines 18 genes that have known associations with drug metabolism, including the six major cytochrome P450 enzymes. A sample of a patient’s DNA is taken by a certified pharmacist and sent to MD Labs for analysis. A detailed report, included in the cost, is provided to each patient and interpreted by the pharmacist. Rxight® certified pharmacists consult with clinicians to ensure that the prescribed medication therapy regimen is best suited for the patient’s genetic characteristics. Doctors can select medicines and doses that may result in fewer side effects and provide better therapeutic value. Patients are more likely to take their medicine when they know that the potential for side effects is reduced. Better adherence to a drug therapy program helps maintain health.

    CMS Episode Payment Model to Bolster Hospital Cardiovascular Services

    By | CMS Cardiac Bundle | No Comments

    MD Labs Offers Turnkey PGx Program for Cath Lab Implementation


    Heart disease kills 1 in 4 men and women in the United States each year, according to the National Institute of Heart, Lung, and Blood Institute (NHLBI). Additionally, coronary heart disease (CHD) is the number one killer for women. (NHLBI) (National Heart, Lung, and Blood Institute, “What Causes Heart Disease,” April 2014).


    Risk factors, such as traits, conditions, and habits raise the risk for coronary heart disease and heart attacks in female patients. More than 75 percent of women from ages 40 to 60 have one or several risk factors for CHD.  Despite this, heart diseases can affect women all of ages with symptoms starting as early in childhood (NHLBI).


    2017 CMS Payment Updates & Potential Savings

    Under the Centers for Medicare and Medicaid Services (CMS) FY2017 hospital inpatient final rule as reported in Cath Lab Digest (Cath Lab Digest, “The FY 2017 Financial Future: How the Cath Lab Impacts the Hospital Bottom Line,” October 2016), all cardiovascular (CV) services will receive increases for inpatient payments with hospitals gaining more in reimbursements.  Adjustments will decrease based on evidence of financial productivity, documentation, coding, and adjustments under the Accountable Care Act. There will only be an increase in two-midnight policy adjustments.


    There is mounting evidence on the cost saving opportunities to hospitals utilizing Pharmacogenetic (PGx) testing for pharmacotherapy following cardiovascular services. In concert with an interventional cardiologist, MD Labs has developed a PGx protocol for Catheter Labs that hospitals are in the process of adopting across the U.S.


    CMS Inpatient and Outpatient Payments will Affect Hospital Budgets in 2017


    The CMS proposed the “cardiac bundle” Episode Payment Model (EPM), directly impacting cardiovascular services. CMS recognizes the role that cardiac rehab plays in the 90-day post-discharge continuum of care, and is encouraging hospitals by providing additional payment: $25 per session for the first 11 sessions and $175 per session for each additional session, up to a total of 36 sessions.


    This EPM will follow the Comprehensive Joint Replacement (CJR) model and will include Coronary Artery Bypass Graft (CABGs) and the Acute Myocardial Infarction (AMI) services. AMIs is one of the highest reasons for patient readmission.

    This proposal will also introduce payment models that calculate the costs for Medicare inpatients plus 90 days post discharge for 98 randomly selected Metropolitan Service Areas (MSAs).


    Since close to 50% of Cath lab procedures are paid as outpatients, CMS recommends that payments for this population must also be seriously considered. “CMS continues to aggressively shift outpatient payments to a true prospective payment system,” according to the Cath Lab Digest article.


    EPM  Model Incentives Care


    The EPM proposal will begin July 2017 and continue on a calendar year basis until 2021, called a Performance Year. Throughout the EPM, hospitals, providers, and suppliers will continue to bill and still collect in the fee-for-service payment systems.  After a performance year, all claims data for an episode are put together for an actual episode payment. Then, the actual episode payment will be adjusted compared with a quality adjusted target price.


    Target prices will be created with a hospital and regional historical data. If the actual payment is less than the target price, the hospital will profit which is called the reconciliation payment. If the actual payment is more than the target price, CMS will receive reimbursement from the hospital.


    With the proposed EPM model, the efficiency and quality of cardiovascular services is expected to improve and PGx testing will play a crucial role in determining appropriate pharmacotherapy, as bolstered by research such as  Expert Opinion on Drug Metabolism & Toxicology The pharmacogenetic control of antiplatelet response: candidate genes and CYP2C19 (July 2015) which surveyed clinical outcomes of using pharmacogenetics to guide antiplatelet therapy used for preventing ischemic events in patients with acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) and other indications. The pharmacogenetics of available antiplatelet agents – Aspirin, Clopidogrel, Prasugrel and Ticagrelor – were analyzed.



    Cath Lab DigestThe FY 2017 Financial Future: How the Cath Lab Impacts the Hospital Bottom Line” (October 2016).

    National Heart, Lung, and Blood Institute “What Causes Heart Disease” (April 2014).

    National Heart, Lung, and Blood Institute “Who Is at Risk for Heart Disease” (April 2014).

    MayoClinic “Heart Disease in Women: Understand Symptoms and Risk Factors” (June 2016)

    Co-Occuring Autism and Depression: A Clinical Challenge

    By | Antidepressants, Antipsychotics | No Comments

    Is depression more common in patients with autism spectrum disorder (ASD) than in the general population? Yes, according to research on the co-morbidity of mood disorders and ASD – which according to the CDC affects an estimated 1 in 45 children in the U.S.
    An article published in Dialogues in Clinical Neuroscience, “Challenges in the diagnosis and treatment of depression in autism spectrum disorders across the lifespan” (2015), found that some research points to rates of depression as high as 57 percent in ASD patients. One study of adult patients found the rate of suicide of ASD adults was almost 2 percent, compared to less than.5 percent of adults without autism.

    Clinicians Face Difficulties Differentiating between Depression and ASD

    It can be difficult to differentiate between symptoms of autism and those of depression. In fact, diagnosing depression in those with autism represents a clinical challenge that dates back to Leo Kanner’s original description of the condition in his 1943 paper where he identified that individuals with autism spectrum disorders show little facial emotion – called a “flat affect.” However, in autism, affect doesn’t necessarily correspond to the individuals’ mood, which is an internal state not always congruent with emotion.
    Another challenge that clinicians face in diagnosing depression in patients with autism is the overlap in symptoms. Those of depression typically include a flat facial expression as with autism, reduced appetite, sleep disturbance, low energy, reduced motivation, social withdrawal and reduced desire to communicate with others. Many of these same symptoms can stem from autism rather than depression.

    Find the Right Medications with Rxight® Pharmacogenetic Testing

    Two drugs for treating the irritability and aggression that is commonly associated with the autism – risperidone (Risperdal) and aripiprazole (Abilify) – have been approved by the Food and Drug Administration. Additionally, so-called “off-label” medications include naltrexone, which is FDA-approved for the treatment of alcohol and opioid addictions. It can ease disabling repetitive and self-injurious behaviors. (Autism Speaks, “Medicines for Treating Autism’s Core Symptoms”).
    MD Labs’ CLIA-certified Rxight® genetic testing panel – which among the most comprehensive available – includes risperidone and aripiprazole, along with 26 antidepressant medications across clinically significant antidepressant classes. Over 200 other medication are also covered in the Rxight® panel.

    Your Insurance May Cover Testing with Rxight®

    Many insurance companies now cover tetrabenazine (Xenazine), nortriptyline (branded as Pamelor and Aventyl Hydrochloride) and amitriptyline (branded as Elavil, Endep and Vanatrip), antidepressants within the Rxight® panel.
    If you or a loved one suffers from depression and has been diagnosed with ASD as well, ask your doctor about authorizing the Rxight® Pharmacogenetic Test. Genetic testing with Rxight® enables you and your prescribers to know – preferably ahead of time – which medications may causes potentially dangerous adverse reactions and conversely which may be ineffective.
    To get started, we invite you to email us today or call 1-888-888-1932 to discover how you may benefit from our pharmacogenetic testing program.

    Pharmacogenetic Testing Could Help Reduce Side Effects Caused by Commonly Prescribed Diabetes Medication

    By | Antidepressants, Diabetes | No Comments

    Diabetes is a serious public health issue, and is projected to be the seventh leading cause of death worldwide by 2030. In the sub-Saharan African region, it is estimated that nearly 1 in 10 people suffer from diabetes, according to the World Health Organization Global Report on Diabetes (WHO, 2016). In the United States, we see similar statistics. The CDC reported in 2014 that nearly 1 in every 11 people in the U.S. are diagnosed with diabetes, accounting for nearly 29.1 million people (Centers for Disease Control and Prevention, 2014 National Diabetes Statistics Report).

    Complications can arise in those with diabetes and therefore, proper medication therapy is crucial.
    Diabetic Peripheral Neuropathy (DPN) is the most common complication of diabetes and occurs in up to half of diabetic patients, according to a recent study in Pharmacogenomics (Chaudhry et al., April 2017).

    The most common symptoms of diabetic neuropathy are increased pain sensitivity, numbness and spontaneous pain in the limbs. Patients frequently describe the pain as burning and shooting.

    Amitriptyline: The Drug of Choice for DPN in Developing Countries

    Since there are currently no treatments available to completely restore nerve function, drug therapy is often aimed at managing the pain. Antidepressants in particular, specifically amitriptyline, are often used to treat DPN.

    This Pharmacogenomics study investigated the use of amitriptyline for DPN in a South African population. Amitriptyline is used to treat the DPN pain due to its numbing effect on the nerves. It is regarded as the drug of choice to for painful peripheral neuropathy in this population given its cost effectiveness.

    Genetics Influence How You’ll React to Medications

    Common side effects of amitriptyline include blurred vision, drowsiness, constipation, urinary retention and dryness of mouth/eyes. More serious side effects include build-up of metabolic toxins in the heart or the nervous system.

    Genetics play a major role in how the body metabolizes medications. Amitriptyline is mainly metabolized in the liver and cleared by the kidneys. How one’s body metabolizes this medication in encoded by two specific genes and one of these genes is responsible for adverse drug reactions (ADRs).

    In the case of amitriptyline, patients who are “slow metabolizers” will experience adverse reactions. Patients who are “fast metabolizers” do not experience these adverse reactions. However, since these fast metabolizers clear the drug from their bodies so quickly, they are at risk for not benefiting from treatment.

    Study Calls for Pharmacogenetic Screening in Amitriptyline Therapy

    The study concluded that pharmacogenetic testing might be useful for tailoring treatment and thereby improving amitriptyline effectiveness. Chaudhry et al. noted that if a patient is a non-responder to amitriptyline, or experiences severe side effects, pre-emptive genetic screening can be performed so an alternative medication may be considered, or the dose adjusted appropriately.

    “Our findings…support the use of pharmacogenetic testing in the context of amitriptyline therapy for the management of diabetic pain,” the authors stated, adding that PGx testing can be “valuable to guide drug choice and dosage and thereby improve treatment outcomes in patients with DPN.”