There are multiple reasons for SSRI intolerance – you can find more details here.Below we provide an overview of some alternative medications that can be used for treatment of anxiety and the role of pharmacogenetic variations that impact on tolerability and response.Pregabalin (Lyrica) is an antiepileptic medication that commonly prescribed for anxiety in Europe and South America where it is approved for GAD, but in Canada and US it is approved for treatment of neuropathic pain in patients with diabetic peripheral neuropathy and postherpetic neuralgia.Pregabalin is more sedating than SSRIs and might be beneficial for anxiety patients experiencing insomnia. D., MBA – FOUNDER, CSO & CTO Ruslan Dorfman is a trailblazer in personalized medicine, a molecular geneticist, and technology builder.Please direct all correspondence to: Gary Zammit, Ph D, Clinilabs, Inc, 423 W. 55th St, 4th Floor, New York, NY 10019; Tel: 212-994-4560; Fax: 212-523-1704; E-mail: [email protected]; Website: Nierenberg AA, Adler LA, Peselow E, Zornberg G, Rosenthal M.
Gabapentin and pregabalin are mostly eliminated renally (not through the liver) and are therefore unlikely to be influenced by pharmacogenetic variations. Systematic review and meta-analysis: Dose-response curve of SSRIs and SNRIs in anxiety disorders.
Clinical pharmacists can assist physicians to optimize medication management, particularly for patients with complex drug metabolic profiles who frequently present as “treatment resistant” or intolerant to SSRIs. Treatment-refractory anxiety; definition, risk factors, and treatment challenges. Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M; Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and Mc Gill University, Antony MM, Bouchard S, Brunet A, Flament M, Grigoriadis S, Mendlowitz S, O’Connor K, Rabheru K, Richter PM, Robichaud M, Walker JR.
Zammit is president and CEO of Clinilabs, director of the Sleep Disorders Institute, and clinical associate professor at the Columbia University College of Physicians and Surgeons in New York City. Zammit is a consultant to Boehringer-Ingelheim, sanofi-aventis, Sepracor, and Takeda; receives research support from Forest, Glaxo Smith Kline, Pfizer, sanofi-aventis, Sepracor, Takeda Pharmaceuticals North America, Transcept, and Wyeth; and receives honoraria from Takeda. Possible trazodone potentiation of fluoxetine: a case series.
Depending on ethnic background, 30-50% of people in North America have inherently altered CYP2D6 activity and may experience side effects when treated with duloxetine or venlafaxine.
Poor and Ultrarapid metabolizers should not be prescribed these medications due to the availability of other alternatives.
The activity of CYP3A4 can vary by a factor of 10-100 between individuals.