Impact of Pharmacogenomics on Pediatric Psychotropic Medication Prescribing in an Ambulatory Care Setting.

Objective: Evidence for pharmacogenomic (PGx) guided treatment in child and adolescent psychiatry is growing. This study evaluated the impact of PGx testing on psychotropic medication prescribing in an ambulatory child and adolescent psychiatry and a developmental pediatrics clinic. Methods: This was a single-center, retrospective, descriptive analysis of patients who underwent PGx testing between January 2015 and October 2022 at a child and adolescent psychiatry clinic or developmental pediatrics clinic. The primary outcome was the proportion of patients with at least one psychotropic medication modification made 6-month posttesting that could be attributed to CYP2C19, CYP2D6, HLA-B*15:02, or HLA-A*31:01. Secondary outcomes included reason for testing, types of therapeutic modifications made, and whether the therapeutic modifications concorded with PGx guidelines. Results: A total of 193 patients were analyzed. The average age was 10 ± 4 years old, 60% were male, 78% were Caucasian. Sixty-eight percent had a primary diagnosis of a neurodevelopmental disorder, namely autism spectrum disorder (51%), and attention-deficit/hyperactivity disorder (14%). The reasons for PGx testing included medication inefficacy (34%), medication intolerance (20%), and family request (19%). At the time of PGx testing, 37% of patients were taking ≥1 psychotropic medication with PGx annotation. Overall, 35 PGx-related therapeutic modifications were made in 32 (17%) patients. These included continuing current PGx medication (6.2%) and starting PGx medication (5.2%). These modifications mainly involved antidepressants. Out of these 35 PGx-related therapeutic modifications, 94% were concordant with PGx guidelines. Among 29 patients who were prescribed at least one CYP2D6 inhibitor, 25 (86%) underwent CYP2D6 phenoconversion. Conclusions: It is critical to apply pediatric age-specific considerations when utilizing PGx testing in child and adolescent psychiatry. PGx testing stewardship could provide a framework to guide the clinical utility of PGx in a pediatric population with mental health conditions, including neurodevelopmental disorders.

Eosinophilic pustular folliculitis due to naltrexone: A case report.

BACKGROUND: The effectiveness of naltrexone in treating both alcohol and opioid use disorders is unique when compared with other agents used for substance use disorder (SUD). It is estimated that 2 million Americans suffer from opioid use disorder, and 14.5 million have alcohol use disorder, underscoring the need for medication-supported SUD treatment. The aims of this case report are 2-fold: (1) to underscore the importance of conducting a thorough medication history when considering a recent adverse drug reaction and(2) to report a novel cutaneous reaction to naltrexone oral tablet. CASE SUMMARY: A 20-year-old female with a medical history significant for bipolar disorder, obsessive compulsive disorder, major depression disorder, and polysubstance use disorder experienced a drug-induced cutaneous adverse reaction on 2 separate occasions, about 3 months apart. Drug-induced adverse reactions can lead to treatment modifications, resulting in differences in efficacy and undesirable adverse effects. The purpose of this case report is to introduce naltrexone-induced skin reactions and emphasize the importance of a careful medication history when determining which medication is related to an adverse reaction. PRACTICE IMPLICATIONS: Naltrexone will continue to be used to manage cravings related to SUD. This case brings awareness to severe cutaneous adverse reactions associated with enteral naltrexone. Monitoring upon initiation for any adverse effects should be part of a holistic treatment plan. In addition to conducting a complete and thorough medication history, adverse drug reactions can be correctly attributed to the offending agent and prevent future adverse reactions.