For CYP2D6 there are more than 50 different alleles. By targeting the 3 most common gene variants (*3, *4, *5), 95% of poor metabolisers can be identified in the Caucasian population.
Until genotyping becomes routinely available, however, 2D6 phenotyping may be helpful in other situations by measuring the ratio of parent compound to metabolite eg for perhexilene (measured by HPLC).
In the future, population-based pharmacogenetic testing will allow more individualized drug treatment and avoid current empiricism. Indeed, it appears that it may already be culpable not to do so.
Chris Florkowski
Christchurch, NZ
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