4 ms·

What drug has a 10 fold difference in Cmax, as a pharmacist I can’t think of anything even close to that.

by 303uru 3y ago

NicotineFiend 3y ago
Many tricyclic antidepressants metabolized by CYP2D6 would be here, if you put the nonmetabolizers up against the rapid metabolizer, https://en.wikipedia.org/wiki/Doxepin https://en.wikipedia.org/wiki/Doxepin for example.
klevertree 3y ago
Cyclosporine and tacrolimus, if you look at the range in any of their pk trials you'll easily see 10 fold variability.
opportune 3y ago
Warfarin is one of the most well known scientifically, but as a practitioner you may not know this because hospitals and insurers are scared to acknowledge the ongoing rate of preventable bad outcomes caused by not accounting for variances in metabolism. That is to say, if we were to actually start assessing patients’ ability to metabolize warfarin we’d have to confront the fact that a huge number of bad clinical outcomes in the recent past stemmed from not doing this.
- carbocation 3y ago
  > hospitals and insurers are scared to acknowledge the ongoing rate of preventable bad outcomes caused by not accounting for variances in metabolism. Healthcare systems are so aware of and open about warfarin's risks that they have warfarin clinics set up to repeatedly measure patients' prothrombin times so that they can adjust dosing empirically. Further, they also provide nutritional guidance to patients taking warfarin to help them reduce diet-influenced variance in warfarin metabolism.
  - deleted 3y ago
    [deleted]
scheme271 3y ago
What about codeine with ultra-rapid metabolizers (e.g. the significant population in Saudi Arabia), it might not be a 10x difference but normal dosages can result in overdose or death in people that are ultra-rapid metabolizers or even in their babies if they are nursing mothers.
ikiris 3y ago
you're a bit behind on your CE time. There are lots with that high of variability.

What drug has a 10 fold difference in Cmax, as a pharmacist I can’t think of anything even close to that.

by 303uru 3y ago

What drug has a 10 fold difference in Cmax, as a pharmacist I can’t think of anything even close to that.

Many tricyclic antidepressants metabolized by CYP2D6 would be here, if you put the nonmetabolizers up against the rapid metabolizer, https://en.wikipedia.org/wiki/Doxepin https://en.wikipedia.org/wiki/Doxepin for example.

klevertree 3y ago

Cyclosporine and tacrolimus, if you look at the range in any of their pk trials you'll easily see 10 fold variability.

opportune 3y ago

Warfarin is one of the most well known scientifically, but as a practitioner you may not know this because hospitals and insurers are scared to acknowledge the ongoing rate of preventable bad outcomes caused by not accounting for variances in metabolism. That is to say, if we were to actually start assessing patients’ ability to metabolize warfarin we’d have to confront the fact that a huge number of bad clinical outcomes in the recent past stemmed from not doing this.

carbocation 3y ago
> hospitals and insurers are scared to acknowledge the ongoing rate of preventable bad outcomes caused by not accounting for variances in metabolism. Healthcare systems are so aware of and open about warfarin's risks that they have warfarin clinics set up to repeatedly measure patients' prothrombin times so that they can adjust dosing empirically. Further, they also provide nutritional guidance to patients taking warfarin to help them reduce diet-influenced variance in warfarin metabolism.
- deleted 3y ago
  [deleted]

scheme271 3y ago

What about codeine with ultra-rapid metabolizers (e.g. the significant population in Saudi Arabia), it might not be a 10x difference but normal dosages can result in overdose or death in people that are ultra-rapid metabolizers or even in their babies if they are nursing mothers.

ikiris 3y ago

you're a bit behind on your CE time. There are lots with that high of variability.