Genetic factors contribute to the high inter-individual variability in response to anti-epileptic drugs.
Many medications, including the majority of anti-epileptic medications, are metabolized by two enzymes in the liver: CYP2C9 and CYP2C19.
Other metabolic pathways include CYP3A4, CYP3A5, HLA-B*15:02, HLA-A*31:01 and UGT1A1.
Your genes are the main factor determining the level of these enzymes found primarily in your liver — if you have too much of the enzyme, you process the medication too quickly, too little of the enzyme and the medication builds up in your bloodstream potentially causing adverse reactions or side effects.
Without knowing your genetics, your physician may need to go through months of trial-and-error prescribing.
Population Frequency of Cytochrome P450 (CYP) Metabolizer Types [5]
| Poor (no or low enzyme levels) |
Intermediate (reduced enzyme levels) |
Normal (normal enzyme levels) |
|
|---|---|---|---|
| CYP2C9 | 3% | 30% | 68% |
| CYP2C19* | 3%-21% | 24-36% | 79-97% |
*CYP2C19 variability depends on ethnicity.
Some epilepsy medications that are impacted by your genetics: [12]
| Trade Name | DRUG |
|---|---|
| Briviact® | brivaracetam |
| Cerebyx® | fosphenytoin |
| Depakote | valproic acid |
| Dilantin® | phenytoin |
| Tegretol® | carbamazepine |
| Trileptal® | oxcarbazepine |
| Vimpat® | lacosamide |