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.
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 |