A New Guideline for Safer Emergency Prescribing
The Clinical Pharmacogenetics Implementation Consortium (CPIC) has released a crucial 2025 update to its guideline for thiopurine dosing. These drugs, including azathioprine, are used in acute and chronic inflammatory conditions. The guideline provides specific recommendations for adjusting starting doses based on genetic testing for two key enzymes, TPMT and NUDT15. Individuals with genetic variants that reduce or eliminate the function of these enzymes are at a significantly higher risk of severe, life-threatening myelosuppression when given standard doses. This updated protocol is vital for personalizing emergency and acute care to prevent iatrogenic harm.
Why it might matter to you: In the fast-paced emergency department, where azathioprine may be initiated for conditions like severe autoimmune flares, this guideline underscores the growing importance of pre-emptive or rapid pharmacogenetic testing. It directly impacts overdose management and toxicology protocols by providing a clear, evidence-based framework to avoid a common and dangerous adverse drug reaction. Integrating this knowledge can refine rapid sequence induction and acute care plans for vulnerable patients, moving towards precision medicine in time-sensitive scenarios.
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