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Pharmacogenomic study—A pilot study of the effect of pharmacogenomic phenotypes on the adequate dosing of verapamil for migraine prevention

The Pharmacogenomics Journal volume 24, Article number: 11 (2024) Cite this article

Subjects

Abstract

Objective

To investigate factors affecting the efficacy and tolerability of verapamil for migraine prevention using individual pharmacogenomic phenotypes.

Background

Verapamil has a wide range of dosing in headache disorders without reliable tools to predict the optimal doses for an individual.

Methods

This is a retrospective chart review examining adults with existing pharmacogenomic reports at Mayo Clinic who had used verapamil for migraine. Effects of six cytochrome P450 phenotypes on the doses of verapamil for migraine prevention were assessed.

Results

Our final analysis included 33 migraine patients (82% with aura). The mean minimum effective and maximum tolerable doses of verapamil were 178.2(20-320) mg and 227.9(20-480) mg. A variety of CYP2C9, CYP2D6, and CYP3A5 phenotypes were found, without significant association with the verapamil doses after adjusting for age, sex, body mass index, and smoking status.

Conclusions

We demonstrated a wide range of effective and tolerable verapamil doses used for migraine in a cohort with various pharmacogenomic phenotypes.

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Fig. 1: Study subjects identifying process.
Fig. 2: The overall distribution of verapamil dose used in this dataset.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

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Author information

Authors and Affiliations

  1. Department of Pharmacy, Mayo Clinic, Rochester, MN, USA

    Yi-Chieh Chen

  2. Department of Neurology, Mayo Clinic Health System, Mankato, MN, USA

    Han Wang

  3. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Jayawant N. Mandrekar, Carrie E. Robertson, Fred M. Cutrer & Chia-Chun Chiang

  4. Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA

    Amaal J. Starling

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Contributions

Y-CC was responsible for designing the review protocol, screening the patients to identify the final cohort, conducting the chart review, extracting the data, and writing the manuscript. HW and JNM performed the data analysis. CER, AJS and FMC reviewed and provided feedback on the manuscript. CCC was responsible for designing the review protocol, assisting the chart review, and writing the manuscript.

Corresponding author

Correspondence to Yi-Chieh Chen.

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Competing interests

Dr. Robertson has served on advisory boards for Impel, Linpharma, Satsuma, Biohaven, Eli Lilly, and Lundbeck. She has received research funding from Teva, Pfizer, and Lundbeck. She receives compensation as an author and associate editor of UpToDate. Dr. Starling has received consulting fees from Allergan, Amgen, Axsome Therapeutics, Eli Lilly & Company, Everyday Health, Impel, Lundbeck, Med-IQ, Medscape, Neurolief, Novartis, Satsuma, Teva, and Theranica. Dr. Chiang serves on the advisory board for Satsuma and eNeura. Other authors declare no competing financial interests. This paper did not receive any funding.

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Chen, YC., Wang, H., Mandrekar, J.N. et al. Pharmacogenomic study—A pilot study of the effect of pharmacogenomic phenotypes on the adequate dosing of verapamil for migraine prevention. Pharmacogenomics J 24, 11 (2024). https://doi.org/10.1038/s41397-024-00331-4

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  • DOI: https://doi.org/10.1038/s41397-024-00331-4

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