{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:35:42Z","timestamp":1792805742582,"version":"4.5.0"},"reference-count":44,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T00:00:00Z","timestamp":1672963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Tabula Rasa HealthCare","id":[{"id":"https:\/\/ror.org\/03akc2z91","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Pharmacotherapy for major depressive disorder (MDD) typically consists of trial-and-error and clinician preference approaches, where patients often fail one or more antidepressants before finding an optimal regimen. Pharmacogenomics (PGx) can assist in prescribing appropriate antidepressants, thereby reducing the time to MDD remission and occurrence of adverse drug events. Since many antidepressants are metabolized by and\/or inhibit cytochrome P450 enzymes (e.g., CYP2C19 or CYP2D6), drug-induced phenoconversion is common in patients on antidepressant combinations. This condition influences the interpretation of a patient\u2019s PGx results, overall risk of ineffective\/adverse medication response due to multi-drug interactions, and the recommendations. This complex case describes a patient with MDD, generalized anxiety disorder, and chronic pain who experienced a fall due to excessive sedation following a prescribing cascade of fluoxetine, bupropion, and doxepin. These antidepressants delivered a significant additive sedative effect and interacted with the patient\u2019s hydrocodone, potentially contributing to uncontrolled pain, upward dose titration of hydrocodone, and a higher overall sedative burden. The PGx results and drug-induced phenoconversion described in this case report explain the patient\u2019s excessive sedation and possibly ineffective\/toxic antidepressant and opioid treatment. This case report also illustrates how a more timely multi-drug interaction assessment (preferably in conjunction with preemptive PGx testing) may have informed a different prescribing pattern, reduced\/avoided a prescribing cascade, and potentially prevented a drug-related fall.<\/jats:p>","DOI":"10.3390\/medicina59010118","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T02:09:39Z","timestamp":1673230179000},"page":"118","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Case Report: Performing a Medication Safety Review Assisted by Pharmacogenomics to Explain a Prescribing Cascade Resulting in a Patient Fall"],"prefix":"10.3390","volume":"59","author":[{"given":"Joshua","family":"Russell","sequence":"first","affiliation":[{"name":"Tabula Rasa HealthCare, Office of Translational Research and Residency Programs, Moorestown, NJ 08057, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan J.","family":"Arwood","sequence":"additional","affiliation":[{"name":"Tabula Rasa HealthCare, Precision Pharmacotherapy Research and Development Institute, Orlando, FL 32827, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole M. Del","family":"Toro-Pag\u00e1n","sequence":"additional","affiliation":[{"name":"Tabula Rasa HealthCare, Office of Translational Research and Residency Programs, Moorestown, NJ 08057, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishita S.","family":"Amin","sequence":"additional","affiliation":[{"name":"Tabula Rasa HealthCare, Office of Translational Research and Residency Programs, Moorestown, NJ 08057, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele D.","family":"Cambridge","sequence":"additional","affiliation":[{"name":"Franciscan Senior Health and Wellness, Program of All-Inclusive Care for the Elderly (PACE), Indianapolis, IN 46259, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7978-9280","authenticated-orcid":false,"given":"Jacques","family":"Turgeon","sequence":"additional","affiliation":[{"name":"Tabula Rasa HealthCare, Precision Pharmacotherapy Research and Development Institute, Orlando, FL 32827, USA"},{"name":"Faculty of Pharmacy, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, QC H3C 3J7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronique","family":"Michaud","sequence":"additional","affiliation":[{"name":"Tabula Rasa HealthCare, Precision Pharmacotherapy Research and Development Institute, Orlando, FL 32827, USA"},{"name":"Faculty of Pharmacy, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, QC H3C 3J7, Canada"},{"name":"Faculty of Pharmacy, University of Montreal Hospital Research Center (CRCHUM), Montr\u00e9al, QC H2X 0A9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sharp, C.N., Linder, M.W., and Valdes, R. 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