Does Pillcheck report pharmacodynamic genes COMT and MTHFR?

No. Pillcheck’s report focuses on pharmacokinetic genes, which determine how your body metabolizes a medication, rather than pharmacodynamic genes, which relate to how a drug acts on the body. That’s why genes like COMT and MTHFR are not currently included on the Pillcheck Report. 

COMT and MTHFR assessment is offered by some other commercial pharmacogenomic (PGx) tesing providers. COMT testing is sometimes discussed in relation to stimulant medications like Adderall or Ritalin. Similarly, MTHFR testing has been suggested for depression treatment and folate metabolism. However, neither gene is supported by clinical pharmacogenetic guidelines. Here are a few key reasons why: 

• Lack of consistent evidence: Large, well-controlled studies haven’t shown that these genetic markers have a consistent, highly predictive value for how a patient will respond to a specific medication.
  
  
• No guideline or regulatory support: There is no Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline, and no FDA drug label, that recommends COMT or MTHFR testing to guide medication selection or dosing. (CPIC/PharmGKB references for COMT)
  
  
• Multifactorial nature: Treatment response depends on many complex factors, genetics included, but also dose, other medications, lifestyle, and the condition itself. Current pharmacodynamic markers only account for a small fraction of that variability.
  
  
• Some professional societies have cautioned against routine testing: For example, the American College of Medical Genetics and Genomics (ACMG) and the American College of Obstetricians and Gynecologists (ACOG) have specifically advised against routine MTHFR testing for other common indications (such as clotting risk or pregnancy loss workups), citing unproven clinical utility.
  
  
• Standard of care remains unchanged: The recommended approach for finding the right medication and dose remains careful clinical monitoring and adjustment under the guidance of a healthcare professional. 

What Pillcheck reports instead 

Pillcheck’s reporting currently focuses on pharmacokinetic genes with robust, guideline-supported evidence, such as CYP2D6, CYP2C19, and CYP3A4, that are key for metabolism-based dosing of various medications, including many used in ADHD and mental health care. 

Pillcheck follows pharmacogenetic guidelines. Once guidelines for pharmacodynamic genes are established, they will be incorporated into future Pillcheck reporting.

Related:

What genes does Pillcheck test? 

Does Pillcheck test pharmacodynamic genes?