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PGxOneV3_drug_action.txt
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PGxOneV3_drug_action.txt
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Therapeutic Area Action Drug Class Drug Clinical Annotation Gene Phenotype ICD Codes Conditions Source LOE
Anesthesiology DOWN/DOWN General Anesthetics Ketamine (Ketalar?), Propofol (Diprivan?) DECREASE DOSE due to decreased drug clearance/DECREASE DOSE due to decreased drug clearance CYP2B6 G516T Heterozygous/G516T Homozygous PGKB 2, 2
Anesthesiology SLOW/SLOW Local Anesthetics Lidocaine (Lidoderm?), Ropivacaine (Naropin?) USE CAUTION due to increased risk of drug toxicity/USE CAUTION due to increased risk for loss of efficacy CYP1A2 Poor Metabolizer/Ultrarapid Metabolizer R25, R29, M62, M72, M79 pain Literature 3, 3
Anesthesiology STOP Local Anesthetics Lidocaine/Prilocaine (Emla?) CONSIDER ALTERNATIVES due to high susceptibility to drug-induced methemoglobinemia G6PD G6PD Deficiency R25, R29, M62, M72, M79 pain FDA 1
Anesthesiology GO Sedatives Dexmedetomidine (Precedex?) NORMAL DOSE may have an increased sedative response ADRA2A rs1800544 CC genotype PGKB 2
Cardiology SLOW/SLOW ACE Inhibitors Benazepril (Lotensin?), Perindopril (Aceon?) USE CAUTION due to reduced response/USE CAUTION due to reduced response ACE Heterozygous ACE Insertion/Homozygous ACE Insertion E08, E10, E11, E13, E78, I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 heart failure, chronic obstructive pulmonary disease, diabetes PGKB 2, 2
Cardiology SLOW/SLOW ACE Inhibitors Captopril (Capoten?), Perindopril (Aceon?) USE CAUTION due to increased major cardiovascular events rate/USE CAUTION due to increased major cardiovascular events rate AGTR1 rs5186 AC genotype/rs5186 CC genotype E08, E10, E11, E13, E78, I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 heart failure, chronic obstructive pulmonary disease, diabetes PGKB 2, 2
Cardiology SLOW ACE Inhibitors Captopril (Capoten?), Quinapril (Accupril?) USE CAUTION due to reduced response ACE ACE Deletion E08, E10, E11, E13, E78, I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 heart failure, chronic obstructive pulmonary disease, diabetes PGKB 2, 2
Cardiology SLOW/SLOW Angiotensin II Receptor Blockers Candesartan (Atacand?) USE CAUTION due to reduced response/USE CAUTION due to reduced response AGTR1 rs5186 AC genotype/rs5186 CC genotype E08, E10, E11, E13, E78, I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 hypertension, diabetes PGKB 2
Cardiology SLOW/SLOW Angiotensin II Receptor Blockers Irbesartan (Avapro?) USE CAUTION due to reduced response/USE CAUTION due to reduced response ACE ACE Deletion/Heterozygous ACE Insertion E08, E10, E11, E13, E78, I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 hypertension, diabetes PGKB 2
Cardiology SLOW Angiotensin II Receptor Blockers Losartan (Cozaar?) USE CAUTION due to reduced response ABCB1 rs1045642 GG genotype E08, E10, E11, E13, E78, I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 hypertension, diabetes PGKB 2
Cardiology SLOW Angiotensin II Receptor Blockers Losartan (Cozaar?) USE CAUTION due to reduced response AGTR1 rs5186 AA genotype E08, E10, E11, E13, E78, I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 hypertension, diabetes PGKB 2
Cardiology SLOW Antianginal Drugs Ranolazine (Ranexa?) USE CAUTION due to the risk of increased exposure to the drug leading to adverse events CYP2D6 Poor Metabolizer I20, I25 chronic angina, chest pain EMA 2
Cardiology SLOW/SLOW Antiarrhythmic Drugs Amiodarone (Cordarone?) USE CAUTION due to increased risk of drug-induced ventricular arrhythmia and QT prolongation/USE CAUTION due to increased risk of drug-induced ventricular arrhythmia and QT prolongation NOS1AP rs10800397 T Allele Carrier/rs10919035 T Allele Carrier I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 angina, hypertension, heart attack, irregular heartbeats, heart failure PGKB 2
Cardiology STOP Antiarrhythmic Drugs Dronedarone (Multaq?) CONSIDER ALTERNATIVES CYP3A4 Poor Metabolizer I47, I48, I49, R00, R01 heart rhythm disorders, ventricular arrhythmias, atrial fibrillation, supra-ventricular tachycardia, atrial tachycardia, AV nodal tachycardia, bypass tract tachycardias EMA 2
Cardiology SLOW/SLOW/SLOW Antiarrhythmic Drugs Digoxin (Lanoxin?) USE CAUTION due to decreased metabolism/USE CAUTION due to decreased metabolism/USE CAUTION due to decreased metabolism ABCB1 rs2032582 AA genotype/rs1045642 AA genotype/rs1045642 AG genotype I47, I48, I49, R00, R01 heart rhythm disorders, ventricular arrhythmias, atrial fibrillation, supra-ventricular tachycardia, atrial tachycardia, AV nodal tachycardia, bypass tract tachycardias PGKB 2
Cardiology DOWN/DOWN/STOP Antiarrhythmic Drugs Flecainide (Tambocor?) DECREASE DOSE by 50%/DECREASE DOSE by 25%/CONSIDER ALTERNATIVES (e.g., sotalol, disopyramide, quinidine, amiodarone) CYP2D6 Poor Metabolizer/Intermediate Metabolizer/Ultrarapid Metabolizer I47, I48, I49, R00, R01 heart rhythm disorders, ventricular arrhythmias, atrial fibrillation, supra-ventricular tachycardia, atrial tachycardia, AV nodal tachycardia, bypass tract tachycardias DPWG 2
Cardiology DOWN/STOP/STOP Antiarrhythmic Drugs Propafenone (Rythmol?) DECREASE DOSE by 70% and avoid simultaneous use with a CYP3A4 inhibitor/CONSIDER ALTERNATIVES (e.g., sotalol, disopyramide, quinidine, amiodarone)/CONSIDER ALTERNATIVES (e.g., sotalol, disopyramide, quinidine, amiodarone) CYP2D6 Poor Metabolizer/Intermediate Metabolizer/Ultrarapid Metabolizer I47, I48, I49, R00, R01 heart rhythm disorders, ventricular arrhythmias, atrial fibrillation, supra-ventricular tachycardia, atrial tachycardia, AV nodal tachycardia, bypass tract tachycardias FDA, DPWG 1
Cardiology UP/UP Anticoagulants Phenprocoumon (Marcoumar?) INCREASE DOSE/INCREASE DOSE CYP4F2 Poor Metabolizer/Intermediate Metabolizer G45, I20, I21, I24, I25, I26, I42, I47, I48, I49, I50, I65, I67, I70, I73, I82 heart attacks, strokes, and blood clots in veins and arteries PGKB 2
Cardiology SLOW Anticoagulants Rivaroxaban (Xarelto?) USE CAUTION due to increased bleeding risk CYP3A4 Poor Metabolizer G45, I20, I21, I24, I25, I26, I42, I47, I48, I49, I50, I65, I67, I70, I73, I82 heart attacks, strokes, and blood clots in veins and arteries Literature 3
Cardiology SLOW Anticoagulants Warfarin (Coumadin?) Genetic testing required CYP2C9 Poor Metabolizer/Intermediate Metabolizer G45, I20, I21, I24, I25, I26, I42, I47, I48, I49, I50, I65, I67, I70, I73, I82 heart attacks, strokes, and blood clots in veins and arteries FDA, CPIC, HCSC 1
Cardiology SLOW Anticoagulants Warfarin (Coumadin?) Genetic testing required VKORC1 rs9923231 A Allele Carrier G45, I20, I21, I24, I25, I26, I42, I47, I48, I49, I50, I65, I67, I70, I73, I82 heart attacks, strokes, and blood clots in veins and arteries FDA, CPIC, HCSC 1
Cardiology SLOW/SLOW Antilipemic Agents (Statins) Atorvastatin (Lipitor?) USE CAUTION due to higher risk of developing myalgia/USE CAUTION due to higher risk of developing myalgia ABCB1 rs1045642 AA genotype/rs1045642 AG genotype E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease PGKB 2
Cardiology GO Antilipemic Agents (Statins) Atorvastatin (Lipitor?) NORMAL DOSE may have a better response APOE E2 Carrier E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease PGKB 2
Cardiology SLOW Antilipemic Agents (Statins) Atorvastatin (Lipitor?), Lovastatin (Mevacor?), Rosuvastatin (Crestor?) USE CAUTION due to impaired efficacy CYP3A5 High Expresser E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease PGKB 2, 2, 2
Cardiology DOWN Antilipemic Agents (Statins) Atorvastatin (Lipitor?), Pitavastatin (Livalo?), Pravastatin (Pravachol?), Rosuvastatin (Crestor?) DECREASE DOSE SLCO1B1 Low Activity E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease CPIC 2, 2, 2, 2
Cardiology SLOW Antilipemic Agents (Statins) Atorvastatin (Lipitor?), Pravastatin (Pravachol?) USE CAUTION due to poorer response to statin treatment with decreased risk for adverse cardiovascular events KIF6 rs20455 AA genotype E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease PGKB 2, 2
Cardiology SLOW/SLOW Antilipemic Agents (Statins) Lovastatin (Mevacor?) USE CAUTION due to decreased response/USE CAUTION due to decreased response LDLR rs688 CC Genotype/rs688 CT Genotype E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease PGKB 3
Cardiology SLOW/SLOW Antilipemic Agents (Statins) Fluvastatin (Lescol?) USE CAUTION due to reduced response/USE CAUTION due to reduced response ACE Heterozygous ACE Insertion/Homozygous ACE Insertion E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease PGKB 2
Cardiology SLOW/SLOW/SLOW Antilipemic Agents (Statins) Simvastatin (Zocor?) USE CAUTION due to reduced response and increased risk of developing myalgia /USE CAUTION due to higher risk of developing myalgia/USE CAUTION due to higher risk of developing myalgia ABCB1 rs2032582 CC genotype/rs1045642 AG genotype/rs1045642 GG genotype E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease PGKB 2
Cardiology STOP DOWN/STOP DOWN Antilipemic Agents (Statins) Simvastatin (Zocor?) CONSIDER ALTERNATIVES or DECREASE DOSE to 20mg daily/CONSIDER ALTERNATIVES or DECREASE DOSE to 20mg daily SLCO1B1 Low Activity/Intermediate Activity E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease CPIC 2
Cardiology SLOW/SLOW Antilipemic Agents Fenofibrate (Tricor?) USE CAUTION due to decreased response/USE CAUTION due to decreased response APOB rs676210 GG Genotype/rs676210 GA Genotype E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease PGKB 3
Cardiology GO Antilipemic Agents Fenofibrate (Tricor?) NORMAL DOSE may have an increased response APOE E2 Carrier E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 high cholesterol, high triglycerides, stroke, heart attack, other heart complications, coronary heart disease PGKB 2
Cardiology STOP/STOP Antiplatelets Clopidogrel (Plavix?) CONSIDER ALTERNATIVES (if no contraindication e.g., prasugrel, ticagrelor)/CONSIDER ALTERNATIVES (if no contraindication e.g., prasugrel, ticagrelor) CYP2C19 Poor Metabolizer/Intermediate Metabolizer G45, I20, I21, I24, I25, I42, I47, I48, I49, I50, I65, I67, I70, I73 heart attack, stroke, heart disorders, blood vessels disorders; FDA, EMA, PMDA, HCSC, CPIC, DPWG 1
Cardiology GO/GO Antiplatelets Ticagrelor (Brilinta?) NORMAL DOSE/NORMAL DOSE CYP2C19 Poor Metabolizer/Intermediate Metabolizer G45, I20, I21, I24, I25, I42, I47, I48, I49, I50, I65, I67, I70, I73 heart attack, stroke, heart disorders, blood vessels disorders; FDA, EMA 1
Cardiology SLOW/SLOW Beta Blockers Atenolol (Tenormin?) USE CAUTION due to decreased drug response/USE CAUTION due to decreased drug response ADRA2A rs1800545 GA genotype/rs1800545 AA genotype I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 angina, hypertension, heart attack, irregular heartbeats, heart failure PGKB 2
Cardiology SLOW Beta Blockers Carvedilol (Coreg?) USE CAUTION due to higher plasma concentrations of R(+)-carvedilol and higher rate of dizziness CYP2D6 Poor Metabolizer I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 angina, hypertension, heart attack, irregular heartbeats, heart failure FDA, HCSC 1
Cardiology STOP DOWN/STOP DOWN/STOP UP Beta Blockers Metoprolol (Lopressor?) CONSIDER ALTERNATIVES (e.g., bisoprolol, carvedilol) or DECREASE DOSE by 75% due to heart failure caused by the decreased drug cardioselectivity/CONSIDER ALTERNATIVES (e.g., bisoprolol, carvedilol) or DECREASE DOSE by 50% due to heart failure caused by the decreased drug cardioselectivity/CONSIDER ALTERNATIVES (e.g., bisoprolol, carvedilol) or INCREASE DOSE by 250% in response to efficacy and ADE CYP2D6 Poor Metabolizer/Intermediate Metabolizer/Ultrarapid Metabolizer I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 angina, hypertension, heart attack, irregular heartbeats, heart failure FDA, DPWG 1
Cardiology GO Beta Blockers Nebivolol (Bystolic?), Propranolol (Inderal LA?) NORMAL DOSE CYP2D6 Poor Metabolizer I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 angina, hypertension, heart attack, irregular heartbeats, heart failure FDA 1, 1
Cardiology SLOW Calcium Channel Blockers Amlodipine (Norvasc?), Diltiazem (Cardizem?), Felodipine (Plendil?), Lercanidipine (Zanidip?), Nisoldipine (Sular?) USE CAUTION due to significant increase in drug exposure and therefore clinical monitoring may be required CYP3A4 Poor Metabolizer I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 angina, hypertension, heart attack, irregular heartbeats, heart failure Literature 2, 3, 3, 3, 3
Cardiology SLOW/SLOW Calcium Channel Blockers Amlodipine (Norvasc?), Nifedipine (Adalat?) USE CAUTION due to increased risk for QTc prolongation/USE CAUTION due to increased risk for QTc prolongation NOS1AP rs10494366 GG genotype/rs10494366 GT genotype I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 angina, hypertension, heart attack, irregular heartbeats, heart failure PGKB 2, 3
Cardiology SLOW/SLOW Calcium Channel Blockers Nitrendipine (Nitrepin?) USE CAUTION due to reduced response/USE CAUTION due to reduced response AGTR1 rs5186 AC genotype/rs5186 CC genotype I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 angina, hypertension, heart attack, irregular heartbeats, heart failure PGKB 2
Cardiology SLOW Calcium Channel Blockers Verapamil (Calan?) USE CAUTION due to increased risk for QTc prolongation NOS1AP rs10494366 GG genotype I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 angina, hypertension, heart attack, irregular heartbeats, heart failure PGKB 2
Cardiology SLOW Diuretics Bumetanide (Bumex?), Furosemide (Lasix?), Hydrochlorothiazide (Microzide?), Torsemide (Demadex?) USE CAUTION due to reduced response ACE Homozygous ACE Insertion E78, I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 hypertension PGKB 2, 2, 2, 2
Cardiology GO Diuretics Hydrochlorothiazide (Microzide?) NORMAL DOSE may have a decreased risk of developing diabetes AGTR1 rs5186 CC genotype E78, I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 hypertension PGKB 2
Cardiology GO Diuretics Spironolactone (Aldactone?) NORMAL DOSE may be associated with greater symptom improvement ACE Homozygous ACE Insertion E78, I10, I11, I12, I15, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 hypertension PGKB 2
Cardiology SLOW Miscellaneous Cardiovascular Agents Ivabradine (Corlanor?) USE CAUTION due to significant increase in drug exposure and therefore clinical monitoring may be required CYP3A4 Poor Metabolizer I20, I25 chronic angina, chest pain EMA 2
Cardiology SLOW Phosphodiesterase Inhibitors Cilostazol (Pletal?) USE CAUTION due to decrease in drug clearance CYP3A5 Non Expresser I73 Peripheral vascular disease (pvd), Intermittent claudication, Vascular Graft Occlusion PGKB 2
Cardiology SLOW/SLOW Vasodilators Hydralazine USE CAUTION due to decreased drug response/USE CAUTION due to decreased drug response NAT2 Rapid Acetylator/Intermediate Acetylator E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 hypertension FDA 1
Cardiology GO Vasodilators Nitroprusside (Nitropress?) NORMAL DOSE may experience greater vasodilation ACE Homozygous ACE Insertion E78, I10, I11, I12, I20, I21, I24, I25, I42, I47, I48, I49, I50, I51, I70 hypertension PGKB 2
Dentistry SLOW Cholinergic Agonists Cevimeline (Evoxac?) USE CAUTION due to higher risk of adverse events CYP2D6 Poor Metabolizer dry mouth FDA 1
Endocrinology SLOW/SLOW Biguanides Metformin (Glucophage?) USE CAUTION due to decreased drug response/USE CAUTION due to decreased drug response ATM rs11212617 AA genotype/rs11212617 AC genotype E08, E09, E10, E11, E13 diabetes PGKB 2
Endocrinology DOWN/STOP Endocrine Enzyme Inhibitors Eliglustat (Cerdelga?) DECREASE DOSE by 50% to 84mg once daily/CONSIDER ALTERNATIVES due to adequate drug concentrations won't be achieved for a therapeutic effect CYP2D6 Poor Metabolizer/Ultrarapid Metabolizer E75 Gaucher disease type 1 FDA, EMA, PMDA 1
Endocrinology STOP Sulfonylureas Chlorpropamide (Diabinese?), Glimepiride (Amaryl?), Glipizide (Glucotrol?), Glyburide (Glynase?), Tolbutamide CONSIDER ALTERNATIVES G6PD G6PD Deficiency E08, E09, E10, E11, E13 diabetes FDA, EMA 1, 1, 1, 1, 3
Endocrinology SLOW Thiazolidinediones Pioglitazone (Actos?) USE CAUTION due to higher risk of side effects caused by decreased drug metabolism CYP2C8 Allele 3 Carrier E08, E09, E10, E11, E13 diabetes PGKB 2
Endocrinology SLOW Thiazolidinediones Rosiglitazone (Avandia?) USE CAUTION due to decreased response caused by increased drug metabolism CYP2C8 Allele 3 Carrier E08, E09, E10, E11, E13 diabetes PGKB 2
Gastroenterology GO/GO/GO/GO Histamine H2 Antagonists Famotidine (Pepcid?) NORMAL DOSE/NORMAL DOSE/NORMAL DOSE/NORMAL DOSE CYP2C19 Poor Metabolizer/Intermediate Metabolizer/Rapid Metabolizer/Ultrarapid Metabolizer K21, K29, K31 heartburn, gastroesophageal reflux disease (GERD), and esophageal damage Literature 3
Gastroenterology SLOW Monoclonal Antibody Adalimumab (Humira?) USE CAUTION due to decreased response HFE rs2071303 TT Genotype K50 Crohn's disease PGKB 3
Gastroenterology SLOW Osmotic Laxatives Ascorbic Acid (MoviPrep?) USE CAUTION due to a risk of hemolytic anemia G6PD G6PD Deficiency K59 Constipation FDA, PMDA, HCSC 1
Gastroenterology UP/UP/SLOW/SLOW Proton Pump Inhibitors (PPIs) Dexlansoprazole (Dexilant?), Esomeprazole (Nexium?), Lansoprazole (Prevacid?), Omeprazole (Prilosec?), Pantoprazole (Protonix?), Rabeprazole (Aciphex?) INCREASE DOSE by 50-200% and then adjusted to achieve a favorable clinical response due to decreased efficacy/INCREASE DOSE by 50-200% and then adjusted to achieve a favorable clinical response due to decreased efficacy/USE CAUTION due to higher drug plasma levels/USE CAUTION due to higher drug plasma levels CYP2C19 Ultrarapid Metabolizer/Rapid Metabolizer/Poor Metabolizer/Intermediate Metabolizer K21, K29, K31 heartburn, gastroesophageal reflux disease (GERD), and esophageal damage FDA, EMA, HCSC, DPWG 1, 1, 1, 1, 1, 1
Gynecology STOP SLOW Hormonal Contraceptives Ethinyl Estradiol/Norelgestromin (Ortho Evra?) CONSIDER ALTERNATIVES (e.g., copper intrauterine device, progestin-only contraceptive) with presence of positive family history of thrombotic events or USE CAUTION by avoid additional risk factors (e.g., obesity, smoking) with absence of positive family history of thrombotic events F5 Factor V Leiden Carrier EMA, DPWG 1
Gynecology SLOW Hormones Oral-Contraceptive USE CAUTION due to an increased risk for deep vein thrombosis F2 F2 G20210A Mutation PGKB 2
Gynecology SLOW Mixed 5-HT1A Agonists/5-HT2A Antagonists Flibanserin (Addyi?) USE CAUTION due to an increased risk for ADRs such as syncope CYP2C19 Poor Metabolizer F52 decreased sexual desire in women FDA 1
Hematology SLOW Colony Stimulating Factors Eltrombopag (Promacta?) USE CAUTION due to the potential for an increased risk of thromboembolism F5 Factor V Leiden Carrier FDA, EMA 1
Immunology SLOW 5-Aminosalicylic Acid Derivatives Sulfasalazine (Azulfidine?) USE CAUTION due to a risk of hemolytic anemia G6PD G6PD Deficiency K51, M05, M06 ulcerative colitis, rheumatoid arthritis FDA 1
Immunology SLOW Antigout Agents Lesinurad (Zurampic?) USE CAUTION due to increased drug exposure CYP2C9 Poor Metabolizer M10 Gout FDA 1
Immunology SLOW Antirheumatic Immunosuppressants Methotrexate (Trexall?) USE CAUTION due to an increased risk for gastrointestinal toxicities and a decreased response to drug ITPA rs1127354 A Allele Carrier M06, M12, M13 Rheumatoid arthritis PGKB 2
Immunology UP/UP Immunosuppressant Agents Cyclosporine (Gengraf?), Sirolimus (Rapamune?) INCREASE DOSE/INCREASE DOSE CYP3A5 High Expresser/Expresser D89 Graft-versus-host disease, organ rejection PGKB 2, 2
Immunology UP/UP Immunosuppressant Agents Tacrolimus (Prograf?) INCREASE DOSE/INCREASE DOSE CYP3A4 Poor Metabolizer/Intermediate Metabolizer D89 Graft-versus-host disease, organ rejection PGKB 2
Immunology UP/UP Immunosuppressant Agents Tacrolimus (Prograf?) INCREASE DOSE with 1.5 to 2 times recommended starting dose not exceed 0.3mg per kg per day/INCREASE DOSE with 1.5 to 2 times recommended starting dose not exceed 0.3mg per kg per day CYP3A5 High Expresser/Expresser D89 Graft-versus-host disease, organ rejection CPIC 2
Immunology STOP DOWN/DOWN Immunosuppressive Drugs Azathioprine (Imuran?) CONSIDER ALTERNATIVES or DECREASE DOSE by 90% of full dose then titrate based on tolerance/DECREASE DOSE by 30-70% of full dose and titrate based on tolerance TPMT Poor Metabolizer/Intermediate Metabolizer D69, G35, M06, M12, M13 Crohn's disease, Ulcerative colitis, Systemic lupus erythematosus, Rheumatoid arthritis, Multiple sclerosis, Idiopathic thrombocytopenic purpura, Hashimoto's encephalopathy FDA, CPIC, DPWG 1
Immunology SLOW/SLOW Systemic Corticosteroids Methylprednisolone (Medrol?), Prednisolone (Orapred?), Prednisone (Deltasone?) USE CAUTION due to increased risk of Osteonecrosis/USE CAUTION due to increased risk of Osteonecrosis ABCB1 rs1045642 AG genotype/rs1045642 GG genotype G35 inflammation, severe allergies, flares of chronic illnesses, Multiple sclerosis PGKB 2, 2, 2
Immunology SLOW Urate-Oxidase (Recombinent) Pegloticase (Krystexxa?) USE CAUTION due to the risk of hemolysis and methemoglobinemia G6PD G6PD Deficiency M10 Gout FDA, EMA 1
Immunology SLOW Uricosuric Agents Probenecid USE CAUTION due to the risk of hemolysis and methemoglobinemia G6PD G6PD Deficiency M10 Gout FDA, EMA 1
Immunology STOP Xanthine Oxidase Inhibitors Allopurinol (Zyloprim?) CONSIDER ALTERNATIVES due to significantly increased risk of drug-induced SCAR HLA-B HLA-B*5801 Allele Carrier M10 Gout CPIC, PMDA 1
Infectious Diseases STOP/STOP/STOP Antifungal Drugs Voriconazole (Vfend?) CONSIDER ALTERNATIVES (e.g., isavuconazole, liposomal amphotericin B, posaconazole)/CONSIDER ALTERNATIVES (e.g., isavuconazole, liposomal amphotericin B, posaconazole)/CONSIDER ALTERNATIVES (e.g., isavuconazole, liposomal amphotericin B, posaconazole) CYP2C19 Poor Metabolizer/Rapid Metabolizer/Ultrarapid Metabolizer B37 serious infections of Aspergillus fumigatu, Candida, Scedosporium, Fusarium and other species FDA, EMA, PMDA, HCSC, CPIC, DPWG 1
Infectious Diseases SLOW Antihepaciviral Drugs Boceprevir (Victrelis?), Ledipasvir/Sofosbuvir (Harvoni?), Peginterferon alfa-2b (PegIntron?), Ribavirin (Copegus?), Telaprevir (Incivo?) USE CAUTION due to decreased response and increased likelihood of relapse IFNL3 Unfavorable Response Genotype B18, B19, K76 HCV FDA, EMA, CPIC, DPWG 1, 1, 1, 2, 1
Infectious Diseases SLOW Antihepaciviral Drugs Boceprevir (Victrelis?), Peginterferon alfa-2b (PegIntron?), Ribavirin (Copegus?), Telaprevir (Incivo?) USE CAUTION due to increased risk of ribavirin-induced hemolytic anemia ITPA Non-protective Wild Type B18, B19, K76 HCV Literature 3, 2, 2, 3
Infectious Diseases SLOW Antimalarial Drugs Chloroquine (Aralen?), Primaquine Phosphate (Primaquine?), Quinine (Qualaquin?) USE CAUTION due to high risk for hemolysis G6PD G6PD Deficiency B50, B51, B52, B53, B54 Malaria FDA, HCSC 1, 1, 1
Infectious Diseases STOP Antiretroviral Drugs Abacavir (Ziagen?) CONSIDER ALTERNATIVES due to significantly increased risk of abacavir hypersensitivity HLA-B HLA-B*5701 Allele Carrier B20 HIV FDA, EMA, PMDA, CPIC, DPWG 1
Infectious Diseases STOP Antiretroviral Drugs Atazanavir (Reyataz?) CONSIDER ALTERNATIVES due to high likelihood of drug discontinuation resulted from jaundice UGT1A1 Homozygous *28 Allele Carrier B20 HIV CPIC 2
Infectious Diseases SLOW Antiretroviral Drugs Dolutegravir (Tivicay?) USE CAUTION due to higher potential for ADRs caused by decreased drug clearance UGT1A1 Homozygous *28 Allele Carrier B20 HIV FDA 1
Infectious Diseases SLOW/SLOW/SLOW Antiretroviral Drugs Efavirenz (Sustiva?), Nevirapine (Viramune?) USE CAUTION due to higher potential for an increased frequency and severity of drug-associated adverse events/USE CAUTION due to higher potential for an increased frequency and severity of drug-associated adverse events/USE CAUTION due to higher potential for an increased frequency and severity of drug-associated adverse events CYP2B6 G516T Homozygous/A785G Homozygous/T983C Homozygous B20 HIV EMA, HCSC 1, 2
Infectious Diseases SLOW/SLOW Antiretroviral Drugs Lamivudine (Epivir?), Lopinavir/Ritonavir (Kaletra?), Zidovudine (Retrovir?) USE CAUTION due to the increased risk of virological failure/USE CAUTION due to the increased risk of virological failure ABCB1 rs1045642 AG genotype/rs1045642 GG genotype B20 HIV PGKB 2, 2, 2
Infectious Diseases SLOW/SLOW Antiretroviral Drugs Nelfinavir (Viracept?) USE CAUTION due to reduced therapeutic effect/USE CAUTION due to the increased risk of adverse effects caused by the increased drug plasma concentration CYP2C19 Ultrarapid Metabolizer/Poor Metabolizer B20 HIV FDA, EMA 1
Infectious Diseases SLOW Antiretroviral Drugs Nevirapine (Viramune?) USE CAUTION due to increased risk of drug hepatotoxicity ABCB1 rs1045642 GG genotype B20 HIV PGKB 2
Infectious Diseases SLOW/SLOW Antitubercular Agents Ethambutol (Myambutol?), Isoniazid, Pyrazinamide (Rifater?), Rifampin (Rifadin?) USE CAUTION due to increased risk of hepatotoxicity caused by decreased drug clearance/USE CAUTION due to increased risk of hepatotoxicity caused by decreased drug clearance NAT2 Slow Acetylator/Intermediate Acetylator B90 tuberculosis FDA 2, 1, 1, 1
Infectious Diseases SLOW/SLOW Lipopeptides Daptomycin (Cubicin?) USE CAUTION due to decreased drug response/USE CAUTION due to decreased drug response ABCB1 rs1045642 AG genotype/rs1045642 GG genotype PGKB 2
Infectious Diseases DOWN Macrolides Erythromycin/Sulfisoxazole (Pediazole?) DECREASE DOSE due to a risk of hemolytic anemia G6PD G6PD Deficiency FDA 1
Infectious Diseases SLOW Miscellaneous Antibiotics Dapsone, Sulfamethoxazole/Trimethoprim (Bactrim?) USE CAUTION due to an increased risk of hemolytic adverse reactions G6PD G6PD Deficiency Leprosy, Dermatitis herpetiformis, Lepromatous leprosy FDA 1, 1
Infectious Diseases SLOW Miscellaneous Antibiotics Nalidixic Acid (Neggram?), Nitrofurantoin (Macrobid?) USE CAUTION due to an association with hemolytic anemia G6PD G6PD Deficiency N39, N41, R31 FDA 1, 1
Infectious Diseases STOP Topical Antibiotics Mafenide (Sulfamylon?) CONSIDER ALTERNATIVES due to reported fatal ADR cases G6PD G6PD Deficiency FDA 1
Neurology SLOW/SLOW/SLOW Acetylcholinesterase Inhibitors Donepezil (Aricept?) USE CAUTION due to decreased drug response caused by increased drug metabolism/USE CAUTION due to possible increased ADRs caused by decreased drug metabolism/USE CAUTION due to possible increased ADRs caused by decreased drug metabolism CYP2D6 Ultrarapid Metabolizer/Poor Metabolizer/Intermediate Metabolizer G30 Alzheimer, dementia FDA 1
Neurology SLOW Acetylcholinesterase Inhibitors Galantamine (Razadyne?) USE CAUTION the drug should be individually titrated to tolerability CYP2D6 Poor Metabolizer G30 Alzheimer, dementia FDA, HCSC 1
Neurology DOWN/SLOW Anticonvulsant Drugs Brivaracetam (Briviact?) DECREASE DOSE/USE CAUTION due to possible increased ADRs CYP2C19 Poor Metabolizer/Intermediate Metabolizer F63, G40, M79, R29, R52, R53, R56 seizures, convulsion, epilepsy FDA, HCSC 1
Neurology GO Anticonvulsant Drugs Carbamazepine (Tegretol?), Lamotrigine (Lamictal?), Oxcarbazepine (Trileptal?), Phenytoin (Dilantin?), Topiramate (Topamax?) NORMAL DOSE may have a decreased risk of drug resistance SCN2A rs2304016 GG genotype F50, F63, G40, M79, R29, R52, R53, R56 seizures, convulsion, epilepsy, eating disorder PGKB 2, 2, 2, 2, 2
Neurology STOP Anticonvulsant Drugs Carbamazepine (Tegretol?), Phenytoin (Dilantin?) CONSIDER ALTERNATIVES HLA-B HLA-B*1502 Allele Carrier F63, G40, M79, R29, R52, R53, R56 seizures, convulsion, epilepsy FDA, CPIC, PRO 1, 1
Neurology SLOW Anticonvulsant Drugs Clobazam (Onfi?) USE CAUTION with initial daily dose of 5 mg then titrate to daily 10~20 mg and further to a maximum daily 40 mg if tolerated CYP2C19 Poor Metabolizer F20, F25, F41, F51, G47 Anxiety, Agoraphobia, Panic disorder, Depressive Disorder FDA 1
Neurology GO Anticonvulsant Drugs Valproic Acid (Depakote?) NORMAL DOSE may have lower weight gain ANKK1 A1 Homozygous F20, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome PGKB 2
Neurology SLOW/SLOW Anticonvulsant Drugs Phenobarbital USE CAUTION due to increased risk of drug resistance/USE CAUTION due to increased risk of drug resistance ABCB1 rs1045642 AG genotype/rs1045642 GG genotype G40, G47, M79, R29, R52, R53, R56 seizures, convulsion, epilepsy PGKB 2
Neurology SLOW Antimigraine Agents Eletriptan (Relpax?) USE CAUTION due to the risk of increased exposure to the drug leading to adverse events CYP3A4 Poor Metabolizer G43 migraine Literature 3
Neurology SLOW/SLOW Antimigraine Agents Zolmitriptan (Zomig?) USE CAUTION due to the increased risk of drug toxicity/USE CAUTION due to the increased risk for loss of efficacy CYP1A2 Poor Metabolizer/Ultrarapid Metabolizer G43 migraine Literature 3
Neurology DOWN Central Monoamine-Depleting Agents Tetrabenazine (Xenazine?) DECREASE DOSE to 50mg daily with a maximum single dose of 25mg CYP2D6 Poor Metabolizer FDA 1
Neurology SLOW COMT Inhibitors Entacapone (Comtan?) USE CAUTION due to decreased response COMT MET Homozygous G20 Parkinson PGKB 2
Neurology STOP/STOP NMDA Receptor Antagonists Dextromethorphan/Quinidine (Nuedexta?) CONSIDER ALTERNATIVES due to risk of significant toxicity/CONSIDER ALTERNATIVES due to lower, potentially subtherapeutic effectiveness CYP2D6 Poor Metabolizer/Ultrarapid Metabolizer F48 pseudobulbar affect FDA, EMA 1
Oncology SLOW Alkylating Agents Cyclophosphamide (Cytoxan?) USE CAUTION due to worse outcome including overall survival and progression-free survival NQO1 rs1800566 AA genotype C16, C34, C50 stomach cancer, lung cancer, breast cancer PGKB 2
Oncology SLOW Alkylating Agents Cyclophosphamide (Cytoxan?) USE CAUTION due to decreased drug response and increased severity of toxicity GSTP1 rs1695 GG genotype C50 breast cancer PGKB 2
Oncology SLOW/SLOW Alkylating Agents Cyclophosphamide (Cytoxan?) USE CAUTION due to poorer response and increased risk of toxicity/USE CAUTION due to poorer response and increased risk of toxicity MTHFR C677T Heterozygous Mutation/C677T Homozygous Mutation C34, C50, C56, C81, C82, C83, C84, C85, C95 lung cancer, breast cancer, ovarian cancer, lymphoma, leukemia PGKB 2
Oncology SLOW/SLOW Anthracyclines Doxorubicin (Doxil?) USE CAUTION due to the decreased survival rate/USE CAUTION due to the decreased survival rate ABCB1 rs1045642 GG genotype/rs2032582 CC genotype C90 Multiple Myeloma PGKB 2
Oncology SLOW Anthracyclines Doxorubicin (Doxil?) USE CAUTION due to worse outcome including overall survival and progression-free survival NQO1 rs1800566 AA genotype C16, C34, C50 stomach cancer, lung cancer, breast cancer PGKB 2
Oncology SLOW Anthracyclines Epirubicin (Ellence?) USE CAUTION due to decreased drug response and increased severity of toxicity GSTP1 rs1695 GG genotype C50 breast cancer PGKB 2
Oncology SLOW Anthracyclines Epirubicin (Ellence?) USE CAUTION due to worse outcome including overall survival and progression-free survival NQO1 rs1800566 AA genotype C16, C34, C50 stomach cancer, lung cancer, breast cancer PGKB 2
Oncology SLOW/SLOW Antiemetics Dexamethasone (Decadron?) USE CAUTION due to the decreased survival rate/USE CAUTION due to the decreased survival rate ABCB1 rs1045642 GG genotype/rs2032582 CC genotype C34, C90 Multiple Myeloma PGKB 2
Oncology SLOW/SLOW Antiemetics Dronabinol (Marinol?) USE CAUTION due to increased adverse reactions caused by reduced drug clearance/USE CAUTION due to increased adverse reactions caused by reduced drug clearance CYP2C9 Poor Metabolizer/Intermediate Metabolizer C16, C18, C19, C20, C21, C25, C34, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer FDA 1
Oncology SLOW Antiemetics (Selective 5-HT3 Receptor Antagonist) Dolasetron (Anzemet?), Granisetron (Sancuso?) USE CAUTION due to reduced response CYP2D6 Ultrarapid Metabolizer C16, C18, C19, C20, C21, C25, C34, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer PGKB 2, 2
Oncology SLOW/SLOW Antiemetics (Selective 5-HT3 Receptor Antagonist) Dolasetron (Anzemet?), Granisetron (Sancuso?) USE CAUTION due to increased risk for QTc interval prolongation/USE CAUTION due to increased risk for QTc interval prolongation NOS1AP rs10494366 GT genotype/rs10494366 TT genotype C16, C18, C19, C20, C21, C25, C34, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer PGKB 2, 2
Oncology SLOW/SLOW/SLOW/SLOW/SLOW/SLOW Antiemetics (Selective 5-HT3 Receptor Antagonist) Ondansetron (Zofran?) USE CAUTION due to increased likelihood of nausea and vomiting/USE CAUTION due to increased likelihood of nausea and vomiting/USE CAUTION due to increased likelihood of nausea and vomiting/USE CAUTION due to increased likelihood of nausea and vomiting/USE CAUTION due to increased likelihood of nausea and vomiting/USE CAUTION due to increased likelihood of nausea and vomiting ABCB1 rs1045642 AG genotype/rs1045642 GG genotype/rs2032582 AC genotype/rs2032582 AT genotype/rs2032582 CC genotype/rs2032582 TT genotype C16, C18, C19, C20, C21, C25, C34, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer PGKB 2
Oncology STOP Antiemetics (Selective 5-HT3 Receptor Antagonist) Ondansetron (Zofran?) CONSIDER ALTERNATIVES which are not predominantly metabolized by CYP2D6 CYP2D6 Ultrarapid Metabolizer C16, C18, C19, C20, C21, C25, C34, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer CPIC 2
Oncology GO Antiemetics (Selective 5-HT3 Receptor Antagonist) Palonosetron (Aloxi?) NORMAL DOSE CYP2D6 Poor Metabolizer C16, C18, C19, C20, C21, C25, C34, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer FDA 1
Oncology STOP DOWN/DOWN Antimetabolites (Purine Analog) Mercaptopurine (Purinethol?), Thioguanine (Tabloid?) CONSIDER ALTERNATIVES nonthiopurine immunosuppressant therapy for nonmalignant conditions or DECREASE DOSE by 90% of full dose and reduce frequency to thrice weekly then adjust doses of MP based on degree of myelosuppression /DECREASE DOSE by 30-70% of full dose then adjust doses of MP based on degree of myelosuppression TPMT Poor Metabolizer/Intermediate Metabolizer C81, C82, C83, C84, C90, C91, C92, C93, C94 leukemia, lymphoma FDA, EMA, CPIC, DPWG 1, 1
Oncology STOP/DOWN Antimetabolites (Pyrimidine Analog) Capecitabine (Xeloda?), Fluorouracil (Carac?), Pyrimidinedione (Tegafur-Uracil?) CONSIDER ALTERNATIVES/DECREASE DOSE by 50% at start followed by titration of dose based on toxicity or pharmacokinetic test DPYD Poor Metabolizer/Intermediate Metabolizer C18, C20, C43, C44, C50, C61, C67, C76 breast and colon cancer, keratoses and skin cancer, breast colon gallbladder gastric head liver lung neck pancreatic prostate cancer FDA, EMA, CPIC, DPWG 1, 1, 2
Oncology SLOW Antimetabolites (Pyrimidine Analog) Cytarabine (Depocyt?) USE CAUTION due to decreased survival time and an increased risk of death CDA rs532545 T Allele C81, C82, C83, C84, C90, C91, C92, C93, C94 leukemia, lymphoma PGKB 2
Oncology SLOW/SLOW Antimetabolites (Pyrimidine Analog) Fluorouracil (Carac?) USE CAUTION due to increased risk of diarrhea/USE CAUTION due to increased risk of diarrhea ABCB1 rs1045642 AA genotype/rs1045642 AG genotype C18, C19, C20, C21 colorectal cancer PGKB 2
Oncology SLOW Antimetabolites (Pyrimidine Analog) Fluorouracil (Carac?) USE CAUTION due to an increased risk for nephrotoxicity, decreased survival and a poorer response ERCC1 rs11615 AA genotype C16, C18, C19, C20, C21, C25, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer PGKB 2
Oncology SLOW Antimetabolites (Pyrimidine Analog) Fluorouracil (Carac?) USE CAUTION due to a highly increased risk of toxicity and poorer treatment outcome GSTP1 rs1695 AA genotype C18, C19, C20, C21 colorectal cancer PGKB 2
Oncology SLOW/SLOW Antimetabolites (Pyrimidine Analog) Fluorouracil (Carac?) USE CAUTION due to poorer response and increased risk of toxicity/USE CAUTION due to poorer response and increased risk of toxicity MTHFR C677T Heterozygous Mutation/C677T Homozygous Mutation C34, C50, C56, C81, C82, C83, C84, C85, C95 lung cancer, breast cancer, ovarian cancer, lymphoma, leukemia PGKB 2
Oncology SLOW Antimetabolites (Pyrimidine Analog) Fluorouracil (Carac?) USE CAUTION due to worse outcome including overall survival and progression-free survival NQO1 rs1800566 AA genotype C16, C34, C50 stomach cancer, lung cancer, breast cancer PGKB 2
Oncology SLOW/SLOW Antimetabolites (Pyrimidine Analog) Fluorouracil (Carac?) USE CAUTION due to decreased survival and response/USE CAUTION due to increased risk of severe neutropenia XRCC1 rs25487 T Allele Carrier/rs25487 C Allele Carrier C16, C18, C19, C20, C21, C25, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer PGKB 2
Oncology SLOW BCR-ABL Tyrosine Kinase Inhibitors Nilotinib (Tasigna?), Pazopanib (Votrient?) USE CAUTION due to increased risk of hyperbilirubinemia UGT1A1 Homozygous *28 Allele Carrier C61, C64, C67 lung pancreatic cancer, leukemia, kidney, soft tissue EMA 1, 1
Oncology SLOW BRAF Kinase Inhibitors Dabrafenib (Tafinlar?) USE CAUTION by closely observing patients with G6PD deficiency for signs of hemolytic anemia G6PD G6PD Deficiency C43, C44 skin cancer FDA 1
Oncology SLOW Chemotherapy Modulating Agents Leucovorin (Wellcovorin?) USE CAUTION due to an increased risk for nephrotoxicity, decreased survival and a poorer response ERCC1 rs11615 AA genotype C16, C18, C19, C20, C21, C25, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer PGKB 2
Oncology SLOW Chemotherapy Modulating Agents Leucovorin (Wellcovorin?) USE CAUTION due to a highly increased risk of toxicity and poorer treatment outcome GSTP1 rs1695 AA genotype C18, C19, C20, C21 colorectal cancer PGKB 3
Oncology SLOW/SLOW Chemotherapy Modulating Agents Leucovorin (Wellcovorin?) USE CAUTION due to poorer response and increased risk of toxicity/USE CAUTION due to poorer response and increased risk of toxicity MTHFR C677T Heterozygous Mutation/C677T Homozygous Mutation C34, C50, C56, C81, C82, C83, C84, C85, C95 lung cancer, breast cancer, ovarian cancer, lymphoma, leukemia PGKB 2
Oncology SLOW/SLOW Chemotherapy Modulating Agents Leucovorin (Wellcovorin?) USE CAUTION due to decreased survival and response/USE CAUTION due to increased risk of severe neutropenia XRCC1 rs25487 T Allele Carrier/rs25487 C Allele Carrier C16, C18, C19, C20, C21, C25, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer PGKB 3
Oncology SLOW EGFR Tyrosine Kinase Inhibitors Erlotinib (Tarceva?) USE CAUTION due to increased risk of hyperbilirubinemia UGT1A1 Homozygous *28 Allele Carrier C61, C64, C67 lung pancreatic cancer, leukemia, kidney, soft tissue EMA 2
Oncology SLOW EGFR Tyrosine Kinase Inhibitors Gefitinib (Iressa?) USE CAUTION due to possible adverse reactions CYP3A4 Poor Metabolizer C34 lung cancer EMA 2
Oncology DOWN EGFR Tyrosine Kinase Inhibitors Ruxolitinib (Jakavi?) DECREASE DOSE by 50% of the usual dose CYP3A4 Poor Metabolizer D48 bone marrow cancer EMA 2
Oncology SLOW/SLOW Folate Antimetabolites Methotrexate (Trexall?) USE CAUTION due to increased risk of toxicity caused by increased drug concentration/USE CAUTION due to increased risk of toxicity caused by increased drug concentration ABCB1 rs1045642 AA genotype/rs1045642 AG genotype C81, C82, C83, C84, C90, C91, C92, C93, C94 leukemia, lymphoma PGKB 2
Oncology SLOW/SLOW Folate Antimetabolites Methotrexate (Trexall?) USE CAUTION due to poorer response and increased risk of toxicity/USE CAUTION due to poorer response and increased risk of toxicity MTHFR C677T Heterozygous Mutation/C677T Homozygous Mutation C34, C50, C56, C81, C82, C83, C84, C85, C95 lung cancer, breast cancer, ovarian cancer, lymphoma, leukemia PGKB 2
Oncology SLOW/SLOW Folate Antimetabolites Pemetrexed (Alimta?) USE CAUTION due to poorer response and increased risk of toxicity/USE CAUTION due to poorer response and increased risk of toxicity MTHFR C677T Heterozygous Mutation/C677T Homozygous Mutation C34, C50, C56, C81, C82, C83, C84, C85, C95 lung cancer, breast cancer, ovarian cancer, lymphoma, leukemia PGKB 2
Oncology DOWN Histone Deacetylase (HDAC) Inhibitors Belinostat (Beleodaq?) DECREASE DOSE to 750 mg per square meter of body surface UGT1A1 Homozygous *28 Allele Carrier C16, C18, C19, C20, C21, C25, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer FDA 1
Oncology SLOW Immunomodulators Thalidomide (Thalomid?) USE CAUTION due to decreased overall survival ERCC1 rs735482 AA genotype PGKB 2
Oncology SLOW Platinum Analog Carboplatin (Paraplatin?), Cisplatin (Platinol?), Oxaliplatin (Eloxatin?) USE CAUTION due to an increased risk for nephrotoxicity, decreased survival and a poorer response ERCC1 rs11615 AA genotype C16, C18, C19, C20, C21, C25, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer PGKB 2, 2, 2
Oncology SLOW Platinum Analog Carboplatin (Paraplatin?), Cisplatin (Platinol?), Oxaliplatin (Eloxatin?) USE CAUTION due to a highly increased risk of toxicity and poorer treatment outcome GSTP1 rs1695 AA genotype C18, C19, C20, C21 colorectal cancer PGKB 2, 2, 2
Oncology SLOW/SLOW Platinum Analog Carboplatin (Paraplatin?), Cisplatin (Platinol?), Oxaliplatin (Eloxatin?) USE CAUTION due to decreased survival and response/USE CAUTION due to increased risk of severe neutropenia XRCC1 rs25487 T Allele Carrier/rs25487 C Allele Carrier C16, C18, C19, C20, C21, C25, C43, C44, C50, C53, C61, C64, C67, C76 all types of cancer PGKB 2, 2, 2
Oncology SLOW/SLOW Platinum Analog Carboplatin (Paraplatin?), Oxaliplatin (Eloxatin?) USE CAUTION due to poorer response and increased risk of toxicity/USE CAUTION due to poorer response and increased risk of toxicity MTHFR C677T Heterozygous Mutation/C677T Homozygous Mutation C34, C50, C56, C81, C82, C83, C84, C85, C95 lung cancer, breast cancer, ovarian cancer, lymphoma, leukemia PGKB 2, 2
Oncology SLOW Platinum Analog Cisplatin (Platinol?) USE CAUTION due to increased risk for nephrotoxicity or mucositis ERCC1 rs3212986 C Allele Carrier C50, C56 breast cancer, ovarian cancer PGKB 2
Oncology SLOW Platinum Analog Cisplatin (Platinol?), Oxaliplatin (Eloxatin?) USE CAUTION due to worse outcome including overall survival and progression-free survival NQO1 rs1800566 AA genotype C16, C34, C50 stomach cancer, lung cancer, breast cancer PGKB 2, 2
Oncology STOP/STOP Selective Estrogen Receptor Modulators (SERMs) Tamoxifen (Soltamox?) CONSIDER ALTERNATIVES like aromatase inhibitor for postmenopausal women due to increased risk for relapse of breast cancer/CONSIDER ALTERNATIVES like aromatase inhibitor for postmenopausal women due to increased risk for relapse of breast cancer CYP2D6 Poor Metabolizer/Intermediate Metabolizer C50 breast cancer, precocious puberty, retroperitoneal fibrosis, pancreatic tumor FDA, HCSC, DPWG 2
Oncology SLOW Selective Estrogen Receptor Modulators (SERMs) Tamoxifen (Soltamox?) USE CAUTION due to increase in the incidence of thromboembolic effects F2 F2 G20210A Mutation C50 breast cancer FDA 1
Oncology DOWN Taxane Derivatives Cabazitaxel (Jevtana?) DECREASE DOSE by 25% of the usual dose CYP3A4 Poor Metabolizer C61 prostate cancer EMA 2
Oncology SLOW Taxane Derivatives Docetaxel (Taxotere?) USE CAUTION due to increased risk for nephrotoxicity or mucositis ERCC1 rs3212986 C Allele Carrier C50, C56 breast cancer, ovarian cancer PGKB 2
Oncology SLOW Taxane Derivatives Paclitaxel (Abraxane?) USE CAUTION due to decreased response ABCB1 rs2032582 CC genotype C50, C56 breast cancer, ovarian cancer PGKB 2
Oncology SLOW Taxane Derivatives Paclitaxel (Abraxane?) USE CAUTION due to increased risk for nephrotoxicity or mucositis ERCC1 rs3212986 C Allele Carrier C50, C56 breast cancer, ovarian cancer PGKB 2
Oncology DOWN Topoisomerase I Inhibitors Irinotecan (Camptosar?) DECREASE DOSE at start by at least one level due to increased risk for neutropenia UGT1A1 Homozygous *28 Allele Carrier C18, C20 colon, leukemia, lung, lymphoma FDA, DPWG 1
Oncology SLOW/SLOW Topoisomerase II Inhibitors Idarubicin (Idamycin?) USE CAUTION due to increased likelihood of toxic liver disease/USE CAUTION due to increased likelihood of toxic liver disease SLCO1B1 Low Activity/Intermediate Activity C81, C82, C83, C84, C90, C91, C92, C93, C94 leukemia, lymphoma PGKB 2
Oncology STOP Urate-Oxidases (Recombinant) Rasburicase (Elitek?) CONSIDER ALTERNATIVES include allopurinol G6PD G6PD Deficiency C81, C82, C83, C84, C90, C91, C92, C93, C94 leukemia, lymphoma FDA, EMA, CPIC 1
Oncology SLOW/SLOW VEGF Tyrosine Kinase Inhibitors Sorafenib (NexAvar?) USE CAUTION due to increased risk of hyperbilirubinemia and treatment interruption/USE CAUTION due to increased risk of hyperbilirubinemia and treatment interruption UGT1A1 Heterozygous *28 Allele Carrier/Homozygous *28 Allele Carrier C64, C22, C73 kidney, liver, and thyroid cancer PGKB 2
Oncology STOP DOWN VEGF Tyrosine Kinase Inhibitors Sunitinib (Sutent?) CONSIDER ALTERNATIVES or DECREASE DOSE CYP3A4 Poor Metabolizer C25, C64 late-stage kidney cancer, gastrointestinal stromal tumor, pancreatic neuroendocrine tumor EMA 2
Oncology SLOW/SLOW Vinca Alkaloids Vincristine (Marqibo?) USE CAUTION due to the decreased survival rate/USE CAUTION due to the decreased survival rate ABCB1 rs1045642 GG genotype/rs2032582 CC genotype C90 Multiple Myeloma PGKB 2
Osteoporosis SLOW/SLOW Selective Estrogen Receptor Modulators (SERMs) Raloxifene (Evista?) USE CAUTION due to decreased hip bone mineral density/USE CAUTION due to decreased hip bone mineral density UGT1A1 Non *28 Allele Carrier/Heterozygous *28 Allele Carrier M13, M15, M16, M17, M18, M19 osteoporosis PGKB 2
Pain Management SLOW/SLOW Alpha-2 Adrenergic Agonists Tizanidine (Zanaflex?) USE CAUTION due to increased risk of adverse symptoms/USE CAUTION due to increased risk for loss of efficacy CYP1A2 Poor Metabolizer/Ultrarapid Metabolizer R25, R29, M62, M72, M79 pain Literature 3
Pain Management DOWN/SLOW Nonsteroidal Antiinflammatory Drugs (NSAIDs) Celecoxib (Celebrex?), Diclofenac (Voltaren?), Meloxicam (Mobic?) DECREASE DOSE by 50%/USE CAUTION due to increased exposure to the drug CYP2C9 Poor Metabolizer/Intermediate Metabolizer G56, M06, M12, M15, M16, M17, M19, M25, M45, M46, M65, M70, M71, M75, M77, M81, M85, M94, N20 Pain, Rheumatoid arthritis, Osteoarthritis, Ankylosing spondylitis, Menstrual cramps FDA, EMA 1, 2, 2
Pain Management SLOW/SLOW Nonsteroidal Antiinflammatory Drugs (NSAIDs) Ibuprofen (Advil?), Naproxen (Aleve?) USE CAUTION due to the risk of increased exposure to the drug leading to adverse events/USE CAUTION due to the risk of increased exposure to the drug leading to adverse events CYP2C9 Poor Metabolizer/Intermediate Metabolizer G56, M06, M12, M15, M16, M17, M19, M25, M45, M46, M65, M70, M71, M75, M77, M81, M85, M94, N20 Pain, Rheumatoid arthritis, Osteoarthritis, Ankylosing spondylitis, Menstrual cramps Literature 3, 3
Pain Management DOWN Nonsteroidal Antiinflammatory Drugs (NSAIDs) Piroxicam (Feldene?) DECREASE DOSE due to reduced drug metabolic clearance CYP2C9 Poor Metabolizer M13, M15, M16, M17, M18, M19 osteoporosis FDA 1
Pain Management UP Opioids Alfentanil (Alfenta?), Fentanyl (Duragesic?), Hydromorphone (Dilaudid?), Morphine (MS Contin?) INCREASE DOSE due to decreased efficacy OPRM1 rs1799971 G Allele Carrier F11, G62, G64, G89, M12, M47, M50, M51, M53, M54, M96, R52 pain PGKB Level 2B 2, 2, 3, 2
Pain Management DOWN SLOW/DOWN SLOW Opioids Buprenorphine (Subutex?), Fentanyl (Duragesic?), Hydrocodone/Acetaminophen (Vicodin?), Methadone (Methadose?), Oxycodone (Oxycontin?), Sufentanil (Sufenta?) DECREASE DOSE or USE CAUTION due to the risk of increased exposure to the drug leading to adverse events/DECREASE DOSE or USE CAUTION due to the risk of increased exposure to the drug leading to adverse events CYP3A4 Poor Metabolizer/Intermediate Metabolizer F11, G62, G64, G89, M12, M47, M50, M51, M53, M54, M96, R52 pain Quest Diagnostics, Literature 3, 3, 3, 3, 3, 3
Pain Management STOP/STOP/STOP Opioids Codeine (Codeine?), Codeine/Acetaminophen (Tylenol #3 & #4?), Hydrocodone/Acetaminophen (Vicodin?), Oxycodone (Oxycontin?) CONSIDER ALTERNATIVES due to lack of efficacy/CONSIDER ALTERNATIVES if no response/CONSIDER ALTERNATIVES due to potential toxicity CYP2D6 Poor Metabolizer/Intermediate Metabolizer/Ultrarapid Metabolizer F11, G62, G64, G89, M12, M47, M50, M51, M53, M54, M96, R52 pain FDA, HCSC, CPIC, DPWG, CPNDS 2, 2, 2, 2
Pain Management SLOW Opioids Hydrocodone/Acetaminophen (Vicodin?) USE CAUTION due to increased risk for experiencing side effects OPRM1 rs1799971 G Allele Carrier F11, G62, G64, G89, M12, M47, M50, M51, M53, M54, M96, R52 pain PGKB Level 3 2
Pain Management DOWN/DOWN Opioids Methadone (Methadose?) DECREASE DOSE/DECREASE DOSE CYP2B6 G516T Homozygous/A785G Homozygous F11, G62, G64, G89, M12, M47, M50, M51, M53, M54, M96, R52 pain, drug dependence PGKB 2
Pain Management DOWN Opioids Methadone (Methadose?) DECREASE DOSE DRD2 rs1799978 C allele Carrier F11, G62, G64, G89, M12, M47, M50, M51, M53, M54, M96, R52 pain, drug dependence PGKB 2
Pain Management SLOW Opioids Methadone (Methadose?) USE CAUTION due to increased severity of sleep disorders OPRM1 rs1799971 A Allele Carrier F11, G62, G64, G89, M12, M47, M50, M51, M53, M54, M96, R52 pain, drug dependence PGKB 2
Pain Management STOP/STOP UP/STOP DOWN Opioids Tramadol Hydrochloride/Acetaminophen (Ultracet?), Tramadol (Ultram?) CONSIDER ALTERNATIVES (not oxycodone, codeine)/CONSIDER ALTERNATIVES (not oxycodone, codeine) or INCREASE DOSE/CONSIDER ALTERNATIVES (acetaminophen, NSAID, morphine-not oxycodone, codeine) or DECREASE DOSE by 30% CYP2D6 Poor Metabolizer/Intermediate Metabolizer/Ultrarapid Metabolizer F11, G62, G64, G89, M12, M47, M50, M51, M53, M54, M96, R52 pain FDA, HCSC, DPWG 1, 1
Pain Management SLOW Skeletal Muscle Relaxants Carisoprodol (Soma?) USE CAUTION due to increased exposure to the drug CYP2C19 Poor Metabolizer R25, R29, M62, M72, M79 Pain, Muscle Spasms, Cramp, Spasticity, Inflammation of the skeletal muscle, Muscle Rigidity FDA 2
Pain Management DOWN SLOW/UP SLOW Skeletal Muscle Relaxants Cyclobenzaprine (Flexeril?) DECREASE DOSE or USE CAUTION due to the risk of increased exposure to the drug leading to adverse events/INCREASE DOSE or USE CAUTION due to the risk of decreased exposure to the drug leading to lower effectiveness CYP1A2 Poor Metabolizer/Ultrarapid Metabolizer R25, R29, M62, M72, M79 Pain, Muscle Spasms, Cramp, Spasticity, Inflammation of the skeletal muscle, Muscle Rigidity Literature 3
Psychiatry GO/GO Aldehyde Dehydrogenase Inhibitors Disulfiram (Antabuse?) NORMAL DOSE may have an increased likelihood of response/NORMAL DOSE may have an increased likelihood of response ANKK1 A1 Homozygous/A1 Heterozygous F10, F14 chronic alcoholism, Cocaine-Related Disorders PGKB 2
Psychiatry SLOW/SLOW/SLOW Alpha-2 Antagonists Mirtazapine (Remeron?) USE CAUTION due to decreased drug response/USE CAUTION due to possible increased ADRs/USE CAUTION due to possible increased ADRs CYP2D6 Ultrarapid Metabolizer/Poor Metabolizer/Intermediate Metabolizer F20, F23, F25, F31, F32, F33, F34, F40, F41, F42, F43, F63 depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder PGKB 2
Psychiatry SLOW Anti-Anxiety Agents Buspirone (Buspar?) USE CAUTION due to reduced response HTR1A rs1800044 A Allele Carrier F20, F25, F41 Anxiety, Agoraphobia, Panic disorder, Depressive Disorder Literature 3
Psychiatry SLOW/SLOW Antimanic Agents Lithium (Lithobid?) USE CAUTION due to possible less drug response/USE CAUTION due to possible less drug response ABCB1 rs2032582 AA genotype/rs2032582 AC genotype F20, F25, F41, F63 Anxiety, Agoraphobia, Panic disorder, Depressive Disorder PGKB 2
Psychiatry DOWN Antipsychotics Aripiprazole (Abilify?) DECREASE DOSE by 50% of the usual dose CYP3A4 Poor Metabolizer F20, F23, F25, F31, F32, F33, F34, F84 bipolar, schizophrenia, autism EMA 2
Psychiatry DOWN Antipsychotics Aripiprazole (Abilify?), Brexpiprazole (Rexulti?), Iloperidone (Fanapt?), Pimozide (Orap?) DECREASE DOSE by 50% of the usual dose and then adjusted to achieve a favorable clinical response CYP2D6 Poor Metabolizer F20, F23, F25, F31, F32, F33, F34, F84 bipolar, schizophrenia, autism FDA, EMA, DPWG 1, 1, 1, 1
Psychiatry SLOW/SLOW/SLOW Antipsychotics Chlorpromazine, Fluphenazine USE CAUTION due to possible increased QT interval/USE CAUTION due to possible increased QT interval/USE CAUTION due to possible increased QT interval CYP1A2 Poor Metabolizer/Intermediate Metabolizer/Normal Metabolizer F20, F22, F23, F25, F31, F32, F33, F34 Schizophrenia, Bipolar disorder, Psychosis PGKB 2, 2
Psychiatry SLOW Antipsychotics Clozapine (Clozaril?) USE CAUTION due to an increased risk for seizures CYP1A2 High Inducibility Metabolizer F20, F22, F23, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome PGKB 2
Psychiatry DOWN SLOW Antipsychotics Clozapine (Clozaril?) DECREASE DOSE or USE CAUTION when administering concomitantly with drugs that are inducers or inhibitors of CYP2D6 CYP2D6 Poor Metabolizer F20, F22, F23, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome FDA 1
Psychiatry SLOW/SLOW Antipsychotics Clozapine (Clozaril?) USE CAUTION due to increased risk of side effects including hyperprolactinemia and weight gain/USE CAUTION due to increased risk of side effects including hyperprolactinemia and weight gain ANKK1 A1 Homozygous/A1 Heterozygous F20, F22, F23, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome PGKB 2
Psychiatry SLOW/SLOW Antipsychotics Olanzapine (Zyprexa?) USE CAUTION due to increased risk of side effects including hyperprolactinemia and weight gain/USE CAUTION due to increased risk of side effects including hyperprolactinemia and weight gain ANKK1 A1 Homozygous/A1 Heterozygous F20, F22, F23, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome PGKB 2
Psychiatry SLOW/SLOW Antipsychotics Risperidone (Risperdal?) USE CAUTION due to increased risk of side effects including hyperprolactinemia and weight gain/USE CAUTION due to increased risk of side effects including hyperprolactinemia and weight gain ANKK1 A1 Homozygous/A1 Heterozygous F20, F22, F23, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome PGKB 2
Psychiatry SLOW Antipsychotics Clozapine (Clozaril?) USE CAUTION due to increased risk of developing metabolic syndrome HTR2C rs1414334 C Allele Carrier F20, F22, F23, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome PGKB 2
Psychiatry SLOW Antipsychotics Olanzapine (Zyprexa?) USE CAUTION due to increased risk of developing metabolic syndrome HTR2C rs1414334 C Allele Carrier F20, F22, F23, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome PGKB 2
Psychiatry SLOW Antipsychotics Risperidone (Risperdal?) USE CAUTION due to increased risk of developing metabolic syndrome HTR2C rs1414334 C Allele Carrier F20, F22, F23, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome PGKB 2
Psychiatry STOP DOWN/STOP Antipsychotics Haloperidol (Haldol?) CONSIDER ALTERNATIVES (e.g., pimozide, flupenthixol, fluphenazine, quetiapine, olanzapine, clozapine) or DECREASE DOSE by 50%/CONSIDER ALTERNATIVES (e.g., pimozide, flupenthixol, fluphenazine, quetiapine, olanzapine, clozapine) CYP2D6 Poor Metabolizer/Ultrarapid Metabolizer F20, F22, F25, F31, F32, F33, F34 Schizophrenia, Bipolar, Psychosis, Tourette syndrome, Vomiting, Alzheimer's disease, Child Behavior Disorders, Withdrawal syndrome DPWG 2
Psychiatry DOWN/UP Antipsychotics Olanzapine (Zyprexa?) DECREASE DOSE due to reduced rate of drug clearance/INCREASE DOSE due to decreased response CYP1A2 Poor Metabolizer/High Inducibility Metabolizer F20, F22, F23, F25, F31, F32, F33, F34 Schizophrenia, Bipolar disorder, Psychosis EMA 2
Psychiatry SLOW Antipsychotics Olanzapine (Zyprexa?), Quetiapine (Seroquel?) USE CAUTION due to increased risk of side effects SLC6A4 HTTLPR Long Form F20, F22, F23, F25, F31, F32, F33, F34 Schizophrenia, Bipolar disorder, Psychosis PGKB 2, 2
Psychiatry SLOW Antipsychotics Risperidone (Risperdal?) USE CAUTION due to increased risk of side effects SLC6A4 HTTLPR Long Form F20, F22, F23, F25, F31, F32, F33, F34 Schizophrenia, Bipolar disorder, Psychosis PGKB 2
Psychiatry DOWN Antipsychotics Perphenazine DECREASE DOSE due to significantly greater side effects CYP2D6 Poor Metabolizer F20, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome FDA, PMDA 1
Psychiatry SLOW/SLOW Antipsychotics Quetiapine (Seroquel?) USE CAUTION due to increased likelihood of higher percentage of weight gain/USE CAUTION due to increased likelihood of higher percentage of weight gain FAAH rs324420 AA genotype/rs324420 CA genotype F20, F22, F23, F25, F31, F32, F33, F34 Schizophrenia, Bipolar disorder, Psychosis PGKB 2
Psychiatry STOP/STOP/STOP Antipsychotics Risperidone (Risperdal?) CONSIDER ALTERNATIVES (e.g., quetiapine, olanzapine, clozapine)/CONSIDER ALTERNATIVES (e.g., quetiapine, olanzapine, clozapine)/CONSIDER ALTERNATIVES (e.g., quetiapine, olanzapine, clozapine) CYP2D6 Poor Metabolizer/Intermediate Metabolizer/Ultrarapid Metabolizer F20, F22, F23, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome FDA, DPWG 1
Psychiatry SLOW Antipsychotics Risperidone (Risperdal?) USE CAUTION due to reduced symptoms improvement and increased risk of Hyperprolactinemia DRD2 rs1799978 C allele Carrier F20, F22, F23, F25, F31, F32, F33, F34, F84 Schizophrenia, Bipolar disorder, Dementia, Autism, Tourette syndrome PGKB 2
Psychiatry STOP/STOP Antipsychotics Thioridazine (Mellaril?) CONSIDER ALTERNATIVES/CONSIDER ALTERNATIVES CYP2D6 Poor Metabolizer/Intermediate Metabolizer F20, F22, F25, F31, F32, F33, F34 Schizophrenia, Bipolar disorder, Psychosis FDA 1
Psychiatry SLOW Benzodiazepines Alprazolam (Xanax?) USE CAUTION due to the risk of increased exposure to the drug leading to adverse events CYP3A4 Poor Metabolizer F20, F25, F41, F51, G47 Anxiety, Agoraphobia, Panic disorder, Depressive Disorder Literature 3
Psychiatry SLOW/SLOW/SLOW/SLOW Benzodiazepines Diazepam (Valium?) USE CAUTION due to possible increased ADRs/USE CAUTION due to possible increased ADRs/USE CAUTION due to decreased drug response/USE CAUTION due to decreased drug response CYP2C19 Poor Metabolizer/Intermediate Metabolizer/Rapid Metabolizer/Ultrarapid Metabolizer F20, F25, F41, F51, G47 Anxiety, Agoraphobia, Panic disorder, Depressive Disorder PGKB 1
Psychiatry SLOW Benzodiazepines Lorazepam (Ativan?), Oxazepam (Serax?) USE CAUTION due to increased risk of side effects caused by decreased clearance of drug UGT2B15 rs1902023 AA genotype F20, F25, F41, F51, G47 Anxiety, Agoraphobia, Panic disorder, Depressive Disorder PGKB 2, 2
Psychiatry SLOW Benzodiazepines Midazolam (Versed?) USE CAUTION due to increased risk of side effects caused by decreased clearance of drug CYP3A5 Non Expresser F20, F25, F41, F51, G47 Anxiety, Agoraphobia, Panic disorder, Depressive Disorder PGKB 2
Psychiatry SLOW CNS Stimulants (ADHD) Amphetamine (Adderall?) USE CAUTION due to reduced response OPRM1 rs510769 TT genotype F84, F90 ADHD, Autism PGKB 2
Psychiatry SLOW CNS Stimulants (ADHD) Amphetamine (Adderall?), Dexmethylphenidate (Focalin?), Dextroamphetamine (Adderall?), Lisdexamfetamine (Vyvanse?), Methylphenidate (Ritalin?) USE CAUTION due to reduced response COMT MET Homozygous F84, F90 ADHD, Autism PGKB 2, 2, 2, 3, 2
Psychiatry SLOW CNS Stimulants (ADHD) Dextroamphetamine (Adderall?), Methylphenidate (Ritalin?) USE CAUTION due to increased severity of social withdrawal or nausea DRD1 rs4532 CC genotype F84, F90 ADHD, Autism PGKB 2, 2
Psychiatry SLOW/SLOW CNS Stimulants (ADHD) Methamphetamine (Desoxyn?) USE CAUTION due to increased risk for drug dependence/USE CAUTION due to increased risk for drug dependence FAAH rs324420 CA genotype/rs324420 AA genotype F84, F90 ADHD, Autism PGKB 2
Psychiatry DOWN CNS Stimulants (ADHD) Methylphenidate (Ritalin?) DECREASE DOSE CES1 rs71647871 T Allele F84, F90 ADHD, Autism PGKB 2
Psychiatry SLOW/SLOW Dopamine/Norepinephrine-Reuptake Inhibitors Bupropion (Wellbutrin?) USE CAUTION due to reduced response and increased risk of side effects/USE CAUTION due to reduced response and increased risk of side effects CYP2B6 G516T Heterozygous/G516T Homozygous F20, F23, F25, F31, F32, F33, F34, F40, F41, F42, F43, F63, F84, depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder, autism PGKB 2
Psychiatry SLOW/SLOW Dopamine/Norepinephrine-Reuptake Inhibitors Bupropion (Wellbutrin?) USE CAUTION due to reduced response and increased risk of side effects/USE CAUTION due to reduced response and increased risk of side effects CYP2C19 Poor Metabolizer/Intermediate Metabolizer F20, F23, F25, F31, F32, F33, F34, F40, F41, F42, F43, F63, F84, depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder, autism PGKB 2
Psychiatry UP Opioids Antagonists Naloxone (Evzio?), Naltrexone (Revia?) INCREASE DOSE due to decreased efficacy OPRM1 rs1799971 G Allele Carrier F10, F84 drug dependence, drug overdose, alcohol abuse, autism PGKB 2, 2
Psychiatry SLOW/SLOW Other Stimulants Cannabinoids USE CAUTION due to increased risk of tetrahydrocannabinol (THC) dependence/USE CAUTION due to increased risk of tetrahydrocannabinol (THC) dependence FAAH rs324420 CC genotype/rs324420 CA genotype F12 Cannabis use PGKB 2
Psychiatry SLOW Other Stimulants Cocaine USE CAUTION due to increased risk of cocaine dependence CNR1 rs806368 TT genotype F14 cocaine-related disorder PGKB 2
Psychiatry SLOW Selective Serotonin Reuptake Inhibitors (SSRIs) Citalopram (Celexa?) USE CAUTION due to reduced response GRIK4 rs1954787 T Allele Carrier F20, F23, F25, F31, F32, F33, F34, F40, F41, F43 Major depression, Obsessive-compulsive disorder, Alcoholism, Dementia, Diabetic nerve damage, Tobacco abuse, Depressive Disorder PGKB Level 3 2
Psychiatry SLOW Selective Serotonin Reuptake Inhibitors (SSRIs) Citalopram (Celexa?) USE CAUTION due to less improvement in symptoms HTR2A rs7997012 GG genotype F20, F23, F25, F31, F32, F33, F34, F40, F41, F43 Major depression, Obsessive-compulsive disorder, Alcoholism, Dementia, Diabetic nerve damage, Tobacco abuse, Depressive Disorder PGKB Level 2B 2
Psychiatry STOP DOWN/STOP UP/STOP UP Selective Serotonin Reuptake Inhibitors (SSRIs) Citalopram (Celexa?), Escitalopram (Lexapro?) CONSIDER ALTERNATIVES or DECREASE DOSE by 50% of the recommended starting dose (maximum daily dose of 20 mg) and titrate to response/CONSIDER ALTERNATIVES or INCREASE DOSE by 150% in response to efficacy and adverse drug event/CONSIDER ALTERNATIVES or INCREASE DOSE by 150% in response to efficacy and adverse drug event CYP2C19 Poor Metabolizer/Rapid Metabolizer/Ultrarapid Metabolizer F20, F23, F25, F31, F32, F33, F34, F40, F41, F43 Major depression, Obsessive-compulsive disorder, Alcoholism, Dementia, Diabetic nerve damage, Tobacco abuse, Depressive Disorder FDA, HCSC, CPIC, DPWG 1, 1
Psychiatry SLOW Selective Serotonin Reuptake Inhibitors (SSRIs) Citalopram (Celexa?), Escitalopram (Lexapro?) USE CAUTION due to decreased response SLC6A4 HTTLPR Short Form F20, F23, F25, F31, F32, F33, F34, F40, F41, F43 Major depression, Obsessive-compulsive disorder, Alcoholism, Dementia, Diabetic nerve damage, Tobacco abuse, Depressive Disorder PGKB Level 2A 2, 2
Psychiatry SLOW/SLOW Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine (Prozac?) USE CAUTION due to elevated risk for drug overdose resulting in adverse events and drug interactions/USE CAUTION due to elevated risk for drug overdose resulting in adverse events and drug interaction CYP2D6 Poor Metabolizer/Intermediate Metabolizer F20, F23, F25, F31, F32, F33, F34, F40, F41, F42, F43, F50, F63, F84 depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder, autism, eating disorder FDA, Medscape 1
Psychiatry STOP DOWN Selective Serotonin Reuptake Inhibitors (SSRIs) Fluvoxamine (Luvox?) CONSIDER ALTERNATIVES or DECREASE DOSE by 25-50% of recommended starting dose and titrate to response CYP2D6 Poor Metabolizer F20, F23, F25, F31, F32, F33, F34, F40, F41, F42, F43, F63 depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder CPIC 1
Psychiatry SLOW Selective Serotonin Reuptake Inhibitors (SSRIs) Fluvoxamine (Luvox?), Paroxetine (Paxil?), Sertraline (Zoloft?) USE CAUTION due to reduced response HTR1A rs6295 CC genotype F20, F23, F25, F31, F32, F33, F34, F40, F41, F42, F43, F50, F63 depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder, eating disorder PGKB 2, 2, 2
Psychiatry STOP DOWN/STOP Selective Serotonin Reuptake Inhibitors (SSRIs) Paroxetine (Paxil?) CONSIDER ALTERNATIVES or DECREASE DOSE by 50% of recommended starting dose and titrate to response/CONSIDER ALTERNATIVES CYP2D6 Poor Metabolizer/Ultrarapid Metabolizer F20, F23, F25, F31, F32, F33, F34, F40, F41, F42, F43 depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder CPIC 1
Psychiatry STOP DOWN/SLOW/STOP/STOP Selective Serotonin Reuptake Inhibitors (SSRIs) Sertraline (Zoloft?) CONSIDER ALTERNATIVES or DECREASE DOSE by 50%/USE CAUTION with high alert to adverse drug events/CONSIDER ALTERNATIVES for non-responders/CONSIDER ALTERNATIVES for non-responders CYP2C19 Poor Metabolizer/Intermediate Metabolizer/Rapid Metabolizer/Ultrarapid Metabolizer F20, F23, F25, F31, F32, F33, F34, F40, F41, F42, F43, F50, F63 Major depression, Obsessive-compulsive disorder, Panic disorder, Posttraumatic stress disorder, Eating disorder, Depressive Disorder FDA, CPIC, DPWG 2
Psychiatry DOWN Selective Serotonin Reuptake Inhibitors (SSRIs) Vilazodone (Viibryd?) DECREASE DOSE by 50% CYP3A4 Poor Metabolizer F20, F25, F31, F32, F33, F34, F40, F41, F43 depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder Literature 3
Psychiatry DOWN Selective Serotonin Reuptake Inhibitors (SSRIs) Vortioxetine (Trintellix?) DECREASE DOSE to 10mg daily CYP2D6 Poor Metabolizer F20, F25, F31, F32, F33, F34, F40, F41, F43 Major depression, Anxiety disorder FDA 1
Psychiatry SLOW/STOP Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) Atomoxetine (Strattera?) USE CAUTION be alert to ADEs and make necessary dose adjustments/CONSIDER ALTERNATIVES CYP2D6 Poor Metabolizer/Ultrarapid Metabolizer F84, F90 Autism, ADHD FDA, DPWG 1
Psychiatry SLOW Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) Duloxetine (Cymbalta?) USE CAUTION due to increased exposure to the drug CYP1A2 Poor Metabolizer F20, F23, F25, F31, F32, F33, F34, F40, F41, F43, F84, F90 Major depression, Pain, Obsessive-compulsive disorder, Attention deficit hyperactivity disorder, Autism, Chronic fatigue syndrome, Depressive Disorder, narcolepsy FDA 3
Psychiatry DOWN Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) Levomilnacipran (Fetzima?) DECREASE DOSE to less than 80mg daily CYP3A4 Poor Metabolizer F20, F25, F31, F32, F33, F34, F40, F41, F43, F84, F90 Major depression, Pain, Obsessive-compulsive disorder, Attention deficit hyperactivity disorder, Autism, Chronic fatigue syndrome, Depressive Disorder, narcolepsy Literature 3
Psychiatry SLOW Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) Milnacipran (Savella?) USE CAUTION due to reduced response ADRA2A rs1800544 GG genotype F20, F23, F25, F31, F32, F33, F34, F40, F41, F42, F43, F63, K58 depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder PGKB 2
Psychiatry SLOW Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) Milnacipran (Savella?) USE CAUTION due to reduced response HTR1A rs6295 CC genotype F20, F23, F25, F31, F32, F33, F34, F40, F41, F42, F43, F63, K58 depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder PGKB 2
Psychiatry SLOW Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) Reboxetine (Edronax?) USE CAUTION be alert to ADEs and make necessary dose adjustments CYP3A4 Poor Metabolizer F20, F25, F31, F32, F33, F34, F40, F41, F43, F84, F90, G47 Major depression, Pain, Obsessive-compulsive disorder, Attention deficit hyperactivity disorder, Autism, Chronic fatigue syndrome, Depressive Disorder, narcolepsy Literature 3
Psychiatry STOP/STOP/STOP UP Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) Venlafaxine (Effexor?) CONSIDER ALTERNATIVES (e.g., citalopram, sertraline)/CONSIDER ALTERNATIVES (e.g., citalopram, sertraline)/CONSIDER ALTERNATIVES (e.g., citalopram, sertraline) or INCREASE DOSE by 150% CYP2D6 Poor Metabolizer/Intermediate Metabolizer/Ultrarapid Metabolizer F20, F23, F25, F31, F32, F33, F34, F40, F41, F43, F50, F84, F90 Major depression, Pain, Obsessive-compulsive disorder, Attention deficit hyperactivity disorder, Autism, Chronic fatigue syndrome, Depressive Disorder, narcolepsy, eating disorder DPWG 1
Psychiatry SLOW Serotonin Reuptake Inhibitors/Antagonists Trazodone (Desyrel?) USE CAUTION be alert to ADEs and make necessary dose adjustments CYP3A4 Poor Metabolizer F20, F25, F31, F32, F33, F34, F40, F41, F43, F84, F90, G47 Major depression, Pain, Obsessive-compulsive disorder, Attention deficit hyperactivity disorder, Autism, Chronic fatigue syndrome, Depressive Disorder, narcolepsy Literature 3
Psychiatry DOWN/DOWN/UP Tetracyclic Antidepressants Maprotiline DECREASE DOSE/DECREASE DOSE/INCREASE DOSE CYP2D6 Poor Metabolizer/Intermediate Metabolizer/Ultrarapid Metabolizer F20, F25, F31, F32, F33, F34, F40, F41, F43, F84, F90 Major depression, Depressive Disorder Literature 2
Psychiatry STOP DOWN/STOP/STOP Tricyclic Antidepressants Amitriptyline (Elavil?), Clomipramine (Anafranil?), Doxepin (Silenor?), Imipramine (Tofranil?), Protriptyline (Vivactil?), Trimipramine (Surmontil?) CONSIDER ALTERNATIVES or DECREASE DOSE by 50%/CONSIDER ALTERNATIVES/CONSIDER ALTERNATIVES CYP2C19 Poor Metabolizer/Rapid Metabolizer/Ultrarapid Metabolizer F20, F25, F31, F32, F33, F34, F40, F41, F42, F43, F51, F63, F84, F90 ADHD, Pain, Minor depressive disorder, Depressive Disorder FDA, CPIC, DPWG 2, 2, 1, 2, 2, 2
Psychiatry STOP DOWN/DOWN/STOP UP Tricyclic Antidepressants Amitriptyline (Elavil?), Clomipramine (Anafranil?), Doxepin (Silenor?), Imipramine (Tofranil?), Protriptyline (Vivactil?), Trimipramine (Surmontil?) CONSIDER ALTERNATIVES or DECREASE DOSE by 50%/DECREASE DOSE by 25%/CONSIDER ALTERNATIVES or INCREASE DOSE by titrating to a higher target dose in accordance with observed clinical response including symptom improvement and minimal if any side effects CYP2D6 Poor Metabolizer/Intermediate Metabolizer/Ultrarapid Metabolizer F20, F25, F31, F32, F33, F34, F40, F41, F42, F43, F51, F63, F84, F90, K58 ADHD, Pain, Minor depressive disorder, Depressive Disorder FDA, CPIC, DPWG 1, 1, 1, 1, 1, 1
Psychiatry STOP DOWN/DOWN/STOP UP Tricyclic Antidepressants Desipramine (Norpramin?), Nortriptyline (Pamelor?) CONSIDER ALTERNATIVES or DECREASE DOSE by 50%/DECREASE DOSE by 25%/CONSIDER ALTERNATIVES or INCREASE DOSE by titrating to a higher target dose in accordance with observed clinical response including symptom improvement and minimal if any side effects CYP2D6 Poor Metabolizer/Intermediate Metabolizer/Ultrarapid Metabolizer F20, F25, F31, F32, F33, F34, F40, F41, F42, F43, F51, F63, F84, F90, K58 ADHD, Pain, Minor depressive disorder, Depressive Disorder FDA, CPIC, DPWG 1, 1
Rheumatology SLOW Nonsteroidal Antiinflammatory Drugs (NSAIDs) Flurbiprofen (Ansaid?) USE CAUTION due to the possibility of high plasma levels resulting from decreased clearance CYP2C9 Poor Metabolizer M13, M15, M16, M17, M18, M19 osteoporosis FDA 1
Smoking Cessation SLOW/SLOW Smoking Cessation Aids Bupropion (Zyban?) USE CAUTION due to reduced effectiveness/USE CAUTION due to reduced effectiveness ANKK1 A1 Homozygous/A1 Heterozygous F17 Tabacco Use Disorder PGKB 2
Smoking Cessation GO Smoking Cessation Aids Nicotine (Nicoderm?) NORMAL DOSE may have an increased likelihood of smoking cessation and decreased risk of relapse COMT MET Homozygous F17 Tabacco Use Disorder PGKB 2
Supplements STOP/STOP Vitamins Folic Acid CONSIDER ALTERNATIVES (e.g., supplements containing methylfolate) due to reduced folic acid conversion/CONSIDER ALTERNATIVES (e.g., supplements containing methylfolate) due to significantly reduced folic acid conversion MTHFR C677T Heterozygous Mutation/C677T Homozygous Mutation D52, F20, F25, F31, F32, F33, F34, F40, F41, F43, F84, F90 PGKB 2
Toxicology SLOW/SLOW Antidotes Ethanol USE CAUTION due to increased risk for alcoholism/USE CAUTION due to increased risk for alcoholism ANKK1 A1 Homozygous/A1 Heterozygous F10 Alcoholism PGKB 2
Toxicology SLOW Antidotes Ethanol USE CAUTION due to increased severity of intoxication and an increased response OPRM1 rs1799971 G Allele Carrier F10 Alcoholism PGKB 2
Toxicology SLOW Antidotes Methylene Blue (Provayblue?) USE CAUTION due to risk of hemolytic anemia G6PD G6PD Deficiency D74 methemoglobinemia FDA, EMA, PMDA 1
Toxicology STOP Antidotes Sodium Nitrite CONSIDER ALTERNATIVES G6PD G6PD Deficiency FDA 1
Urology SLOW Alpha 1 Blockers Dutasteride/Tamsulosin (Jalyn?), Tamsulosin (Flomax?) USE CAUTION due to a marked increase in drug exposure CYP2D6 Poor Metabolizer N32, N40, N41 benign prostatic hyperplasia; urination problem AIBiotech 1, 1
Urology SLOW Alpha 1 Blockers Silodosin (Rapaflo?) USE CAUTION due to a marked increase in drug exposure CYP3A4 Poor Metabolizer N32, N40, N41 benign prostatic hyperplasia; urination problem Literature 3
Urology SLOW Anticholinergic Agents Darifenacin (Enablex?), Fesoterodine (Toviaz?) USE CAUTION when taking CYP3A4 inhibitors due to greater exposure of the drug CYP2D6 Poor Metabolizer N23, N32, N39, N40, R30, R32, R35, R39 an overactive bladder; incontinence; frequence urination FDA, EMA, PMDA, HCSC 1, 1
Urology SLOW Anticholinergic Agents Tolterodine (Detrol?) USE CAUTION due to a greater chance of seeing cardiac problems from long QT CYP2D6 Poor Metabolizer N23, N32, N39, N40, R30, R32, R35, R39 an overactive bladder; incontinence; frequence urination FDA 1