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reproduce_setup/pgx-main/pgx_results/CAN-NA12003-29Mar2025_S25_pgx_result/output.json

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{
"report_entries": [
{
"report_table": "",
"drug": "phenobarbital",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "phenytoin",
"drug_url": "https://drugs.com/phenytoin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/group-i-antiarrhythmics.html",
"path": [
"cardiovascular agents",
"antiarrhythmic agents",
"group I antiarrhythmics"
]
},
{
"href": "https://drugs.com/drug-class/hydantoin-anticonvulsants.html",
"path": [
"central nervous system agents",
"anticonvulsants",
"hydantoin anticonvulsants"
]
}
],
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "carbamazepine",
"drug_url": "https://drugs.com/carbamazepine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/dibenzazepine-anticonvulsants.html",
"path": [
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"anticonvulsants",
"dibenzazepine anticonvulsants"
]
}
],
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "primidone",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "lamotrigine",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "oxcarbazepine",
"drug_url": "https://drugs.com/mtm/oxcarbazepine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/dibenzazepine-anticonvulsants.html",
"path": [
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"anticonvulsants",
"dibenzazepine anticonvulsants"
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}
],
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": [
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
"original_recommendation": {
"drugid": "RxNorm:32624",
"drugname": "oxcarbazepine",
"guidelinename": "HLA-A, HLA-B and Carbamazepine and Oxcarbazepine",
"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
"guidelinepharmgkbids": [
"PA166105008",
"PA166176623"
],
"genes": [
"HLA-B"
],
"citations": [
{
"id": 110009,
"guidelineid": 100423,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for HLA-B Genotype and Carbamazepine Dosing",
"authors": [
"Leckband Susan G",
"Kelsoe John R",
"Dunnenberger H Mark",
"George Alfred L",
"Tran Eric",
"Berger Reisel",
"M\u00fcller Daniel J",
"Whirl-Carrillo Michelle",
"Caudle Kelly E",
"Pirmohamed Munir"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23695185",
"pmcid": "PMC3748365",
"doi": "10.1038/clpt.2013.103",
"url": null,
"version": 3,
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"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/carbamazepine/2013/23695185.pdf"
},
{
"id": 110034,
"guidelineid": 100423,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for HLA Genotype and Use of Carbamazepine and Oxcarbazepine: 2017 Update.",
"authors": [
"Phillips Elizabeth J",
"Sukasem Chonlaphat",
"Whirl-Carrillo Michelle",
"M\u00fcller Daniel J",
"Dunnenberger Henry M",
"Chantratita Wasun",
"Goldspiel Barry",
"Chen Yuan-Tsong",
"Carleton Bruce C",
"George Alfred L",
"Mushiroda Taisei",
"Klein Teri",
"Gammal Roseann S",
"Pirmohamed Munir"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 4,
"page": "574-581",
"volume": "103",
"year": 2018,
"pmid": "29392710",
"pmcid": "PMC5847474",
"doi": "10.1002/cpt.1004",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/carbamazepine/2017/29392710.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"HLA-B": "Normal risk of oxcarbazepine-induced SJS/TEN"
},
"drugrecommendation": "Use oxcarbazepine per standard dosing guidelines.",
"classification": "Strong",
"phenotypes": {},
"activityscore": {},
"allelestatus": {
"HLA-B": "HLA-B*15:02 negative"
},
"lookupkey": {
"HLA-B": "*15:02 negative"
},
"comments": "n/a",
"population": "OXC naive",
"subgroups": "HLA-B:*15:02 negative"
}
},
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
"original_recommendation": {
"drugid": "RxNorm:32624",
"drugname": "oxcarbazepine",
"guidelinename": "HLA-A, HLA-B and Carbamazepine and Oxcarbazepine",
"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
"guidelinepharmgkbids": [
"PA166105008",
"PA166176623"
],
"genes": [
"HLA-B"
],
"citations": [
{
"id": 110009,
"guidelineid": 100423,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for HLA-B Genotype and Carbamazepine Dosing",
"authors": [
"Leckband Susan G",
"Kelsoe John R",
"Dunnenberger H Mark",
"George Alfred L",
"Tran Eric",
"Berger Reisel",
"M\u00fcller Daniel J",
"Whirl-Carrillo Michelle",
"Caudle Kelly E",
"Pirmohamed Munir"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23695185",
"pmcid": "PMC3748365",
"doi": "10.1038/clpt.2013.103",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/carbamazepine/2013/23695185.pdf"
},
{
"id": 110034,
"guidelineid": 100423,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for HLA Genotype and Use of Carbamazepine and Oxcarbazepine: 2017 Update.",
"authors": [
"Phillips Elizabeth J",
"Sukasem Chonlaphat",
"Whirl-Carrillo Michelle",
"M\u00fcller Daniel J",
"Dunnenberger Henry M",
"Chantratita Wasun",
"Goldspiel Barry",
"Chen Yuan-Tsong",
"Carleton Bruce C",
"George Alfred L",
"Mushiroda Taisei",
"Klein Teri",
"Gammal Roseann S",
"Pirmohamed Munir"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 4,
"page": "574-581",
"volume": "103",
"year": 2018,
"pmid": "29392710",
"pmcid": "PMC5847474",
"doi": "10.1002/cpt.1004",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/carbamazepine/2017/29392710.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"HLA-B": "Normal risk of oxcarbazepine-induced SJS/TEN"
},
"drugrecommendation": "Use oxcarbazepine per standard dosing guidelines.",
"classification": "Strong",
"phenotypes": {},
"activityscore": {
"HLA-B": "n/a"
},
"allelestatus": {
"HLA-B": "HLA-B*15:02 negative"
},
"lookupkey": {
"HLA-B": "*15:02 negative"
},
"comments": "n/a",
"population": "OXC use >3 mos",
"subgroups": "HLA-B:*15:02 negative"
}
}
]
},
{
"report_table": "",
"drug": "zonisamide",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "rufinamide",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "felbamate",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "cannabidiol",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "fosphenytoin",
"drug_url": "https://drugs.com/mtm/fosphenytoin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hydantoin-anticonvulsants.html",
"path": [
"central nervous system agents",
"anticonvulsants",
"hydantoin anticonvulsants"
]
}
],
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "flunarizine",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "eslicarbazepine acetate",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "stiripentol",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "ezogabine",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "sulthiame",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "ethotoin",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "mephenytoin",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "",
"drug": "progabide",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "The HLA-B*15:02 allele, which is associated with severe cutaneous adverse reactions among patients taking certain aromatic anticonvulsants, was not detected in this patient. No change in therapy is warranted based on these results. It should be noted that a negative HLA-B*15:02 result does not absolutely rule out the possibility of an adverse drug reaction. Please consult a clinical pharmacist for more information [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": []
},
{
"report_table": "MAJOR",
"drug": "abacavir",
"drug_url": "https://drugs.com/mtm/abacavir.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/nrtis.html",
"path": [
"anti-infectives",
"antiviral agents",
"nucleoside reverse transcriptase inhibitors (NRTIs)"
]
}
],
"genes": [
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*57:01 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*57:01 allele"
}
],
"qg_recommendation": "Use abacavir per standard dosing guidelines [CPIC]. The HLA-B*57:01 allele, associated with abacavir hypersensitivity, was detected in this patient. HLA-B*5701 positive patients should NOT be prescribed abacavir [PharmGKB].",
"qg_phenotype_statement": "Standard Dose recommended [PharmGKB, CPIC]",
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"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-abacavir-and-hla-b/",
"original_recommendation": {
"drugid": "RxNorm:190521",
"drugname": "abacavir",
"guidelinename": "HLA-B and Abacavir",
"url": "https://cpicpgx.org/guidelines/guideline-for-abacavir-and-hla-b/",
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"genes": [
"HLA-B"
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"citations": [
{
"id": 110014,
"guidelineid": 100421,
"title": "Clinical Pharmacogenetics Implementation Consortium Guidelines for HLA-B Genotype and Abacavir Dosing",
"authors": [
"Martin M A",
"Klein T E",
"Dong B J",
"Pirmohamed M",
"Haas D W",
"Kroetz D L"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 2,
"page": "",
"volume": "",
"year": 2012,
"pmid": "22378157",
"pmcid": "PMC3374459",
"doi": "10.1038/clpt.2011.355",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/abacavir/2012/22378157.pdf"
},
{
"id": 110015,
"guidelineid": 100421,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for HLA-B Genotype and Abacavir Dosing: 2014 update",
"authors": [
"Martin Michael A",
"Hoffman James M",
"Freimuth Robert R",
"Klein Teri E",
"Dong Betty J",
"Pirmohamed Munir",
"Hicks J Kevin",
"Wilkinson Mark R",
"Haas David W",
"Kroetz Deanna L"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 2,
"page": "",
"volume": "",
"year": 2014,
"pmid": "24561393",
"pmcid": "PMC3994233",
"doi": "10.1038/clpt.2014.38",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/abacavir/2014/24561393.pdf"
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"cpicVersion": "v.1.17.1",
"implications": {
"HLA-B": "Low or reduced risk of abacavir hypersensitivity"
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"drugrecommendation": "Use abacavir per standard dosing guidelines",
"classification": "Strong",
"phenotypes": {},
"activityscore": {},
"allelestatus": {
"HLA-B": "HLA-B*57:01 negative"
},
"lookupkey": {
"HLA-B": "*57:01 negative"
},
"comments": "n/a",
"population": "general",
"subgroups": "HLA-B:*57:01 negative"
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}
]
},
{
"report_table": "USUAL",
"drug": "amitriptyline",
"drug_url": "https://drugs.com/amitriptyline.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/tricyclic-antidepressants.html",
"path": [
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"antidepressants",
"tricyclic antidepressants"
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}
],
"genes": [
{
"name": "CYP2C19",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
},
{
"name": "CYP2D6",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles or one normal function allele and a duplication of a decreased function allele with an activity value of 0.5 or two alleles with a duplication of a decreased function allele with an activity value of 0.5"
}
],
"qg_recommendation": "Initiate therapy with recommended starting dose [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
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"CPIC level": "",
"PharmGKB level": "",
"sources": [
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/",
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"drugname": "amitriptyline",
"guidelinename": "CYP2D6, CYP2C19 and Tricyclic Antidepressants",
"url": "https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/",
"guidelinepharmgkbids": [
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"PA166104999",
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"PA166105002",
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"genes": [
"CYP2C19",
"CYP2D6"
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"citations": [
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"id": 110004,
"guidelineid": 100414,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC) for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants: 2016 Update",
"authors": [
"Kevin Hicks J",
"Sangkuhl Katrin",
"Swen Jesse J",
"Ellingrod Vicki L",
"M\u00fcller Daniel J",
"Shimoda Kazutaka",
"Bishop Jeffrey R",
"Kharasch Evan D",
"Skaar Todd C",
"Gaedigk Andrea",
"Dunnenberger Henry M",
"Klein Teri E",
"Caudle Kelly E",
"Stingl Julia C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 12,
"page": "",
"volume": "",
"year": 2016,
"pmid": "27997040",
"pmcid": "PMC5478479",
"doi": "10.1002/cpt.597",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/TCA/2016/27997040.pdf"
},
{
"id": 110011,
"guidelineid": 100414,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants",
"authors": [
"Hicks J K",
"Swen J J",
"Thorn C F",
"Sangkuhl K",
"Kharasch E D",
"Ellingrod V L",
"Skaar T C",
"M\u00fcller D J",
"Gaedigk A",
"Stingl J C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 1,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23486447",
"pmcid": "PMC3689226",
"doi": "10.1038/clpt.2013.2",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/TCA/2013/23486447.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Normal metabolism of TCAs",
"CYP2C19": "Normal metabolism of tertiary amines"
},
"drugrecommendation": "Initiate therapy with recommended starting dose.",
"classification": "Strong",
"phenotypes": {
"CYP2D6": "Normal Metabolizer",
"CYP2C19": "Normal Metabolizer"
},
"activityscore": {
"CYP2D6": "2.0",
"CYP2C19": "n/a"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2",
"CYP2C19": "Normal Metabolizer"
},
"comments": "Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.",
"population": "general",
"subgroups": "CYP2C19:Normal Metabolizer|CYP2D6:Normal Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448999816",
"annotation_text": "Patients with the CYP2D6*1 allele may have an increased clearance of amitriptyline as compared to patients with the CYP2D6*87, *88, *89, *90, *91, *93, *94, *95, *97, or *98 allele. This annotation only covers the pharmacokinetic relationship between CYP2D6 and amitriptyline and does not include evidence about clinical outcomes. Other genetic and clinical factors may also influence the metabolism of amitriptyline."
}
]
},
{
"report_table": "MAJOR",
"drug": "atazanavir",
"drug_url": "https://drugs.com/mtm/atazanavir.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/protease-inhibitors.html",
"path": [
"anti-infectives",
"antiviral agents",
"protease inhibitors"
]
}
],
"genes": [
{
"name": "UGT1A1",
"genotype": "*1/*80",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
}
],
"qg_recommendation": "There is no need to avoid prescribing of atazanavir based on UGT1A1 genetic test result. Inform the patient that some patients stop atazanavir because of jaundice (yellow eyes and skin), but that this patient's genotype makes this unlikely (less than about a 1 in 20 chance of stopping atazanavir because of jaundice) [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-atazanavir-and-ugt1a1/",
"original_recommendation": {
"drugid": "RxNorm:343047",
"drugname": "atazanavir",
"guidelinename": "UGT1A1 and Atazanavir",
"url": "https://cpicpgx.org/guidelines/guideline-for-atazanavir-and-ugt1a1/",
"guidelinepharmgkbids": [
"PA166128738"
],
"genes": [
"UGT1A1"
],
"citations": [
{
"id": 110008,
"guidelineid": 100429,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for UGT1A1 and Atazanavir Prescribing",
"authors": [
"Gammal Roseann S",
"Court Michael H",
"Haidar Cyrine E",
"Iwuchukwu Otito Frances",
"Gaur Aditya H",
"Alvarellos Maria",
"Guillemette Chantal",
"Lennox Jeffrey L",
"Whirl-Carrillo Michelle",
"Brummel Sean",
"Ratain Mark J",
"Klein Teri E",
"Schackman Bruce R",
"Caudle Kelly E",
"Haas David W"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 9,
"page": "",
"volume": "",
"year": 2015,
"pmid": "26417955",
"pmcid": "PMC4785051",
"doi": "10.1002/cpt.269",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/atazanavir/2015/26417955.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"UGT1A1": "Somewhat decreased UGT1A1 activity; low likelihood of bilirubin-related discontinuation of atazanavir."
},
"drugrecommendation": "There is no need to avoid prescribing of atazanavir based on UGT1A1 genetic test result. Inform the patient that some patients stop atazanavir because of jaundice (yellow eyes and skin), but that this patient's genotype makes this unlikely (less than about a 1 in 20 chance of stopping atazanavir because of jaundice).",
"classification": "Strong",
"phenotypes": {
"UGT1A1": "Intermediate Metabolizer"
},
"activityscore": {
"UGT1A1": "n/a"
},
"allelestatus": {},
"lookupkey": {
"UGT1A1": "Intermediate Metabolizer"
},
"comments": "All studies correlating UGT1A1 genotypes with atazanavir adverse events have involved ritonavir boosting. However, concentration-time profiles are equivalent when boosted with either cobicistat or ritonavir (PMID 23532097), and bilirubin-related adverse events including discontinuation of atazanavir occur in a similar percentage of patients prescribed atazanavir with cobicistat or ritonavir (PMID 23532097). Associations between UGT1A1 genotype, bilirubin elevations, and atazanavir/r discontinuation therefore almost certainly translate to atazanavir/cobicistat.",
"population": "general",
"subgroups": "UGT1A1:Intermediate Metabolizer"
}
}
]
},
{
"report_table": "USUAL",
"drug": "atomoxetine",
"drug_url": "https://drugs.com/mtm/atomoxetine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/cns-stimulants.html",
"path": [
"central nervous system agents",
"CNS stimulants"
]
}
],
"genes": [
{
"name": "CYP2D6",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles or one normal function allele and a duplication of a decreased function allele with an activity value of 0.5 or two alleles with a duplication of a decreased function allele with an activity value of 0.5"
}
],
"qg_recommendation": "Adult patients: Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations [CPIC].",
"qg_phenotype_statement": "Increased Dose Recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-atomoxetine-based-on-cyp2d6-genotype/",
"original_recommendation": {
"drugid": "RxNorm:38400",
"drugname": "atomoxetine",
"guidelinename": "CYP2D6 and Atomoxetine",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-atomoxetine-based-on-cyp2d6-genotype/",
"guidelinepharmgkbids": [
"PA166181885"
],
"genes": [
"CYP2D6"
],
"citations": [
{
"id": 110035,
"guidelineid": 104243,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 Genotype and Atomoxetine Therapy.",
"authors": [
"Brown Jacob T",
"Bishop Jeffrey R",
"Sangkuhl Katrin",
"Nurmi Erika L",
"Mueller Daniel J",
"Dinh Jean C",
"Gaedigk Andrea",
"Klein Teri E",
"Caudle Kelly E",
"McCracken James T",
"de Leon Jose",
"Steven Leeder J"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 2,
"page": "",
"volume": "",
"year": 2019,
"pmid": "30801677",
"pmcid": null,
"doi": null,
"url": null,
"version": 5,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/atomoxetine/2019/30801677.pdf"
}
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"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."
},
"drugrecommendation": "Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.",
"classification": "Moderate",
"phenotypes": {
"CYP2D6": "Normal Metabolizer"
},
"activityscore": {
"CYP2D6": "2.0"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
},
"comments": "Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.",
"population": "adults",
"subgroups": "CYP2D6:Normal Metabolizer"
}
},
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-atomoxetine-based-on-cyp2d6-genotype/",
"original_recommendation": {
"drugid": "RxNorm:38400",
"drugname": "atomoxetine",
"guidelinename": "CYP2D6 and Atomoxetine",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-atomoxetine-based-on-cyp2d6-genotype/",
"guidelinepharmgkbids": [
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"genes": [
"CYP2D6"
],
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{
"id": 110035,
"guidelineid": 104243,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 Genotype and Atomoxetine Therapy.",
"authors": [
"Brown Jacob T",
"Bishop Jeffrey R",
"Sangkuhl Katrin",
"Nurmi Erika L",
"Mueller Daniel J",
"Dinh Jean C",
"Gaedigk Andrea",
"Klein Teri E",
"Caudle Kelly E",
"McCracken James T",
"de Leon Jose",
"Steven Leeder J"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 2,
"page": "",
"volume": "",
"year": 2019,
"pmid": "30801677",
"pmcid": null,
"doi": null,
"url": null,
"version": 5,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/atomoxetine/2019/30801677.pdf"
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],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."
},
"drugrecommendation": "Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If < 200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.",
"classification": "Moderate",
"phenotypes": {
"CYP2D6": "Normal Metabolizer"
},
"activityscore": {
"CYP2D6": "2.0"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
},
"comments": "Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.",
"population": "pediatrics",
"subgroups": "CYP2D6:Normal Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448999559",
"annotation_text": "Patients with the CYP2D6*1 allele may have an increased clearance of atomoxetine as compared to patients with the CYP2D6*87, *88, *90, *91, *93, *95, or *97 allele. This annotation only covers the pharmacokinetic relationship between CYP2D6 and atomoxetine and does not include evidence about clinical outcomes. Other genetic and clinical factors may also influence the metabolism of atomoxetine."
}
]
},
{
"report_table": "MAJOR",
"drug": "atorvastatin",
"drug_url": "https://drugs.com/atorvastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "SLCO1B1",
"genotype": "*1/*5",
"phenotype": "Decreased Function",
"genotype_description": "One normal function allele and one no function allele"
}
],
"qg_recommendation": "Prescribe <40mg as a starting dose and adjust doses of atorvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for 40mg dose. If dose >40mg needed for desired efficacy, consider combination therapy (i.e., atorvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391) [CPIC].",
"qg_phenotype_statement": "Decreased Dose Recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"original_recommendation": {
"drugid": "RxNorm:83367",
"drugname": "atorvastatin",
"guidelinename": "SLCO1B1, ABCG2, CYP2C9, and Statins",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"guidelinepharmgkbids": [
"PA166105005",
"PA166262221",
"PA166262241",
"PA166262261",
"PA166262281",
"PA166262321",
"PA166262341"
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"genes": [
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],
"citations": [
{
"id": 110021,
"guidelineid": 100426,
"title": "The Clinical Pharmacogenomics Implementation Consortium: Guideline for SLCO1B1 and Simvastatin-Induced Myopathy",
"authors": [
"Wilke R A",
"Ramsey L B",
"Johnson S G",
"Maxwell W D",
"McLeod H L",
"Voora D",
"Krauss R M",
"Roden D M",
"Feng Q",
"Cooper-Dehoff R M",
"Gong L",
"Klein T E",
"Wadelius M",
"Niemi M"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2012,
"pmid": "22617227",
"pmcid": "PMC3384438",
"doi": "10.1038/clpt.2012.57",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/simvastatin/2012/22617227.pdf"
},
{
"id": 110022,
"guidelineid": 100426,
"title": "The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1 and simvastatin-induced myopathy: 2014 update",
"authors": [
"Ramsey Laura B",
"Johnson Samuel G",
"Caudle Kelly E",
"Haidar Cyrine E",
"Voora Deepak",
"Wilke Russell A",
"Maxwell Whitney D",
"McLeod Howard L",
"Krauss Ronald M",
"Roden Dan M",
"Feng Qiping",
"Cooper-DeHoff Rhonda M",
"Gong Li",
"Klein Teri E",
"Wadelius Mia",
"Niemi Mikko"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 6,
"page": "",
"volume": "",
"year": 2014,
"pmid": "24918167",
"pmcid": "PMC4169720",
"doi": "10.1038/clpt.2014.125",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/simvastatin/2014/24918167.pdf"
},
{
"id": 1508721,
"guidelineid": 100426,
"title": "The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1, ABCG2, and CYP2C9 and statin-associated musculoskeletal symptoms.",
"authors": [
"Cooper-DeHoff Rhonda M",
"Niemi Mikko",
"Ramsey Laura B",
"Luzum Jasmine A",
"Tarkiainen E Katriina",
"Straka Robert J",
"Gong Li",
"Tuteja Sony",
"Wilke Russell A",
"Wadelius Mia",
"Larson Eric A",
"Roden Dan M",
"Klein Teri E",
"Yee Sook Wah",
"Krauss Ronald M",
"Turner Richard M",
"Palaniappan Latha",
"Gaedigk Andrea",
"Giacomini Kathleen M",
"Caudle Kelly E",
"Voora Deepak"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 2,
"page": null,
"volume": null,
"year": 2022,
"pmid": "35152405",
"pmcid": null,
"doi": "10.1002/cpt.2557",
"url": null,
"version": 4,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/statins/2022/publication.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"SLCO1B1": "Increased atorvastatin exposure as compared to normal function which may translate to increased myopathy risk"
},
"drugrecommendation": "Prescribe <40mg as a starting dose and adjust doses of atorvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for 40mg dose. If dose >40mg needed for desired efficacy, consider combination therapy (i.e., atorvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).",
"classification": "Moderate",
"phenotypes": {
"SLCO1B1": "Decreased Function"
},
"activityscore": {},
"allelestatus": {},
"lookupkey": {
"SLCO1B1": "Decreased Function"
},
"comments": "The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.",
"population": "population general",
"subgroups": "SLCO1B1:Decreased Function"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1043880630",
"annotation_text": "The SLCO1B1*1 allele is assigned as a normal function allele by CPIC. Patients with the SLCO1B1*1 allele in combination with another normal function allele may have decreased atorvastatin concentrations as compared to patients with a no function allele in combination with a normal or increased function allele or with two no function alleles. This annotation only covers the pharmacokinetic relationship between SLCO1B1 and atorvastatin and does not include evidence about clinical outcomes. Other genetic and clinical factors may also influence atorvastatin pharmacokinetics."
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451677736",
"annotation_text": "The SLCO1B1*1 allele is assigned as a normal function allele by CPIC. Patients carrying SLCO1B1*1 allele in combination with another normal function allele may have a lower risk of atorvastatin-related myopathy when treated with atorvastatin as compared to patients with a no function allele in combination with a normal or increased function allele or with two no function alleles. However, conflicting evidence has been reported. Other genetic and clinical factors may also influence the toxicity of atorvastatin."
}
]
},
{
"report_table": "MINOR",
"drug": "avatrombopag",
"drug_url": "https://drugs.com/mtm/avatrombopag.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/platelet-stimulating-agents.html",
"path": [
"coagulation modifiers",
"platelet-stimulating agents"
]
}
],
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*2",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
}
],
"qg_recommendation": "Results in higher systemic concentrations [FDA].",
"qg_phenotype_statement": "Decreased Dose Recommended [FDA]",
"FDA level": 3.0,
"CPIC level": "B/C",
"PharmGKB level": "",
"sources": [
{
"name": "FDA (Potential Impact on Pharmacokinetic Properties Only)",
"level": 3.0,
"url": "https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations",
"gene_drug_interaction": "Results in higher systemic concentrations."
}
]
},
{
"report_table": "USUAL",
"drug": "azathioprine",
"drug_url": "https://drugs.com/mtm/azathioprine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/antirheumatics.html",
"path": [
"miscellaneous agents",
"antirheumatics"
]
},
{
"href": "https://drugs.com/drug-class/other-immunosuppressants.html",
"path": [
"immunologic agents",
"immunosuppressive agents",
"other immunosuppressants"
]
}
],
"genes": [
{
"name": "NUDT15",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
},
{
"name": "TPMT",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Start with normal starting dose (e.g., 2-3 mg/kg/day) and adjust doses of azathioprine based on disease-specific guidelines. Allow 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506) [CPIC].",
"qg_phenotype_statement": "Standard Dose Recommended [CPIC]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": [
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-thiopurines-and-tpmt/",
"original_recommendation": {
"drugid": "RxNorm:1256",
"drugname": "azathioprine",
"guidelinename": "TPMT, NUDT15 and Thiopurines",
"url": "https://cpicpgx.org/guidelines/guideline-for-thiopurines-and-tpmt/",
"guidelinepharmgkbids": [
"PA166104933",
"PA166104945",
"PA166104965"
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"genes": [
"NUDT15",
"TPMT"
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"citations": [
{
"id": 110017,
"guidelineid": 100428,
"title": "Clinical pharmacogenetics implementation consortium guidelines for thiopurine methyltransferase genotype and thiopurine dosing",
"authors": [
"Relling M V",
"Gardner E E",
"Sandborn W J",
"Schmiegelow K",
"Pui C-H",
"Yee S W",
"Stein C M",
"Carrillo M",
"Evans W E",
"Klein T E"
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"journal": "Clinical pharmacology and therapeutics",
"month": 3,
"page": "387-91",
"volume": "89",
"year": 2011,
"pmid": "21270794",
"pmcid": "PMC3098761",
"doi": "10.1038/clpt.2010.320",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/thiopurines/2011/21270794.pdf"
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{
"id": 110024,
"guidelineid": 100428,
"title": "Clinical Pharmacogenetics Implementation Consortium Guidelines for Thiopurine Methyltransferase Genotype and Thiopurine Dosing: 2013 Update",
"authors": [
"Relling M V",
"Gardner E E",
"Sandborn W J",
"Schmiegelow K",
"Pui C-H",
"Yee S W",
"Stein C M",
"Carrillo M",
"Evans W E",
"Hicks J K",
"Schwab M",
"Klein T E"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 1,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23422873",
"pmcid": "PMC3604643",
"doi": "10.1038/clpt.2013.4",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/thiopurines/2013/23422873.pdf"
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{
"id": 110026,
"guidelineid": 100428,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for thiopurine dosing based on TPMT and NUDT15 genotypes: 2018 update.",
"authors": [
"Relling Mary V",
"Schwab Matthias",
"Whirl-Carrillo Michelle",
"Suarez-Kurtz Guilherme",
"Pui Ching-Hon",
"Stein Charles M",
"Moyer Ann M",
"Evans William E",
"Klein Teri E",
"Antillon-Klussmann Federico Guillermo",
"Caudle Kelly E",
"Kato Motohiro",
"Yeoh Allen E J",
"Schmiegelow Kjeld",
"Yang Jun J"
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"journal": "Clinical pharmacology and therapeutics",
"month": 11,
"page": "",
"volume": "",
"year": 2018,
"pmid": "30447069",
"pmcid": null,
"doi": null,
"url": null,
"version": 5,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/thiopurines/2018/30447069.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"TPMT": "Lower concentrations of TGN metabolites, higher MeTIMP, this is the 'normal' pattern. Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression.",
"NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression"
},
"drugrecommendation": "Start with normal starting dose (e.g., 2-3 mg/kg/day) and adjust doses of azathioprine based on disease-specific guidelines. Allow 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506).",
"classification": "Strong",
"phenotypes": {
"TPMT": "Normal Metabolizer",
"NUDT15": "Normal Metabolizer"
},
"activityscore": {
"TPMT": "n/a",
"NUDT15": "n/a"
},
"allelestatus": {},
"lookupkey": {
"TPMT": "Normal Metabolizer",
"NUDT15": "Normal Metabolizer"
},
"comments": "Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.",
"population": "general",
"subgroups": "NUDT15:Normal Metabolizer|TPMT:Normal Metabolizer"
}
}
]
},
{
"report_table": "USUAL",
"drug": "capecitabine",
"drug_url": "https://drugs.com/mtm/capecitabine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/antimetabolites.html",
"path": [
"antineoplastics",
"antimetabolites"
]
}
],
"genes": [
{
"name": "DPYD",
"genotype": "Reference/Reference",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Based on genotype, there is no indication to change dose or therapy. Use label-recommended dosage and administration [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-fluoropyrimidines-and-dpyd/",
"original_recommendation": {
"drugid": "RxNorm:194000",
"drugname": "capecitabine",
"guidelinename": "DPYD and Fluoropyrimidines",
"url": "https://cpicpgx.org/guidelines/guideline-for-fluoropyrimidines-and-dpyd/",
"guidelinepharmgkbids": [
"PA166109594",
"PA166122686",
"PA166122687"
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"genes": [
"DPYD"
],
"citations": [
{
"id": 110019,
"guidelineid": 100419,
"title": "Clinical Pharmacogenetics Implementation Consortium Guidelines for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing",
"authors": [
"Caudle Kelly E",
"Thorn Caroline F",
"Klein Teri E",
"Swen Jesse J",
"McLeod Howard L",
"Diasio Robert B",
"Schwab Matthias"
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"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23988873",
"pmcid": "PMC3831181",
"doi": "10.1038/clpt.2013.172",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/fluoropyrimidines/2013/23988873.pdf"
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{
"id": 110029,
"guidelineid": 100419,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 Update",
"authors": [
"Amstutz Ursula",
"Henricks Linda M",
"Offer Steven M",
"Barbarino Julia",
"Schellens Jan H M",
"Swen Jesse J",
"Klein Teri E",
"McLeod Howard L",
"Caudle Kelly E",
"Diasio Robert B",
"Schwab Matthias"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 11,
"page": "",
"volume": "",
"year": 2017,
"pmid": "29152729",
"pmcid": "PMC5760397",
"doi": "10.1002/cpt.911",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/fluoropyrimidines/2017/29152729.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"DPYD": "Normal DPD activity and \"normal\" risk for fluoropyrimidine toxicity"
},
"drugrecommendation": "Based on genotype, there is no indication to change dose or therapy. Use label-recommended dosage and administration.",
"classification": "Strong",
"phenotypes": {
"DPYD": "Normal Metabolizer"
},
"activityscore": {
"DPYD": "2.0"
},
"allelestatus": {},
"lookupkey": {
"DPYD": "2"
},
"comments": "n/a",
"population": "general",
"subgroups": "DPYD:Normal Metabolizer"
}
}
]
},
{
"report_table": "",
"drug": "carbamazepine",
"drug_url": "https://drugs.com/carbamazepine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/dibenzazepine-anticonvulsants.html",
"path": [
"central nervous system agents",
"anticonvulsants",
"dibenzazepine anticonvulsants"
]
}
],
"genes": [
{
"name": "HLA-A",
"genotype": "reference/reference",
"phenotype": "*31:01 negative",
"genotype_description": "An individual carrying no copies of the HLA-A*31:01 allele"
},
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "Normal Response Expected",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": [
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
"original_recommendation": {
"drugid": "RxNorm:2002",
"drugname": "carbamazepine",
"guidelinename": "HLA-A, HLA-B and Carbamazepine and Oxcarbazepine",
"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
"guidelinepharmgkbids": [
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"genes": [
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"HLA-B"
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"citations": [
{
"id": 110009,
"guidelineid": 100423,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for HLA-B Genotype and Carbamazepine Dosing",
"authors": [
"Leckband Susan G",
"Kelsoe John R",
"Dunnenberger H Mark",
"George Alfred L",
"Tran Eric",
"Berger Reisel",
"M\u00fcller Daniel J",
"Whirl-Carrillo Michelle",
"Caudle Kelly E",
"Pirmohamed Munir"
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"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23695185",
"pmcid": "PMC3748365",
"doi": "10.1038/clpt.2013.103",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/carbamazepine/2013/23695185.pdf"
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{
"id": 110034,
"guidelineid": 100423,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for HLA Genotype and Use of Carbamazepine and Oxcarbazepine: 2017 Update.",
"authors": [
"Phillips Elizabeth J",
"Sukasem Chonlaphat",
"Whirl-Carrillo Michelle",
"M\u00fcller Daniel J",
"Dunnenberger Henry M",
"Chantratita Wasun",
"Goldspiel Barry",
"Chen Yuan-Tsong",
"Carleton Bruce C",
"George Alfred L",
"Mushiroda Taisei",
"Klein Teri",
"Gammal Roseann S",
"Pirmohamed Munir"
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"journal": "Clinical pharmacology and therapeutics",
"month": 4,
"page": "574-581",
"volume": "103",
"year": 2018,
"pmid": "29392710",
"pmcid": "PMC5847474",
"doi": "10.1002/cpt.1004",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/carbamazepine/2017/29392710.pdf"
}
],
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"cpicVersion": "v.1.17.1",
"implications": {
"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE",
"HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"
},
"drugrecommendation": "Use carbamazepine per standard dosing guidelines.",
"classification": "Strong",
"phenotypes": {},
"activityscore": {},
"allelestatus": {
"HLA-A": "HLA-A*31:01 negative",
"HLA-B": "HLA-B*15:02 negative"
},
"lookupkey": {
"HLA-A": "*31:01 negative",
"HLA-B": "*15:02 negative"
},
"comments": "HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).",
"population": "CBZ-no alternatives",
"subgroups": "HLA-A:*31:01 negative|HLA-B:*15:02 negative"
}
},
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
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"drugname": "carbamazepine",
"guidelinename": "HLA-A, HLA-B and Carbamazepine and Oxcarbazepine",
"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
"guidelinepharmgkbids": [
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"citations": [
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"id": 110009,
"guidelineid": 100423,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for HLA-B Genotype and Carbamazepine Dosing",
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"Kelsoe John R",
"Dunnenberger H Mark",
"George Alfred L",
"Tran Eric",
"Berger Reisel",
"M\u00fcller Daniel J",
"Whirl-Carrillo Michelle",
"Caudle Kelly E",
"Pirmohamed Munir"
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"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23695185",
"pmcid": "PMC3748365",
"doi": "10.1038/clpt.2013.103",
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"version": 3,
"highlightedonsite": false,
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{
"id": 110034,
"guidelineid": 100423,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for HLA Genotype and Use of Carbamazepine and Oxcarbazepine: 2017 Update.",
"authors": [
"Phillips Elizabeth J",
"Sukasem Chonlaphat",
"Whirl-Carrillo Michelle",
"M\u00fcller Daniel J",
"Dunnenberger Henry M",
"Chantratita Wasun",
"Goldspiel Barry",
"Chen Yuan-Tsong",
"Carleton Bruce C",
"George Alfred L",
"Mushiroda Taisei",
"Klein Teri",
"Gammal Roseann S",
"Pirmohamed Munir"
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"journal": "Clinical pharmacology and therapeutics",
"month": 4,
"page": "574-581",
"volume": "103",
"year": 2018,
"pmid": "29392710",
"pmcid": "PMC5847474",
"doi": "10.1002/cpt.1004",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/carbamazepine/2017/29392710.pdf"
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],
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"cpicVersion": "v.1.17.1",
"implications": {
"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE",
"HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"
},
"drugrecommendation": "Use carbamazepine per standard dosing guidelines.",
"classification": "Strong",
"phenotypes": {},
"activityscore": {},
"allelestatus": {
"HLA-A": "HLA-A*31:01 negative",
"HLA-B": "HLA-B*15:02 negative"
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"lookupkey": {
"HLA-A": "*31:01 negative",
"HLA-B": "*15:02 negative"
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"comments": "HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).",
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"drugname": "carbamazepine",
"guidelinename": "HLA-A, HLA-B and Carbamazepine and Oxcarbazepine",
"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
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"Kelsoe John R",
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"George Alfred L",
"Tran Eric",
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"M\u00fcller Daniel J",
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"month": 5,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23695185",
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"id": 110034,
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"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for HLA Genotype and Use of Carbamazepine and Oxcarbazepine: 2017 Update.",
"authors": [
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"Whirl-Carrillo Michelle",
"M\u00fcller Daniel J",
"Dunnenberger Henry M",
"Chantratita Wasun",
"Goldspiel Barry",
"Chen Yuan-Tsong",
"Carleton Bruce C",
"George Alfred L",
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"Klein Teri",
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"id": 1608551,
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"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2C19 Genotype and Clopidogrel Therapy: 2022 Update.",
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"Luzum Jasmine A",
"Sangkuhl Katrin",
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"Stein C Michael",
"Kisor David F",
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"genotype_description": "One normal function allele and one decreased function allele"
}
],
"qg_recommendation": "May result in higher systemic concentrations and higher adverse reaction risk. Monitor for adverse reactions [FDA].",
"qg_phenotype_statement": "Standard Dose recommended [FDA]",
"FDA level": 1.0,
"CPIC level": "B/C",
"PharmGKB level": "",
"sources": [
{
"name": "FDA (Therapeutic Management Recommendations)",
"level": 1.0,
"url": "https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations",
"gene_drug_interaction": "May result in higher systemic concentrations and higher adverse reaction risk. Monitor for adverse reactions."
}
]
},
{
"report_table": "MAJOR",
"drug": "efavirenz",
"drug_url": "https://drugs.com/mtm/efavirenz.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/nnrtis.html",
"path": [
"anti-infectives",
"antiviral agents",
"NNRTIs"
]
}
],
"genes": [
{
"name": "CYP2B6",
"genotype": "*6/*6",
"phenotype": "Poor Metabolizer",
"genotype_description": "Two decreased function alleles"
}
],
"qg_recommendation": "Consider initiating efavirenz with decreased dose of 400 or 200 mg/day [CPIC]",
"qg_phenotype_statement": "Decreased Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-efavirenz-based-on-cyp2b6-genotype/",
"original_recommendation": {
"drugid": "RxNorm:195085",
"drugname": "efavirenz",
"guidelinename": "CYP2B6 and efavirenz",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-efavirenz-based-on-cyp2b6-genotype/",
"guidelinepharmgkbids": [
"PA166182603"
],
"genes": [
"CYP2B6"
],
"citations": [
{
"id": 110036,
"guidelineid": 104245,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2B6 and Efavirenz-containing Antiretroviral Therapy.",
"authors": [
"Desta Zeruesenay",
"Gammal Roseann S",
"Gong Li",
"Whirl-Carrillo Michelle",
"Gaur Aditya H",
"Sukasem Chonlaphat",
"Hockings Jennifer",
"Myers Alan",
"Swart Marelize",
"Tyndale Rachel",
"Masimirembwa Collen",
"Iwuchukwu Otito F",
"Chirwa Sanika",
"Lennox Jeffrey",
"Gaedigk Andrea",
"Klein Teri",
"Haas David W"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 4,
"page": "",
"volume": "",
"year": 2019,
"pmid": "31006110",
"pmcid": null,
"doi": null,
"url": null,
"version": 2,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/efavirenz/2019/31006110.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2B6": "Higher dose-adjusted trough concentrations of efavirenz compared with normal metabolizers; significantly increased risk of CNS adverse events and treatment discontinuation"
},
"drugrecommendation": "Consider initiating efavirenz with decreased dose of 400 or 200 mg/day",
"classification": "Moderate",
"phenotypes": {
"CYP2B6": "Poor Metabolizer"
},
"activityscore": {
"CYP2B6": "n/a"
},
"allelestatus": {},
"lookupkey": {
"CYP2B6": "Poor Metabolizer"
},
"comments": "If therapeutic drug monitoring is available and a decreased efavirenz dose is prescribed, consider obtaining steady-state plasma efavirenz concentrations to ensure concentrations are in the suggested therapeutic range (~1 to 4 \u03bcg/mL). To prescribe efavirenz at a decreased dose of 400 mg/day or 200 mg/day in a multidrug regimen may require prescribing more than one pill once daily. If so, the provider should weigh the potential benefit of reduced dose against the potential detrimental impact of increased pill number.",
"population": "child >40kg_adult",
"subgroups": "CYP2B6:Poor Metabolizer"
}
}
]
},
{
"report_table": "USUAL",
"drug": "eliglustat",
"drug_url": "https://drugs.com/mtm/eliglustat.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/miscellaneous-metabolic-agents.html",
"path": [
"metabolic agents",
"miscellaneous metabolic agents"
]
}
],
"genes": [
{
"name": "CYP2D6",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles or one normal function allele and a duplication of a decreased function allele with an activity value of 0.5 or two alleles with a duplication of a decreased function allele with an activity value of 0.5"
}
],
"qg_recommendation": "The recommended dosages are based on CYP2D6 metabolizer status. [FDA]",
"qg_phenotype_statement": "Standard Dose recommended [FDA]",
"FDA level": 1.0,
"CPIC level": "A/B",
"PharmGKB level": "",
"sources": [
{
"name": "FDA (Therapeutic Management Recommendations)",
"level": 1.0,
"url": "https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations",
"gene_drug_interaction": "Alters systemic concentrations, effectiveness, and adverse reaction risk (QT prolongation). Indicated for normal, intermediate, and poor metabolizer patients. Ultrarapid metabolizers may not achieve adequate concentrations to achieve a therapeutic effect. The recommended dosages are based on CYP2D6 metabolizer status. Coadministration with strong CYP3A inhibitors is contraindicated in intermediate and poor CYP2D6 metabolizers. Refer to FDA labeling for specific dosing recommendations."
}
]
},
{
"report_table": "USUAL",
"drug": "escitalopram",
"drug_url": "https://drugs.com/escitalopram.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/ssri-antidepressants.html",
"path": [
"psychotherapeutic agents",
"antidepressants",
"selective serotonin reuptake inhibitors"
]
}
],
"genes": [
{
"name": "CYP2C19",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Initiate therapy with recommended starting dose [CPIC]",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/",
"original_recommendation": {
"drugid": "RxNorm:321988",
"drugname": "escitalopram",
"guidelinename": "CYP2D6, CYP2C19 and Selective Serotonin Reuptake Inhibitors",
"url": "https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/",
"guidelinepharmgkbids": [
"PA166127636",
"PA166127637",
"PA166127638",
"PA166127639"
],
"genes": [
"CYP2C19"
],
"citations": [
{
"id": 110006,
"guidelineid": 100413,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors",
"authors": [
"Hicks J Kevin",
"Bishop Jeffrey R",
"Sangkuhl Katrin",
"M\u00fcller Daniel J",
"Ji Yuan",
"Leckband Susan G",
"Leeder J Steven",
"Graham Rebecca L",
"Chiulli Dana L",
"LLerena Adrian",
"Skaar Todd C",
"Scott Stuart A",
"Stingl Julia C",
"Klein Teri E",
"Caudle Kelly E",
"Gaedigk Andrea"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2015,
"pmid": "25974703",
"pmcid": "PMC4512908",
"doi": "10.1002/cpt.147",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/SSRI/2015/25974703.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C19": "Normal metabolism"
},
"drugrecommendation": "Initiate therapy with recommended starting dose",
"classification": "Strong",
"phenotypes": {
"CYP2C19": "Normal Metabolizer"
},
"activityscore": {
"CYP2C19": "n/a"
},
"allelestatus": {},
"lookupkey": {
"CYP2C19": "Normal Metabolizer"
},
"comments": "n/a",
"population": "general",
"subgroups": "CYP2C19:Normal Metabolizer"
}
}
]
},
{
"report_table": "USUAL",
"drug": "fluorouracil",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "DPYD",
"genotype": "Reference/Reference",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Based on genotype, there is no indication to change dose or therapy. Use label-recommended dosage and administration [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-fluoropyrimidines-and-dpyd/",
"original_recommendation": {
"drugid": "RxNorm:4492",
"drugname": "fluorouracil",
"guidelinename": "DPYD and Fluoropyrimidines",
"url": "https://cpicpgx.org/guidelines/guideline-for-fluoropyrimidines-and-dpyd/",
"guidelinepharmgkbids": [
"PA166109594",
"PA166122686",
"PA166122687"
],
"genes": [
"DPYD"
],
"citations": [
{
"id": 110019,
"guidelineid": 100419,
"title": "Clinical Pharmacogenetics Implementation Consortium Guidelines for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing",
"authors": [
"Caudle Kelly E",
"Thorn Caroline F",
"Klein Teri E",
"Swen Jesse J",
"McLeod Howard L",
"Diasio Robert B",
"Schwab Matthias"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23988873",
"pmcid": "PMC3831181",
"doi": "10.1038/clpt.2013.172",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/fluoropyrimidines/2013/23988873.pdf"
},
{
"id": 110029,
"guidelineid": 100419,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 Update",
"authors": [
"Amstutz Ursula",
"Henricks Linda M",
"Offer Steven M",
"Barbarino Julia",
"Schellens Jan H M",
"Swen Jesse J",
"Klein Teri E",
"McLeod Howard L",
"Caudle Kelly E",
"Diasio Robert B",
"Schwab Matthias"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 11,
"page": "",
"volume": "",
"year": 2017,
"pmid": "29152729",
"pmcid": "PMC5760397",
"doi": "10.1002/cpt.911",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/fluoropyrimidines/2017/29152729.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"DPYD": "Normal DPD activity and \"normal\" risk for fluoropyrimidine toxicity"
},
"drugrecommendation": "Based on genotype, there is no indication to change dose or therapy. Use label-recommended dosage and administration.",
"classification": "Strong",
"phenotypes": {
"DPYD": "Normal Metabolizer"
},
"activityscore": {
"DPYD": "2.0"
},
"allelestatus": {},
"lookupkey": {
"DPYD": "2"
},
"comments": "n/a",
"population": "general",
"subgroups": "DPYD:Normal Metabolizer"
}
}
]
},
{
"report_table": "MAJOR",
"drug": "flurbiprofen",
"drug_url": "https://drugs.com/mtm/flurbiprofen.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/nonsteroidal-anti-inflammatory-agents.html",
"path": [
"central nervous system agents",
"analgesics",
"Nonsteroidal anti-inflammatory drugs"
]
}
],
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*2",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
}
],
"qg_recommendation": "An individual carrying one normal function and one decreased function allele: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
"original_recommendation": {
"drugid": "RxNorm:4502",
"drugname": "flurbiprofen",
"guidelinename": "CYP2C9 and NSAIDs",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
"guidelinepharmgkbids": [
"PA166191841"
],
"genes": [
"CYP2C9"
],
"citations": [
{
"id": 571448,
"guidelineid": 110058,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and Nonsteroidal Anti-inflammatory Drugs.",
"authors": [
"Theken Katherine N",
"Lee Craig R",
"Gong Li",
"Caudle Kelly E",
"Formea Christine M",
"Gaedigk Andrea",
"Klein Teri E",
"Agundez Jose A G",
"Grosser Tilo"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 3,
"page": null,
"volume": null,
"year": 2020,
"pmid": "32189324",
"pmcid": null,
"doi": "10.1002/cpt.1830",
"url": null,
"version": 4,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/NSAID/2020/32189324.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C9": "Mildly reduced metabolism"
},
"drugrecommendation": "Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.",
"classification": "Moderate",
"phenotypes": {
"CYP2C9": "Intermediate Metabolizer"
},
"activityscore": {
"CYP2C9": "1.5"
},
"allelestatus": {},
"lookupkey": {
"CYP2C9": "1.5"
},
"comments": "IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age. Further caution should be taken with ibuprofen use in individuals carrying the CYP2C9*2 allele as it is in linkage disequilibrium with CYP2C8*3 and ibuprofen is also metabolized by CYP2C8.",
"population": "general",
"subgroups": "CYP2C9:Intermediate Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1444842106",
"annotation_text": "The CYP2C9*1 allele has been assigned as a normal function allele by CPIC. Patients carrying the CYP2C9*1 allele in combination with another normal function allele may have increased metabolism of flurbiprofen as compared to patients carrying at least one copy of a decreased or no function allele. Other genetic and clinical factors may also influence flurbiprofen metabolism. This annotation only covers the pharmacokinetic relationship between CYP2C9 and flurbiprofen and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MAJOR",
"drug": "fluvastatin",
"drug_url": "https://drugs.com/mtm/fluvastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*2",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
},
{
"name": "SLCO1B1",
"genotype": "*1/*5",
"phenotype": "Decreased Function",
"genotype_description": "One normal function allele and one no function allele"
}
],
"qg_recommendation": "Prescribe <20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391) [CPIC].",
"qg_phenotype_statement": "Decreased Dose Recommended [CPIC]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": [
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"original_recommendation": {
"drugid": "RxNorm:41127",
"drugname": "fluvastatin",
"guidelinename": "SLCO1B1, ABCG2, CYP2C9, and Statins",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"guidelinepharmgkbids": [
"PA166105005",
"PA166262221",
"PA166262241",
"PA166262261",
"PA166262281",
"PA166262321",
"PA166262341"
],
"genes": [
"CYP2C9",
"SLCO1B1"
],
"citations": [
{
"id": 110021,
"guidelineid": 100426,
"title": "The Clinical Pharmacogenomics Implementation Consortium: Guideline for SLCO1B1 and Simvastatin-Induced Myopathy",
"authors": [
"Wilke R A",
"Ramsey L B",
"Johnson S G",
"Maxwell W D",
"McLeod H L",
"Voora D",
"Krauss R M",
"Roden D M",
"Feng Q",
"Cooper-Dehoff R M",
"Gong L",
"Klein T E",
"Wadelius M",
"Niemi M"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2012,
"pmid": "22617227",
"pmcid": "PMC3384438",
"doi": "10.1038/clpt.2012.57",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/simvastatin/2012/22617227.pdf"
},
{
"id": 110022,
"guidelineid": 100426,
"title": "The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1 and simvastatin-induced myopathy: 2014 update",
"authors": [
"Ramsey Laura B",
"Johnson Samuel G",
"Caudle Kelly E",
"Haidar Cyrine E",
"Voora Deepak",
"Wilke Russell A",
"Maxwell Whitney D",
"McLeod Howard L",
"Krauss Ronald M",
"Roden Dan M",
"Feng Qiping",
"Cooper-DeHoff Rhonda M",
"Gong Li",
"Klein Teri E",
"Wadelius Mia",
"Niemi Mikko"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 6,
"page": "",
"volume": "",
"year": 2014,
"pmid": "24918167",
"pmcid": "PMC4169720",
"doi": "10.1038/clpt.2014.125",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/simvastatin/2014/24918167.pdf"
},
{
"id": 1508721,
"guidelineid": 100426,
"title": "The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1, ABCG2, and CYP2C9 and statin-associated musculoskeletal symptoms.",
"authors": [
"Cooper-DeHoff Rhonda M",
"Niemi Mikko",
"Ramsey Laura B",
"Luzum Jasmine A",
"Tarkiainen E Katriina",
"Straka Robert J",
"Gong Li",
"Tuteja Sony",
"Wilke Russell A",
"Wadelius Mia",
"Larson Eric A",
"Roden Dan M",
"Klein Teri E",
"Yee Sook Wah",
"Krauss Ronald M",
"Turner Richard M",
"Palaniappan Latha",
"Gaedigk Andrea",
"Giacomini Kathleen M",
"Caudle Kelly E",
"Voora Deepak"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 2,
"page": null,
"volume": null,
"year": 2022,
"pmid": "35152405",
"pmcid": null,
"doi": "10.1002/cpt.2557",
"url": null,
"version": 4,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/statins/2022/publication.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.",
"SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with <40 mg."
},
"drugrecommendation": "Prescribe <20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).",
"classification": "Optional",
"phenotypes": {
"CYP2C9": "Intermediate Metabolizer",
"SLCO1B1": "Decreased Function"
},
"activityscore": {
"CYP2C9": "1.5"
},
"allelestatus": {},
"lookupkey": {
"CYP2C9": "1.5",
"SLCO1B1": "Decreased Function"
},
"comments": "The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.",
"population": "general",
"subgroups": "CYP2C9:Intermediate Metabolizer|SLCO1B1:Decreased Function"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451678600",
"annotation_text": "The CYP2C9*1 allele is assigned as a normal function allele by CPIC. Patients carrying CYP2C9*1 allele in combination with another normal function allele may have decreased likelihood of adverse events when treated with fluvastatin as compared to patients carrying at least one copy of a decreased function or no function allele. However, conflicting evidence has been reported. Other genetic and clinical factors may also influence the toxicity of fluvastatin."
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451666740",
"annotation_text": "The CYP2C9*1 allele is assigned as a normal function allele by CPIC. Patients carrying CYP2C9*1 allele in combination with another normal function allele may have increased metabolism of fluvastatin as compared to patients carrying at least one copy of a decreased function or no function allele. Other genetic and clinical factors may also influence the metabolism of fluvastatin. This annotation only covers the pharmacokinetic relationship between CYP2C9 and fluvastatin and does not include evidence about clinical outcomes."
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451678620",
"annotation_text": "The SLCO1B1*1 allele is assigned as a normal function allele by CPIC. Patients carrying SLCO1B1*1 allele in combination with another normal function allele may have decreased fluvastatin concentration when treated with fluvastatin as compared to patients with a no function allele in combination with a normal or increased function allele or with two no function alleles. However, conflicting evidence has been reported. Other genetic and clinical factors may also influence the metabolism of fluvastatin. This annotation only covers the pharmacokinetic relationship between SLCO1B1 and fluvastatin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "USUAL",
"drug": "fluvoxamine",
"drug_url": "https://drugs.com/mtm/fluvoxamine.html",
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"Gaedigk A",
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],
"citations": [
{
"id": 110004,
"guidelineid": 100414,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC) for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants: 2016 Update",
"authors": [
"Kevin Hicks J",
"Sangkuhl Katrin",
"Swen Jesse J",
"Ellingrod Vicki L",
"M\u00fcller Daniel J",
"Shimoda Kazutaka",
"Bishop Jeffrey R",
"Kharasch Evan D",
"Skaar Todd C",
"Gaedigk Andrea",
"Dunnenberger Henry M",
"Klein Teri E",
"Caudle Kelly E",
"Stingl Julia C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 12,
"page": "",
"volume": "",
"year": 2016,
"pmid": "27997040",
"pmcid": "PMC5478479",
"doi": "10.1002/cpt.597",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/TCA/2016/27997040.pdf"
},
{
"id": 110011,
"guidelineid": 100414,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants",
"authors": [
"Hicks J K",
"Swen J J",
"Thorn C F",
"Sangkuhl K",
"Kharasch E D",
"Ellingrod V L",
"Skaar T C",
"M\u00fcller D J",
"Gaedigk A",
"Stingl J C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 1,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23486447",
"pmcid": "PMC3689226",
"doi": "10.1038/clpt.2013.2",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/TCA/2013/23486447.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Normal metabolism of TCAs",
"CYP2C19": "Normal metabolism of tertiary amines"
},
"drugrecommendation": "Initiate therapy with recommended starting dose.",
"classification": "Strong",
"phenotypes": {
"CYP2D6": "Normal Metabolizer",
"CYP2C19": "Normal Metabolizer"
},
"activityscore": {
"CYP2D6": "2.0",
"CYP2C19": "n/a"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2",
"CYP2C19": "Normal Metabolizer"
},
"comments": "Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.",
"population": "general",
"subgroups": "CYP2C19:Normal Metabolizer|CYP2D6:Normal Metabolizer"
}
}
]
},
{
"report_table": "MAJOR",
"drug": "ivacaftor",
"drug_url": "https://drugs.com/mtm/ivacaftor.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/cftr-potentiators.html",
"path": [
"metabolic agents",
"CFTR potentiators"
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}
],
"genes": [
{
"name": "CFTR",
"genotype": "ivacaftor non-responsive CFTR sequence/ivacaftor non-responsive CFTR sequence",
"phenotype": "ivacaftor non-responsive in CF patients",
"genotype_description": "Diagnosed with cystic fibrosis (cf) and negative for a cftr variant listed in the fda-approved drug label as being responsive to ivacaftor"
}
],
"qg_recommendation": "Ivacaftor is not recommended [CPIC].",
"qg_phenotype_statement": "Consider Alternative [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-ivacaftor-and-cftr/",
"original_recommendation": {
"drugid": "RxNorm:1243041",
"drugname": "ivacaftor",
"guidelinename": "CFTR and Ivacaftor",
"url": "https://cpicpgx.org/guidelines/guideline-for-ivacaftor-and-cftr/",
"guidelinepharmgkbids": [
"PA166114461"
],
"genes": [
"CFTR"
],
"citations": [
{
"id": 110023,
"guidelineid": 100409,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for Ivacaftor Therapy in the Context of CFTR Genotype",
"authors": [
"Clancy John P",
"Johnson Samuel G",
"Yee Sook Wah",
"McDonagh Ellen M",
"Caudle Kelly E",
"Klein Teri E",
"Cannavo Matthew",
"Giacomini Kathleen M"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 3,
"page": "",
"volume": "",
"year": 2014,
"pmid": "24598717",
"pmcid": "PMC4026598",
"doi": "10.1038/clpt.2014.54",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/ivacaftor/2014/24598717.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CFTR": "An individual diagnosed with cystic fibrosis (CF) and negative for a CFTR variant listed in the FDA-approved drug label as being responsive to ivacaftor."
},
"drugrecommendation": "Ivacaftor is not recommended",
"classification": "Moderate",
"phenotypes": {
"CFTR": "ivacaftor non-responsive in CF patients"
},
"activityscore": {
"CFTR": "n/a"
},
"allelestatus": {},
"lookupkey": {
"CFTR": "ivacaftor non-responsive in CF patients"
},
"comments": "n/a",
"population": "general",
"subgroups": "CFTR:ivacaftor non-responsive in CF patients"
}
}
]
},
{
"report_table": "USUAL",
"drug": "lansoprazole",
"drug_url": "https://drugs.com/lansoprazole.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/proton-pump-inhibitors.html",
"path": [
"gastrointestinal agents",
"proton pump inhibitors"
]
}
],
"genes": [
{
"name": "CYP2C19",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Initiate standard starting daily dose. Consider increasing dose by 50-100% for the treatment of H. pylori infection and erosive esophagitis. Daily dose may be given in divided doses. Monitor for efficacy [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-proton-pump-inhibitors-and-cyp2c19/",
"original_recommendation": {
"drugid": "RxNorm:17128",
"drugname": "lansoprazole",
"guidelinename": "CYP2C19 and Proton Pump Inhibitors",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-proton-pump-inhibitors-and-cyp2c19/",
"guidelinepharmgkbids": [
"PA166219103",
"PA166219301"
],
"genes": [
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],
"citations": [
{
"id": 571447,
"guidelineid": 110076,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Proton Pump Inhibitor Dosing.",
"authors": [
"Lima John J",
"Thomas Cameron D",
"Barbarino Julia",
"Desta Zeruesenay",
"Van Driest Sara L",
"El Rouby Nihal",
"Johnson Julie A",
"Cavallari Larisa H",
"Shakhnovich Valentina",
"Thacker David L",
"Scott Stuart A",
"Schwab Matthias",
"Uppugunduri Chakradhara Rao S",
"Formea Christine M",
"Franciosi James P",
"Sangkuhl Katrin",
"Gaedigk Andrea",
"Klein Teri E",
"Gammal Roseann S",
"Furuta Takahisa"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": null,
"volume": null,
"year": 2020,
"pmid": "32770672",
"pmcid": null,
"doi": "10.1002/cpt.2015",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/PPI/2020/32770672.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C19": "Normal PPI metabolism; may be at increased risk of therapeutic failure compared to CYP2C19 IMs and PMs"
},
"drugrecommendation": "Initiate standard starting daily dose. Consider increasing dose by 50-100% for the treatment of H. pylori infection and erosive esophagitis. Daily dose may be given in divided doses.\nMonitor for efficacy.",
"classification": "Moderate",
"phenotypes": {
"CYP2C19": "Normal Metabolizer"
},
"activityscore": {
"CYP2C19": "n/a"
},
"allelestatus": {},
"lookupkey": {
"CYP2C19": "Normal Metabolizer"
},
"comments": "n/a",
"population": "general",
"subgroups": "CYP2C19:Normal Metabolizer"
}
}
]
},
{
"report_table": "MAJOR",
"drug": "lornoxicam",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*2",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
}
],
"qg_recommendation": "Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. [CPIC]",
"qg_phenotype_statement": "Standard Dose Recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
"original_recommendation": {
"drugid": "RxNorm:20890",
"drugname": "lornoxicam",
"guidelinename": "CYP2C9 and NSAIDs",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
"guidelinepharmgkbids": [
"PA166191841"
],
"genes": [
"CYP2C9"
],
"citations": [
{
"id": 571448,
"guidelineid": 110058,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and Nonsteroidal Anti-inflammatory Drugs.",
"authors": [
"Theken Katherine N",
"Lee Craig R",
"Gong Li",
"Caudle Kelly E",
"Formea Christine M",
"Gaedigk Andrea",
"Klein Teri E",
"Agundez Jose A G",
"Grosser Tilo"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 3,
"page": null,
"volume": null,
"year": 2020,
"pmid": "32189324",
"pmcid": null,
"doi": "10.1002/cpt.1830",
"url": null,
"version": 4,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/NSAID/2020/32189324.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C9": "Mildly reduced metabolism"
},
"drugrecommendation": "Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.",
"classification": "Moderate",
"phenotypes": {
"CYP2C9": "Intermediate Metabolizer"
},
"activityscore": {
"CYP2C9": "1.5"
},
"allelestatus": {},
"lookupkey": {
"CYP2C9": "1.5"
},
"comments": "IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age. Further caution should be taken with ibuprofen use in individuals carrying the CYP2C9*2 allele as it is in linkage disequilibrium with CYP2C8*3 and ibuprofen is also metabolized by CYP2C8.",
"population": "general",
"subgroups": "CYP2C9:Intermediate Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1183703296",
"annotation_text": "The CYP2C9*1 allele is assigned as a normal function allele by CPIC. Patients carrying the CYP2C9*1 allele in combination with another normal function allele may have increased metabolism of lornoxicam as compared to patients with at lease one decreased or no function allele. Other genetic and clinical factors may also affect lornoxicam metabolism. This annotation only covers the pharmacokinetic relationship between CYP2C9 and lornoxicam and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MAJOR",
"drug": "lovastatin",
"drug_url": "https://drugs.com/mtm/lovastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "SLCO1B1",
"genotype": "*1/*5",
"phenotype": "Decreased Function",
"genotype_description": "One normal function allele and one no function allele"
}
],
"qg_recommendation": "Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins). If lovastatin therapy is warranted, limit dose to <20mg/day [CPIC].",
"qg_phenotype_statement": "Consider Alternative [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"original_recommendation": {
"drugid": "RxNorm:6472",
"drugname": "lovastatin",
"guidelinename": "SLCO1B1, ABCG2, CYP2C9, and Statins",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"guidelinepharmgkbids": [
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"PA166262221",
"PA166262241",
"PA166262261",
"PA166262281",
"PA166262321",
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"genes": [
"SLCO1B1"
],
"citations": [
{
"id": 110021,
"guidelineid": 100426,
"title": "The Clinical Pharmacogenomics Implementation Consortium: Guideline for SLCO1B1 and Simvastatin-Induced Myopathy",
"authors": [
"Wilke R A",
"Ramsey L B",
"Johnson S G",
"Maxwell W D",
"McLeod H L",
"Voora D",
"Krauss R M",
"Roden D M",
"Feng Q",
"Cooper-Dehoff R M",
"Gong L",
"Klein T E",
"Wadelius M",
"Niemi M"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2012,
"pmid": "22617227",
"pmcid": "PMC3384438",
"doi": "10.1038/clpt.2012.57",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/simvastatin/2012/22617227.pdf"
},
{
"id": 110022,
"guidelineid": 100426,
"title": "The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1 and simvastatin-induced myopathy: 2014 update",
"authors": [
"Ramsey Laura B",
"Johnson Samuel G",
"Caudle Kelly E",
"Haidar Cyrine E",
"Voora Deepak",
"Wilke Russell A",
"Maxwell Whitney D",
"McLeod Howard L",
"Krauss Ronald M",
"Roden Dan M",
"Feng Qiping",
"Cooper-DeHoff Rhonda M",
"Gong Li",
"Klein Teri E",
"Wadelius Mia",
"Niemi Mikko"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 6,
"page": "",
"volume": "",
"year": 2014,
"pmid": "24918167",
"pmcid": "PMC4169720",
"doi": "10.1038/clpt.2014.125",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/simvastatin/2014/24918167.pdf"
},
{
"id": 1508721,
"guidelineid": 100426,
"title": "The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1, ABCG2, and CYP2C9 and statin-associated musculoskeletal symptoms.",
"authors": [
"Cooper-DeHoff Rhonda M",
"Niemi Mikko",
"Ramsey Laura B",
"Luzum Jasmine A",
"Tarkiainen E Katriina",
"Straka Robert J",
"Gong Li",
"Tuteja Sony",
"Wilke Russell A",
"Wadelius Mia",
"Larson Eric A",
"Roden Dan M",
"Klein Teri E",
"Yee Sook Wah",
"Krauss Ronald M",
"Turner Richard M",
"Palaniappan Latha",
"Gaedigk Andrea",
"Giacomini Kathleen M",
"Caudle Kelly E",
"Voora Deepak"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 2,
"page": null,
"volume": null,
"year": 2022,
"pmid": "35152405",
"pmcid": null,
"doi": "10.1002/cpt.2557",
"url": null,
"version": 4,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/statins/2022/publication.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"SLCO1B1": "Increased lovastatin acid exposure as compared to normal function which may translate to increased myopathy risk"
},
"drugrecommendation": "Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins). If lovastatin therapy is warranted, limit dose to <20mg/day.",
"classification": "Moderate",
"phenotypes": {
"SLCO1B1": "Decreased Function"
},
"activityscore": {},
"allelestatus": {},
"lookupkey": {
"SLCO1B1": "Decreased Function"
},
"comments": "The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.",
"population": "population general",
"subgroups": "SLCO1B1:Decreased Function"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451678188",
"annotation_text": "The SLCO1B1*1 allele is assigned as a normal function allele by CPIC. Patients with the SLCO1B1*1 allele in combination with another normal function allele may have decreased lovastatin acid concentrations as compared to patients with a no function allele in combination with a normal or increased function allele or with two no function alleles. This annotation only covers the pharmacokinetic relationship between SLCO1B1 and lovastatin and does not include evidence about clinical outcomes. Other genetic and clinical factors may also influence a patient's lovastatin pharmacokinetics."
}
]
},
{
"report_table": "MAJOR",
"drug": "meloxicam",
"drug_url": "https://drugs.com/meloxicam.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/nonsteroidal-anti-inflammatory-agents.html",
"path": [
"central nervous system agents",
"analgesics",
"Nonsteroidal anti-inflammatory drugs"
]
}
],
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*2",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
}
],
"qg_recommendation": "accordance with the meloxicam prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.",
"qg_phenotype_statement": "Standard Dose Recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
"original_recommendation": {
"drugid": "RxNorm:41493",
"drugname": "meloxicam",
"guidelinename": "CYP2C9 and NSAIDs",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
"guidelinepharmgkbids": [
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"genes": [
"CYP2C9"
],
"citations": [
{
"id": 571448,
"guidelineid": 110058,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and Nonsteroidal Anti-inflammatory Drugs.",
"authors": [
"Theken Katherine N",
"Lee Craig R",
"Gong Li",
"Caudle Kelly E",
"Formea Christine M",
"Gaedigk Andrea",
"Klein Teri E",
"Agundez Jose A G",
"Grosser Tilo"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 3,
"page": null,
"volume": null,
"year": 2020,
"pmid": "32189324",
"pmcid": null,
"doi": "10.1002/cpt.1830",
"url": null,
"version": 4,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/NSAID/2020/32189324.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C9": "Mildly reduced metabolism"
},
"drugrecommendation": "Initiate therapy with recommended starting dose. In accordance with the meloxicam prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.",
"classification": "Moderate",
"phenotypes": {
"CYP2C9": "Intermediate Metabolizer"
},
"activityscore": {
"CYP2C9": "1.5"
},
"allelestatus": {},
"lookupkey": {
"CYP2C9": "1.5"
},
"comments": "IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age.",
"population": "general",
"subgroups": "CYP2C9:Intermediate Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451092677",
"annotation_text": "The CYP2C9*1 allele is assigned as a normal function allele by CPIC. Patients carrying the CYP2C9*1 allele in combination with another normal function allele may have increased metabolism of meloxicam as compared to patients carrying at least one copy of a decreased or no function allele. Other genetic and clinical factors may also affect meloxicam metabolism. This annotation only covers the pharmacokinetic relationship between CYP2C9 and meloxicam and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "USUAL",
"drug": "mercaptopurine",
"drug_url": "https://drugs.com/mtm/mercaptopurine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/antimetabolites.html",
"path": [
"antineoplastics",
"antimetabolites"
]
}
],
"genes": [
{
"name": "NUDT15",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
},
{
"name": "TPMT",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Start with normal starting dose (e.g., 75 mg/m2/day or 1.5 mg/kg/day) and adjust doses of mercaptopurine (and of any other myelosuppressive therapy) without any special emphasis on mercaptopurine compared to other agents. Allow at least 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 16401827, 11302950) [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": [
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-thiopurines-and-tpmt/",
"original_recommendation": {
"drugid": "RxNorm:103",
"drugname": "mercaptopurine",
"guidelinename": "TPMT, NUDT15 and Thiopurines",
"url": "https://cpicpgx.org/guidelines/guideline-for-thiopurines-and-tpmt/",
"guidelinepharmgkbids": [
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"PA166104945",
"PA166104965"
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"genes": [
"NUDT15",
"TPMT"
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"citations": [
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"id": 110017,
"guidelineid": 100428,
"title": "Clinical pharmacogenetics implementation consortium guidelines for thiopurine methyltransferase genotype and thiopurine dosing",
"authors": [
"Relling M V",
"Gardner E E",
"Sandborn W J",
"Schmiegelow K",
"Pui C-H",
"Yee S W",
"Stein C M",
"Carrillo M",
"Evans W E",
"Klein T E"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 3,
"page": "387-91",
"volume": "89",
"year": 2011,
"pmid": "21270794",
"pmcid": "PMC3098761",
"doi": "10.1038/clpt.2010.320",
"url": null,
"version": 3,
"highlightedonsite": false,
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"id": 110024,
"guidelineid": 100428,
"title": "Clinical Pharmacogenetics Implementation Consortium Guidelines for Thiopurine Methyltransferase Genotype and Thiopurine Dosing: 2013 Update",
"authors": [
"Relling M V",
"Gardner E E",
"Sandborn W J",
"Schmiegelow K",
"Pui C-H",
"Yee S W",
"Stein C M",
"Carrillo M",
"Evans W E",
"Hicks J K",
"Schwab M",
"Klein T E"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 1,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23422873",
"pmcid": "PMC3604643",
"doi": "10.1038/clpt.2013.4",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/thiopurines/2013/23422873.pdf"
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{
"id": 110026,
"guidelineid": 100428,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for thiopurine dosing based on TPMT and NUDT15 genotypes: 2018 update.",
"authors": [
"Relling Mary V",
"Schwab Matthias",
"Whirl-Carrillo Michelle",
"Suarez-Kurtz Guilherme",
"Pui Ching-Hon",
"Stein Charles M",
"Moyer Ann M",
"Evans William E",
"Klein Teri E",
"Antillon-Klussmann Federico Guillermo",
"Caudle Kelly E",
"Kato Motohiro",
"Yeoh Allen E J",
"Schmiegelow Kjeld",
"Yang Jun J"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 11,
"page": "",
"volume": "",
"year": 2018,
"pmid": "30447069",
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"doi": null,
"url": null,
"version": 5,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/thiopurines/2018/30447069.pdf"
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],
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"cpicVersion": "v.1.17.1",
"implications": {
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"NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression"
},
"drugrecommendation": "Start with normal starting dose (e.g., 75 mg/m2/day or 1.5 mg/kg/day) and adjust doses of mercaptopurine (and of any other myelosuppressive therapy) without any special emphasis on mercaptopurine compared to other agents. Allow at least 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 16401827, 11302950).",
"classification": "Strong",
"phenotypes": {
"TPMT": "Normal Metabolizer",
"NUDT15": "Normal Metabolizer"
},
"activityscore": {
"TPMT": "n/a",
"NUDT15": "n/a"
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"allelestatus": {},
"lookupkey": {
"TPMT": "Normal Metabolizer",
"NUDT15": "Normal Metabolizer"
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"comments": "Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.",
"population": "general",
"subgroups": "NUDT15:Normal Metabolizer|TPMT:Normal Metabolizer"
}
}
]
},
{
"report_table": "USUAL",
"drug": "nortriptyline",
"drug_url": "https://drugs.com/nortriptyline.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/tricyclic-antidepressants.html",
"path": [
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"antidepressants",
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"genes": [
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"name": "CYP2D6",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles or one normal function allele and a duplication of a decreased function allele with an activity value of 0.5 or two alleles with a duplication of a decreased function allele with an activity value of 0.5"
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"level": "A",
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"id": 110004,
"guidelineid": 100414,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC) for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants: 2016 Update",
"authors": [
"Kevin Hicks J",
"Sangkuhl Katrin",
"Swen Jesse J",
"Ellingrod Vicki L",
"M\u00fcller Daniel J",
"Shimoda Kazutaka",
"Bishop Jeffrey R",
"Kharasch Evan D",
"Skaar Todd C",
"Gaedigk Andrea",
"Dunnenberger Henry M",
"Klein Teri E",
"Caudle Kelly E",
"Stingl Julia C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 12,
"page": "",
"volume": "",
"year": 2016,
"pmid": "27997040",
"pmcid": "PMC5478479",
"doi": "10.1002/cpt.597",
"url": null,
"version": 3,
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"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/TCA/2016/27997040.pdf"
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{
"id": 110011,
"guidelineid": 100414,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants",
"authors": [
"Hicks J K",
"Swen J J",
"Thorn C F",
"Sangkuhl K",
"Kharasch E D",
"Ellingrod V L",
"Skaar T C",
"M\u00fcller D J",
"Gaedigk A",
"Stingl J C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 1,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23486447",
"pmcid": "PMC3689226",
"doi": "10.1038/clpt.2013.2",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/TCA/2013/23486447.pdf"
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],
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"cpicVersion": "v.1.17.1",
"implications": {
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"drugrecommendation": "Initiate therapy with recommended starting dose",
"classification": "Strong",
"phenotypes": {
"CYP2D6": "Normal Metabolizer"
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"activityscore": {
"CYP2D6": "2.0"
},
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"lookupkey": {
"CYP2D6": "2"
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"comments": "Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.",
"population": "general",
"subgroups": "CYP2D6:Normal Metabolizer"
}
}
]
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}
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"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
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}
],
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"guidelineid": 110076,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Proton Pump Inhibitor Dosing.",
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"Thomas Cameron D",
"Barbarino Julia",
"Desta Zeruesenay",
"Van Driest Sara L",
"El Rouby Nihal",
"Johnson Julie A",
"Cavallari Larisa H",
"Shakhnovich Valentina",
"Thacker David L",
"Scott Stuart A",
"Schwab Matthias",
"Uppugunduri Chakradhara Rao S",
"Formea Christine M",
"Franciosi James P",
"Sangkuhl Katrin",
"Gaedigk Andrea",
"Klein Teri E",
"Gammal Roseann S",
"Furuta Takahisa"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": null,
"volume": null,
"year": 2020,
"pmid": "32770672",
"pmcid": null,
"doi": "10.1002/cpt.2015",
"url": null,
"version": 3,
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}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C19": "Normal PPI metabolism; may be at increased risk of therapeutic failure compared to CYP2C19 IMs and PMs"
},
"drugrecommendation": "Initiate standard starting daily dose. Consider increasing dose by 50-100% for the treatment of H. pylori infection and erosive esophagitis. Daily dose may be given in divided doses.\nMonitor for efficacy.",
"classification": "Moderate",
"phenotypes": {
"CYP2C19": "Normal Metabolizer"
},
"activityscore": {
"CYP2C19": "n/a"
},
"allelestatus": {},
"lookupkey": {
"CYP2C19": "Normal Metabolizer"
},
"comments": "n/a",
"population": "general",
"subgroups": "CYP2C19:Normal Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1184754040",
"annotation_text": "Patients carrying the CYP2C19*1 allele may have increased metabolism of omeprazole as compared to patients with the CYP2C19*23, *29, *30, *31, or *33 allele when assayed with omeprazole. This annotation only covers the pharmacokinetic relationship between CYP2C19 and omeprazole and does not include evidence about clinical outcomes. Other genetic and clinical factors may also influence the metabolism of omeprazole."
}
]
},
{
"report_table": "USUAL",
"drug": "ondansetron",
"drug_url": "https://drugs.com/ondansetron.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/5ht3-receptor-antagonists.html",
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"url": "https://cpicpgx.org/guidelines/guideline-for-ondansetron-and-tropisetron-and-cyp2d6-genotype/",
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"drugname": "ondansetron",
"guidelinename": "CYP2D6 and Ondansetron and Tropisetron",
"url": "https://cpicpgx.org/guidelines/guideline-for-ondansetron-and-tropisetron-and-cyp2d6-genotype/",
"guidelinepharmgkbids": [
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"genes": [
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"id": 110013,
"guidelineid": 100417,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 Genotype and Use of Ondansetron and Tropisetron",
"authors": [
"Bell Gillian C",
"Caudle Kelly E",
"Whirl-Carrillo Michelle",
"Gordon Ronald J",
"Hikino Keiko",
"Prows Cynthia A",
"Gaedigk Andrea",
"Agundez Jose A G",
"Sadhasivam Senthilkumar",
"Klein Teri E",
"Schwab Matthias"
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"journal": "Clinical pharmacology and therapeutics",
"month": 12,
"page": "",
"volume": "",
"year": 2016,
"pmid": "28002639",
"pmcid": "PMC5479760",
"doi": "10.1002/cpt.598",
"url": null,
"version": 3,
"highlightedonsite": false,
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"cpicVersion": "v.1.17.1",
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"activityscore": {
"CYP2D6": "2.0"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
},
"comments": "Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.",
"population": "general",
"subgroups": "CYP2D6:Normal Metabolizer"
}
}
]
},
{
"report_table": "MAJOR",
"drug": "oxcarbazepine",
"drug_url": "https://drugs.com/mtm/oxcarbazepine.html",
"drug_class": [
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"href": "https://drugs.com/drug-class/dibenzazepine-anticonvulsants.html",
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}
],
"genes": [
{
"name": "HLA-B",
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"phenotype": "*15:02 negative",
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}
],
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"FDA level": "",
"CPIC level": "A",
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"sources": [
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"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
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"drugname": "oxcarbazepine",
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"guidelineid": 100423,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for HLA-B Genotype and Carbamazepine Dosing",
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"Kelsoe John R",
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"page": "",
"volume": "",
"year": 2013,
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"id": 110034,
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"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for HLA Genotype and Use of Carbamazepine and Oxcarbazepine: 2017 Update.",
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"Sukasem Chonlaphat",
"Whirl-Carrillo Michelle",
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"Goldspiel Barry",
"Chen Yuan-Tsong",
"Carleton Bruce C",
"George Alfred L",
"Mushiroda Taisei",
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"month": 4,
"page": "574-581",
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"lookupkey": {
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"month": 5,
"page": "",
"volume": "",
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"doi": "10.1038/clpt.2013.103",
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"id": 110034,
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"Whirl-Carrillo Michelle",
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},
{
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"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-proton-pump-inhibitors-and-cyp2c19/",
"original_recommendation": {
"drugid": "RxNorm:40790",
"drugname": "pantoprazole",
"guidelinename": "CYP2C19 and Proton Pump Inhibitors",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-proton-pump-inhibitors-and-cyp2c19/",
"guidelinepharmgkbids": [
"PA166219103",
"PA166219301"
],
"genes": [
"CYP2C19"
],
"citations": [
{
"id": 571447,
"guidelineid": 110076,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Proton Pump Inhibitor Dosing.",
"authors": [
"Lima John J",
"Thomas Cameron D",
"Barbarino Julia",
"Desta Zeruesenay",
"Van Driest Sara L",
"El Rouby Nihal",
"Johnson Julie A",
"Cavallari Larisa H",
"Shakhnovich Valentina",
"Thacker David L",
"Scott Stuart A",
"Schwab Matthias",
"Uppugunduri Chakradhara Rao S",
"Formea Christine M",
"Franciosi James P",
"Sangkuhl Katrin",
"Gaedigk Andrea",
"Klein Teri E",
"Gammal Roseann S",
"Furuta Takahisa"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": null,
"volume": null,
"year": 2020,
"pmid": "32770672",
"pmcid": null,
"doi": "10.1002/cpt.2015",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/PPI/2020/32770672.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C19": "Normal PPI metabolism; may be at increased risk of therapeutic failure compared to CYP2C19 IMs and PMs"
},
"drugrecommendation": "Initiate standard starting daily dose. Consider increasing dose by 50-100% for the treatment of H. pylori infection and erosive esophagitis. Daily dose may be given in divided doses.\nMonitor for efficacy.",
"classification": "Moderate",
"phenotypes": {
"CYP2C19": "Normal Metabolizer"
},
"activityscore": {
"CYP2C19": "n/a"
},
"allelestatus": {},
"lookupkey": {
"CYP2C19": "Normal Metabolizer"
},
"comments": "n/a",
"population": "general",
"subgroups": "CYP2C19:Normal Metabolizer"
}
}
]
},
{
"report_table": "USUAL",
"drug": "paroxetine",
"drug_url": "https://drugs.com/paroxetine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/ssri-antidepressants.html",
"path": [
"psychotherapeutic agents",
"antidepressants",
"selective serotonin reuptake inhibitors"
]
}
],
"genes": [
{
"name": "CYP2D6",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles or one normal function allele and a duplication of a decreased function allele with an activity value of 0.5 or two alleles with a duplication of a decreased function allele with an activity value of 0.5"
}
],
"qg_recommendation": "Initiate therapy with recommended starting dose [CPIC]",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/",
"original_recommendation": {
"drugid": "RxNorm:32937",
"drugname": "paroxetine",
"guidelinename": "CYP2D6, CYP2C19 and Selective Serotonin Reuptake Inhibitors",
"url": "https://cpicpgx.org/guidelines/guideline-for-selective-serotonin-reuptake-inhibitors-and-cyp2d6-and-cyp2c19/",
"guidelinepharmgkbids": [
"PA166127636",
"PA166127637",
"PA166127638",
"PA166127639"
],
"genes": [
"CYP2D6"
],
"citations": [
{
"id": 110006,
"guidelineid": 100413,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors",
"authors": [
"Hicks J Kevin",
"Bishop Jeffrey R",
"Sangkuhl Katrin",
"M\u00fcller Daniel J",
"Ji Yuan",
"Leckband Susan G",
"Leeder J Steven",
"Graham Rebecca L",
"Chiulli Dana L",
"LLerena Adrian",
"Skaar Todd C",
"Scott Stuart A",
"Stingl Julia C",
"Klein Teri E",
"Caudle Kelly E",
"Gaedigk Andrea"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2015,
"pmid": "25974703",
"pmcid": "PMC4512908",
"doi": "10.1002/cpt.147",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/SSRI/2015/25974703.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Normal metabolism"
},
"drugrecommendation": "Initiate therapy with recommended starting dose",
"classification": "Strong",
"phenotypes": {
"CYP2D6": "Normal Metabolizer"
},
"activityscore": {
"CYP2D6": "2.0"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
},
"comments": "n/a",
"population": "general",
"subgroups": "CYP2D6:Normal Metabolizer"
}
}
]
},
{
"report_table": "MAJOR",
"drug": "phenytoin",
"drug_url": "https://drugs.com/phenytoin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/group-i-antiarrhythmics.html",
"path": [
"cardiovascular agents",
"antiarrhythmic agents",
"group I antiarrhythmics"
]
},
{
"href": "https://drugs.com/drug-class/hydantoin-anticonvulsants.html",
"path": [
"central nervous system agents",
"anticonvulsants",
"hydantoin anticonvulsants"
]
}
],
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*2",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
}
],
"qg_recommendation": "May result in higher systemic concentrations and higher adverse reaction risk (central nervous system toxicity). Refer to FDA labeling for specific dosing recommendations. Carriers of CYP2C9*3 alleles may be at increased risk of severe cutaneous adverse reactions. Consider avoiding phenytoin as an alternative to carbamazepine in patients who are CYP2C9*3 carriers. Genotyping is not a substitute for clinical vigilance and patient management [FDA].",
"qg_phenotype_statement": "Consider Alternative [FDA]",
"FDA level": 1.0,
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "FDA (Therapeutic Management Recommendations)",
"level": 1.0,
"url": "https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations",
"gene_drug_interaction": "May result in higher systemic concentrations and higher adverse reaction risk (central nervous system toxicity). Refer to FDA labeling for specific dosing recommendations. Carriers of CYP2C9*3 alleles may be at increased risk of severe cutaneous adverse reactions. Consider avoiding phenytoin as an alternative to carbamazepine in patients who are CYP2C9*3 carriers. Genotyping is not a substitute for clinical vigilance and patient management."
},
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1449565774",
"annotation_text": "Patients carrying the CYP2C9*1 allele may have an increased rate of phenytoin clearance as compared to patients carrying the CYP2C9*19 or *36 allele, and a decreased rate of phenytoin clearance as compared to patients carrying the CYP2C9*27, *40, *41, *47, *49, *51, *53, *54 or *56 allele. Other genetic or clinical factors may also affect the clearance rate of phenytoin in a patient. This annotation only covers the pharmacokinetic relationship between CYP2C9 and phenytoin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MINOR",
"drug": "phenytoin",
"drug_url": "https://drugs.com/phenytoin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/group-i-antiarrhythmics.html",
"path": [
"cardiovascular agents",
"antiarrhythmic agents",
"group I antiarrhythmics"
]
},
{
"href": "https://drugs.com/drug-class/hydantoin-anticonvulsants.html",
"path": [
"central nervous system agents",
"anticonvulsants",
"hydantoin anticonvulsants"
]
}
],
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*2",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
},
{
"name": "HLA-B",
"genotype": "reference/reference",
"phenotype": "*15:02 negative",
"genotype_description": "An individual carrying no copies of the HLA-B*15:02 allele"
}
],
"qg_recommendation": "An individual carrying one normal function allele plus one decreased function allele; Example diplotype (*1/*2): No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN and patients should be carefully monitored according to a usual standard. ",
"qg_phenotype_statement": "Standard Dose Recommende [CPIC]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": [
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-phenytoin-and-cyp2c9-and-hla-b/",
"original_recommendation": {
"drugid": "RxNorm:8183",
"drugname": "phenytoin",
"guidelinename": "CYP2C9, HLA-B and Phenytoin",
"url": "https://cpicpgx.org/guidelines/guideline-for-phenytoin-and-cyp2c9-and-hla-b/",
"guidelinepharmgkbids": [
"PA166122806"
],
"genes": [
"CYP2C9",
"HLA-B"
],
"citations": [
{
"id": 110003,
"guidelineid": 100412,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C9 and HLA-B Genotype and Phenytoin Dosing",
"authors": [
"Caudle Kelly E",
"Rettie Allan E",
"Whirl-Carrillo Michelle",
"Smith Lisa H",
"Mintzer Scott E",
"Lee Ming Ta Michael",
"Klein Teri E",
"Callaghan J Thomas"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": "",
"volume": "",
"year": 2014,
"pmid": "25099164",
"pmcid": "PMC4206662",
"doi": "10.1038/clpt.2014.159",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/phenytoin/2014/25099164.pdf"
},
{
"id": 110077,
"guidelineid": 100412,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and HLA-B Genotypes and Phenytoin Dosing: 2020 Update.",
"authors": [
"Karnes Jason H",
"Rettie Allan E",
"Somogyi Andrew A",
"Huddart Rachel",
"Fohner Alison E",
"Formea Christine M",
"Lee Ming Ta Michael",
"Llerena Adrian",
"Whirl-Carrillo Michelle",
"Klein Teri E",
"Phillips Elizabeth J",
"Mintzer Scott",
"Gaedigk Andrea",
"Caudle Kelly E",
"Callaghan John T"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": "",
"volume": "",
"year": 2020,
"pmid": "32779747",
"pmcid": null,
"doi": null,
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/phenytoin/2020/32779747.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"HLA-B": "n/a",
"CYP2C9": "Slightly reduced phenytoin metabolism; however, this does not appear to translate into increased side effects."
},
"drugrecommendation": "No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN and patients should be carefully monitored according to a usual standard.",
"classification": "Moderate",
"phenotypes": {
"CYP2C9": "Intermediate Metabolizer"
},
"activityscore": {
"CYP2C9": "1.5"
},
"allelestatus": {
"HLA-B": "HLA-B*15:02 negative"
},
"lookupkey": {
"HLA-B": "*15:02 negative",
"CYP2C9": "1.5"
},
"comments": "n/a",
"population": "PHT naive",
"subgroups": "CYP2C9:Intermediate Metabolizer|HLA-B:*15:02 negative"
}
},
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-phenytoin-and-cyp2c9-and-hla-b/",
"original_recommendation": {
"drugid": "RxNorm:8183",
"drugname": "phenytoin",
"guidelinename": "CYP2C9, HLA-B and Phenytoin",
"url": "https://cpicpgx.org/guidelines/guideline-for-phenytoin-and-cyp2c9-and-hla-b/",
"guidelinepharmgkbids": [
"PA166122806"
],
"genes": [
"CYP2C9",
"HLA-B"
],
"citations": [
{
"id": 110003,
"guidelineid": 100412,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C9 and HLA-B Genotype and Phenytoin Dosing",
"authors": [
"Caudle Kelly E",
"Rettie Allan E",
"Whirl-Carrillo Michelle",
"Smith Lisa H",
"Mintzer Scott E",
"Lee Ming Ta Michael",
"Klein Teri E",
"Callaghan J Thomas"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": "",
"volume": "",
"year": 2014,
"pmid": "25099164",
"pmcid": "PMC4206662",
"doi": "10.1038/clpt.2014.159",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/phenytoin/2014/25099164.pdf"
},
{
"id": 110077,
"guidelineid": 100412,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and HLA-B Genotypes and Phenytoin Dosing: 2020 Update.",
"authors": [
"Karnes Jason H",
"Rettie Allan E",
"Somogyi Andrew A",
"Huddart Rachel",
"Fohner Alison E",
"Formea Christine M",
"Lee Ming Ta Michael",
"Llerena Adrian",
"Whirl-Carrillo Michelle",
"Klein Teri E",
"Phillips Elizabeth J",
"Mintzer Scott",
"Gaedigk Andrea",
"Caudle Kelly E",
"Callaghan John T"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": "",
"volume": "",
"year": 2020,
"pmid": "32779747",
"pmcid": null,
"doi": null,
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/phenytoin/2020/32779747.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"HLA-B": "n/a",
"CYP2C9": "Slightly reduced phenytoin metabolism; however, this does not appear to translate into increased side effects."
},
"drugrecommendation": "No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN and patients should be carefully monitored according to a usual standard.",
"classification": "Moderate",
"phenotypes": {
"CYP2C9": "Intermediate Metabolizer"
},
"activityscore": {
"CYP2C9": "1.5"
},
"allelestatus": {
"HLA-B": "HLA-B*15:02 negative"
},
"lookupkey": {
"HLA-B": "*15:02 negative",
"CYP2C9": "1.5"
},
"comments": "n/a",
"population": "PHT use >3mos",
"subgroups": "CYP2C9:Intermediate Metabolizer|HLA-B:*15:02 negative"
}
},
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1449565774",
"annotation_text": "Patients carrying the CYP2C9*1 allele may have an increased rate of phenytoin clearance as compared to patients carrying the CYP2C9*19 or *36 allele, and a decreased rate of phenytoin clearance as compared to patients carrying the CYP2C9*27, *40, *41, *47, *49, *51, *53, *54 or *56 allele. Other genetic or clinical factors may also affect the clearance rate of phenytoin in a patient. This annotation only covers the pharmacokinetic relationship between CYP2C9 and phenytoin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MAJOR",
"drug": "piroxicam",
"drug_url": "https://drugs.com/mtm/piroxicam.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/nonsteroidal-anti-inflammatory-agents.html",
"path": [
"central nervous system agents",
"analgesics",
"Nonsteroidal anti-inflammatory drugs"
]
}
],
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*2",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
}
],
"qg_recommendation": "Results in higher systemic concentrations [FDA]. Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. [CPIC]",
"qg_phenotype_statement": "Standard Dose Recommended [CPIC, FDA]",
"FDA level": 1.0,
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
"original_recommendation": {
"drugid": "RxNorm:8356",
"drugname": "piroxicam",
"guidelinename": "CYP2C9 and NSAIDs",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
"guidelinepharmgkbids": [
"PA166191841"
],
"genes": [
"CYP2C9"
],
"citations": [
{
"id": 571448,
"guidelineid": 110058,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and Nonsteroidal Anti-inflammatory Drugs.",
"authors": [
"Theken Katherine N",
"Lee Craig R",
"Gong Li",
"Caudle Kelly E",
"Formea Christine M",
"Gaedigk Andrea",
"Klein Teri E",
"Agundez Jose A G",
"Grosser Tilo"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 3,
"page": null,
"volume": null,
"year": 2020,
"pmid": "32189324",
"pmcid": null,
"doi": "10.1002/cpt.1830",
"url": null,
"version": 4,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/NSAID/2020/32189324.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C9": "Mildly reduced metabolism"
},
"drugrecommendation": "Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.",
"classification": "Moderate",
"phenotypes": {
"CYP2C9": "Intermediate Metabolizer"
},
"activityscore": {
"CYP2C9": "1.5"
},
"allelestatus": {},
"lookupkey": {
"CYP2C9": "1.5"
},
"comments": "IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age.",
"population": "general",
"subgroups": "CYP2C9:Intermediate Metabolizer"
}
},
{
"name": "FDA (Therapeutic Management Recommendations)",
"level": 1.0,
"url": "https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations",
"gene_drug_interaction": "Results in higher systemic concentrations. Consider reducing dosage in poor metabolizers."
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451092541",
"annotation_text": "The CYP2C9*1 allele is assigned as a normal function allele by CPIC. Patients carrying the CYP2C9*1 allele in combination with another normal function allele may have increased metabolism of piroxicam as compared to patients carrying at least one copy of a decreased or no function allele. Other genetic and clinical factors may also affect piroxicam metabolism. This annotation only covers the pharmacokinetic relationship between CYP2C9 and piroxicam and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MAJOR",
"drug": "pitavastatin",
"drug_url": "https://drugs.com/mtm/pitavastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "SLCO1B1",
"genotype": "*1/*5",
"phenotype": "Decreased Function",
"genotype_description": "One normal function allele and one no function allele"
}
],
"qg_recommendation": "Prescribe < 2mg as a starting dose and adjust doses of pitavastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >1mg. If dose >2mg needed for desired efficacy, consider an alternative statin (see Figure 1 of PMID: 35152405 for recommendations for alternative statins) or combination therapy (i.e. pitavastatin plus non-statin guideline directed medical therapy) (PMID: 30423391) [CPIC].",
"qg_phenotype_statement": "Decreased Dose Recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"original_recommendation": {
"drugid": "RxNorm:861634",
"drugname": "pitavastatin",
"guidelinename": "SLCO1B1, ABCG2, CYP2C9, and Statins",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"guidelinepharmgkbids": [
"PA166105005",
"PA166262221",
"PA166262241",
"PA166262261",
"PA166262281",
"PA166262321",
"PA166262341"
],
"genes": [
"SLCO1B1"
],
"citations": [
{
"id": 110021,
"guidelineid": 100426,
"title": "The Clinical Pharmacogenomics Implementation Consortium: Guideline for SLCO1B1 and Simvastatin-Induced Myopathy",
"authors": [
"Wilke R A",
"Ramsey L B",
"Johnson S G",
"Maxwell W D",
"McLeod H L",
"Voora D",
"Krauss R M",
"Roden D M",
"Feng Q",
"Cooper-Dehoff R M",
"Gong L",
"Klein T E",
"Wadelius M",
"Niemi M"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2012,
"pmid": "22617227",
"pmcid": "PMC3384438",
"doi": "10.1038/clpt.2012.57",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/simvastatin/2012/22617227.pdf"
},
{
"id": 110022,
"guidelineid": 100426,
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"title": "The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1, ABCG2, and CYP2C9 and statin-associated musculoskeletal symptoms.",
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"Niemi Mikko",
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"url": "https://www.pharmgkb.org/clinicalAnnotation/1450814813",
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"Ramsey L B",
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"title": "The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1, ABCG2, and CYP2C9 and statin-associated musculoskeletal symptoms.",
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"Niemi Mikko",
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{
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"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451231100",
"annotation_text": "The CYP2C9*1 allele is assigned as a normal function allele by CPIC. Patients carrying the CYP2C9*1 allele in combination with another normal function allele may have increased metabolism and decreased plasma concentrations of siponimod as compared to patients carrying at least one decreased or no function alleles. Other genetic and clinical factors may also influence the metabolism of siponimod. This annotation only covers the pharmacokinetic relationship between CYP2C9 and siponimod and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MAJOR",
"drug": "tacrolimus",
"drug_url": "https://drugs.com/pro/tacrolimus.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/calcineurin-inhibitors.html",
"path": [
"immunologic agents",
"immunosuppressive agents",
"calcineurin inhibitors"
]
}
],
"genes": [
{
"name": "CYP3A5",
"genotype": "*1/*3",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one no function allele"
}
],
"qg_recommendation": "Results in lower systemic concentrations, lower probability of achieving target concentrations and may result in higher rejection risk. Measure drug concentrations and adjust dosage based on trough whole blood tacrolimus concentrations [FDA]. Increase starting dose 1.5 to 2 times recommended starting dose. Total starting dose should not exceed 0.3 mg/kg/day. Use therapeutic drug monitoring to guide dose adjustments [CPIC].",
"qg_phenotype_statement": "Increased Dose Recommended [CPIC, FDA]",
"FDA level": 1.0,
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-tacrolimus-and-cyp3a5/",
"original_recommendation": {
"drugid": "RxNorm:42316",
"drugname": "tacrolimus",
"guidelinename": "CYP3A5 and Tacrolimus",
"url": "https://cpicpgx.org/guidelines/guideline-for-tacrolimus-and-cyp3a5/",
"guidelinepharmgkbids": [
"PA166124619"
],
"genes": [
"CYP3A5"
],
"citations": [
{
"id": 110002,
"guidelineid": 100418,
"title": "Clinical pharmacogenetics implementation consortium (CPIC) guidelines for CYP3A5 genotype and tacrolimus dosing",
"authors": [
"Birdwell Kelly A",
"Decker Brian",
"Barbarino Julia M",
"Peterson Josh F",
"Stein C Michael",
"Sadee Wolfgang",
"Wang Danxin",
"Vinks Alexander A",
"He Yijing",
"Swen Jesse J",
"Leeder J Steven",
"van Schaik R H N",
"Thummel Kenneth E",
"Klein Teri E",
"Caudle Kelly E",
"MacPhee Iain A M"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 3,
"page": "",
"volume": "",
"year": 2015,
"pmid": "25801146",
"pmcid": "PMC4481158",
"doi": "10.1002/cpt.113",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/tacrolimus/2015/25801146.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP3A5": "Lower dose-adjusted trough concentrations of tacrolimus and decreased chance of achieving target tacrolimus concentrations."
},
"drugrecommendation": "Increase starting dose 1.5 to 2 times recommended starting dose. Total starting dose should not exceed 0.3 mg/kg/day. Use therapeutic drug monitoring to guide dose adjustments.",
"classification": "Strong",
"phenotypes": {
"CYP3A5": "Intermediate Metabolizer"
},
"activityscore": {
"CYP3A5": "n/a"
},
"allelestatus": {},
"lookupkey": {
"CYP3A5": "Intermediate Metabolizer"
},
"comments": "This recommendation includes the use of tacrolimus in kidney, heart, lung and hematopoietic stem cell transplant patients, and liver transplant patients where the donor and recipient genotypes are identical. Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors (e.g., medication interactions, or hepatic function).Typically with other CYP enzymes, a normal metabolizer would be classified as having normal metabolism, and therefore, the drug dose would not change based on the patient's genotype. However, in the case of CYP3A5 and tacrolimus, a CYP3A5 expresser (i.e., CYP3A5 normal metabolizer or intermediate metabolizer) would require a higher recommended starting dose and the CYP3A5 non-expresser (i.e., poor metabolizer) would require the standard recommended starting dose.",
"population": "general",
"subgroups": "CYP3A5:Intermediate Metabolizer"
}
},
{
"name": "FDA (Therapeutic Management Recommendations)",
"level": 1.0,
"url": "https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations",
"gene_drug_interaction": "Results in lower systemic concentrations, lower probability of achieving target concentrations and may result in higher rejection risk. Measure drug concentrations and adjust dosage based on trough whole blood tacrolimus concentrations."
}
]
},
{
"report_table": "USUAL",
"drug": "tamoxifen",
"drug_url": "https://drugs.com/tamoxifen.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hormones-antineoplastics.html",
"path": [
"antineoplastics",
"hormones/antineoplastics"
]
},
{
"href": "https://drugs.com/drug-class/selective-estrogen-receptor-modulators.html",
"path": [
"hormones",
"selective estrogen receptor modulators"
]
}
],
"genes": [
{
"name": "CYP2D6",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles or one normal function allele and a duplication of a decreased function allele with an activity value of 0.5 or two alleles with a duplication of a decreased function allele with an activity value of 0.5"
}
],
"qg_recommendation": "Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day) [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-tamoxifen-based-on-cyp2d6-genotype/",
"original_recommendation": {
"drugid": "RxNorm:10324",
"drugname": "tamoxifen",
"guidelinename": "CYP2D6 and Tamoxifen",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-tamoxifen-based-on-cyp2d6-genotype/",
"guidelinepharmgkbids": [
"PA166176068"
],
"genes": [
"CYP2D6"
],
"citations": [
{
"id": 110010,
"guidelineid": 100415,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 and Tamoxifen Therapy.",
"authors": [
"Goetz Matthew P",
"Sangkuhl Katrin",
"Guchelaar Henk-Jan",
"Schwab Matthias",
"Province Michael",
"Whirl-Carrillo Michelle",
"Symmans W Fraser",
"McLeod Howard L",
"Ratain Mark J",
"Zembutsu Hitoshi",
"Gaedigk Andrea",
"van Schaik Ron H",
"Ingle James N",
"Caudle Kelly E",
"Klein Teri E"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 5,
"page": "",
"volume": "",
"year": 2018,
"pmid": "29385237",
"pmcid": "PMC5931215",
"doi": "10.1002/cpt.1007",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/tamoxifen/2017/29385237.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Therapeutic endoxifen concentrations"
},
"drugrecommendation": "Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).",
"classification": "Strong",
"phenotypes": {
"CYP2D6": "Normal Metabolizer"
},
"activityscore": {
"CYP2D6": "2.0"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
},
"comments": "n/a",
"population": "general",
"subgroups": "CYP2D6:Normal Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1449000317",
"annotation_text": "Patients with the CYP2D6*1 allele may have increased clearance of tamoxifen as compared to patients with the CYP2D6*87 or *90 or *91 or *93 or *95 or *98 allele. This annotation only covers the pharmacokinetic relationship between CYP2D6 and tamoxifen and does not include evidence about clinical outcomes. Other genetic and clinical factors may also influence the metabolism of tamoxifen."
}
]
},
{
"report_table": "MAJOR",
"drug": "tenoxicam",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*2",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
}
],
"qg_recommendation": "Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. [CPIC]",
"qg_phenotype_statement": "Standard Dose Recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
"original_recommendation": {
"drugid": "RxNorm:37790",
"drugname": "tenoxicam",
"guidelinename": "CYP2C9 and NSAIDs",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
"guidelinepharmgkbids": [
"PA166191841"
],
"genes": [
"CYP2C9"
],
"citations": [
{
"id": 571448,
"guidelineid": 110058,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and Nonsteroidal Anti-inflammatory Drugs.",
"authors": [
"Theken Katherine N",
"Lee Craig R",
"Gong Li",
"Caudle Kelly E",
"Formea Christine M",
"Gaedigk Andrea",
"Klein Teri E",
"Agundez Jose A G",
"Grosser Tilo"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 3,
"page": null,
"volume": null,
"year": 2020,
"pmid": "32189324",
"pmcid": null,
"doi": "10.1002/cpt.1830",
"url": null,
"version": 4,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/NSAID/2020/32189324.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C9": "Mildly reduced metabolism"
},
"drugrecommendation": "Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.",
"classification": "Moderate",
"phenotypes": {
"CYP2C9": "Intermediate Metabolizer"
},
"activityscore": {
"CYP2C9": "1.5"
},
"allelestatus": {},
"lookupkey": {
"CYP2C9": "1.5"
},
"comments": "IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age.",
"population": "general",
"subgroups": "CYP2C9:Intermediate Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451092460",
"annotation_text": "The CYP2C9*1 allele has been assigned as a normal function allele by CPIC. Patients carrying the *1 allele in combination with another normal function allele may have increased metabolism of tenoxicam as compared to patients carrying two decreased or no function alleles or a normal function allele in combination with a decreased or no function allele. This annotation only covers the pharmacokinetic relationship between CYP2C9 and tenoxicam and does not include evidence about clinical outcomes. Other genetic and clinical factors may also affect tenoxicam metabolism."
}
]
},
{
"report_table": "USUAL",
"drug": "thioguanine",
"drug_url": "https://drugs.com/mtm/thioguanine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/antimetabolites.html",
"path": [
"antineoplastics",
"antimetabolites"
]
}
],
"genes": [
{
"name": "NUDT15",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
},
{
"name": "TPMT",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Start with normal starting dose (e.g., 40-60 mg/m2/day) and adjust doses of thioguanine and of other myelosuppressive therapy without any special emphasis on thioguanine. Allow 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11037857) [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": [
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-thiopurines-and-tpmt/",
"original_recommendation": {
"drugid": "RxNorm:10485",
"drugname": "thioguanine",
"guidelinename": "TPMT, NUDT15 and Thiopurines",
"url": "https://cpicpgx.org/guidelines/guideline-for-thiopurines-and-tpmt/",
"guidelinepharmgkbids": [
"PA166104933",
"PA166104945",
"PA166104965"
],
"genes": [
"NUDT15",
"TPMT"
],
"citations": [
{
"id": 110017,
"guidelineid": 100428,
"title": "Clinical pharmacogenetics implementation consortium guidelines for thiopurine methyltransferase genotype and thiopurine dosing",
"authors": [
"Relling M V",
"Gardner E E",
"Sandborn W J",
"Schmiegelow K",
"Pui C-H",
"Yee S W",
"Stein C M",
"Carrillo M",
"Evans W E",
"Klein T E"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 3,
"page": "387-91",
"volume": "89",
"year": 2011,
"pmid": "21270794",
"pmcid": "PMC3098761",
"doi": "10.1038/clpt.2010.320",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/thiopurines/2011/21270794.pdf"
},
{
"id": 110024,
"guidelineid": 100428,
"title": "Clinical Pharmacogenetics Implementation Consortium Guidelines for Thiopurine Methyltransferase Genotype and Thiopurine Dosing: 2013 Update",
"authors": [
"Relling M V",
"Gardner E E",
"Sandborn W J",
"Schmiegelow K",
"Pui C-H",
"Yee S W",
"Stein C M",
"Carrillo M",
"Evans W E",
"Hicks J K",
"Schwab M",
"Klein T E"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 1,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23422873",
"pmcid": "PMC3604643",
"doi": "10.1038/clpt.2013.4",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/thiopurines/2013/23422873.pdf"
},
{
"id": 110026,
"guidelineid": 100428,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for thiopurine dosing based on TPMT and NUDT15 genotypes: 2018 update.",
"authors": [
"Relling Mary V",
"Schwab Matthias",
"Whirl-Carrillo Michelle",
"Suarez-Kurtz Guilherme",
"Pui Ching-Hon",
"Stein Charles M",
"Moyer Ann M",
"Evans William E",
"Klein Teri E",
"Antillon-Klussmann Federico Guillermo",
"Caudle Kelly E",
"Kato Motohiro",
"Yeoh Allen E J",
"Schmiegelow Kjeld",
"Yang Jun J"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 11,
"page": "",
"volume": "",
"year": 2018,
"pmid": "30447069",
"pmcid": null,
"doi": null,
"url": null,
"version": 5,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/thiopurines/2018/30447069.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"TPMT": "Lower concentrations of TGN metabolites, but note that TGN after thioguanine are 5-10X higher than TGN after mercaptopurine or azathioprine. Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression.",
"NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression"
},
"drugrecommendation": "Start with normal starting dose (e.g., 40-60 mg/m2/day) and adjust doses of thioguanine and of other myelosuppressive therapy without any special emphasis on thioguanine. Allow 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11037857).",
"classification": "Strong",
"phenotypes": {
"TPMT": "Normal Metabolizer",
"NUDT15": "Normal Metabolizer"
},
"activityscore": {
"TPMT": "n/a",
"NUDT15": "n/a"
},
"allelestatus": {},
"lookupkey": {
"TPMT": "Normal Metabolizer",
"NUDT15": "Normal Metabolizer"
},
"comments": "Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.",
"population": "general",
"subgroups": "NUDT15:Normal Metabolizer|TPMT:Normal Metabolizer"
}
}
]
},
{
"report_table": "USUAL",
"drug": "tramadol",
"drug_url": "https://drugs.com/tramadol.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/narcotic-analgesics.html",
"path": [
"central nervous system agents",
"analgesics",
"narcotic analgesics"
]
}
],
"genes": [
{
"name": "CYP2D6",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles or one normal function allele and a duplication of a decreased function allele with an activity value of 0.5 or two alleles with a duplication of a decreased function allele with an activity value of 0.5"
}
],
"qg_recommendation": "Use tramadol label recommended age- or weight-specific dosing [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-codeine-and-cyp2d6/",
"original_recommendation": {
"drugid": "RxNorm:10689",
"drugname": "tramadol",
"guidelinename": "CYP2D6, OPRM1, COMT, and Opioids",
"url": "https://cpicpgx.org/guidelines/guideline-for-codeine-and-cyp2d6/",
"guidelinepharmgkbids": [
"PA166104996"
],
"genes": [
"CYP2D6"
],
"citations": [
{
"id": 110031,
"guidelineid": 100416,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for Codeine Therapy in the Context of Cytochrome P450 2D6 (CYP2D6) Genotype",
"authors": [
"Crews K R",
"Gaedigk A",
"Dunnenberger H M",
"Klein T E",
"Shen D D",
"Callaghan J T",
"Kharasch E D",
"Skaar T C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 12,
"page": "",
"volume": "",
"year": 2011,
"pmid": "22205192",
"pmcid": "PMC3289963",
"doi": "10.1038/clpt.2011.287",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/codeine/2012/22205192.pdf"
},
{
"id": 110033,
"guidelineid": 100416,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for cytochrome P450 2D6 (CYP2D6) genotype and codeine therapy: 2014 Update",
"authors": [
"Crews Kristine R",
"Gaedigk Andrea",
"Dunnenberger Henry M",
"Leeder J Steve",
"Klein Teri E",
"Caudle Kelly E",
"Haidar Cyrine E",
"Shen Danny D",
"Callaghan John T",
"Sadhasivam Senthilkumar",
"Prows Cynthia A",
"Kharasch Evan D",
"Skaar Todd C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 1,
"page": "",
"volume": "",
"year": 2014,
"pmid": "24458010",
"pmcid": "PMC3975212",
"doi": "10.1038/clpt.2013.254",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/codeine/2014/24458010.pdf"
},
{
"id": 417705,
"guidelineid": 100416,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6, OPRM1, and COMT genotype and select opioid therapy.",
"authors": [
"Crews Kristine R",
"Monte Andrew A",
"Huddart Rachel",
"Caudle Kelly E",
"Kharasch Evan D",
"Gaedigk Andrea",
"Dunnenberger Henry M",
"Leeder J Steven",
"Callaghan John T",
"Samer Caroline Flora",
"Klein Teri E",
"Haidar Cyrine E",
"Van Driest Sara L",
"Ruano Gualberto",
"Sangkuhl Katrin",
"Cavallari Larisa H",
"M\u00fcller Daniel J",
"Prows Cynthia A",
"Nagy Mohamed",
"Somogyi Andrew A",
"Skaar Todd C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 1,
"page": null,
"volume": null,
"year": 2021,
"pmid": "33387367",
"pmcid": null,
"doi": "10.1002/cpt.2149",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/opioids/2020/33387367.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Expected O-desmethyltramadol (active metabolite) formation"
},
"drugrecommendation": "Use tramadol label recommended age- or weight-specific dosing.",
"classification": "Strong",
"phenotypes": {
"CYP2D6": "Normal Metabolizer"
},
"activityscore": {
"CYP2D6": "2"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
},
"comments": "n/a",
"population": "general",
"subgroups": "CYP2D6:Normal Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451208340",
"annotation_text": "Patients carrying the *1 allele in combination with another normal function or a decreased function allele may have a decreased risk of experiencing sedation when treated with postoperative tramadol and ketoprofen as compared to patients with two decreased function alleles or a no function allele in combination with a decreased function or a normal function allele. Other genetic and clinical factors may also affect a patient's risk of sedation when treated with tramadol and ketoprofen."
}
]
},
{
"report_table": "USUAL",
"drug": "trimipramine",
"drug_url": "https://drugs.com/mtm/trimipramine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/tricyclic-antidepressants.html",
"path": [
"psychotherapeutic agents",
"antidepressants",
"tricyclic antidepressants"
]
}
],
"genes": [
{
"name": "CYP2C19",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
},
{
"name": "CYP2D6",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles or one normal function allele and a duplication of a decreased function allele with an activity value of 0.5 or two alleles with a duplication of a decreased function allele with an activity value of 0.5"
}
],
"qg_recommendation": "Initiate therapy with recommended starting dose [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "",
"PharmGKB level": "",
"sources": [
{
"name": "CPIC",
"level": "",
"url": "https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/",
"original_recommendation": {
"drugid": "RxNorm:10834",
"drugname": "trimipramine",
"guidelinename": "CYP2D6, CYP2C19 and Tricyclic Antidepressants",
"url": "https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/",
"guidelinepharmgkbids": [
"PA166104998",
"PA166104999",
"PA166105000",
"PA166105001",
"PA166105002",
"PA166105006",
"PA166105007"
],
"genes": [
"CYP2C19",
"CYP2D6"
],
"citations": [
{
"id": 110004,
"guidelineid": 100414,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC) for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants: 2016 Update",
"authors": [
"Kevin Hicks J",
"Sangkuhl Katrin",
"Swen Jesse J",
"Ellingrod Vicki L",
"M\u00fcller Daniel J",
"Shimoda Kazutaka",
"Bishop Jeffrey R",
"Kharasch Evan D",
"Skaar Todd C",
"Gaedigk Andrea",
"Dunnenberger Henry M",
"Klein Teri E",
"Caudle Kelly E",
"Stingl Julia C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 12,
"page": "",
"volume": "",
"year": 2016,
"pmid": "27997040",
"pmcid": "PMC5478479",
"doi": "10.1002/cpt.597",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/TCA/2016/27997040.pdf"
},
{
"id": 110011,
"guidelineid": 100414,
"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants",
"authors": [
"Hicks J K",
"Swen J J",
"Thorn C F",
"Sangkuhl K",
"Kharasch E D",
"Ellingrod V L",
"Skaar T C",
"M\u00fcller D J",
"Gaedigk A",
"Stingl J C"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 1,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23486447",
"pmcid": "PMC3689226",
"doi": "10.1038/clpt.2013.2",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/TCA/2013/23486447.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Normal metabolism of TCAs",
"CYP2C19": "Normal metabolism of tertiary amines"
},
"drugrecommendation": "Initiate therapy with recommended starting dose.",
"classification": "Strong",
"phenotypes": {
"CYP2D6": "Normal Metabolizer",
"CYP2C19": "Normal Metabolizer"
},
"activityscore": {
"CYP2D6": "2.0",
"CYP2C19": "n/a"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2",
"CYP2C19": "Normal Metabolizer"
},
"comments": "Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.",
"population": "general",
"subgroups": "CYP2C19:Normal Metabolizer|CYP2D6:Normal Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1183621987",
"annotation_text": "The CYP2C19*1 allele is assigned as a normal function allele by CPIC. Patients carrying the CYP2C19*1 allele in combination with another normal function allele may have increased metabolism of trimipramine as compared to patients with a no or decreased function allele in combination with a normal or increased function allele or with two no or decreased function alleles. This annotation only covers the pharmacokinetic relationship between CYP2C19 and trimipramine and does not include evidence about clinical outcomes. Other genetic and clinical factors may also influence the metabolism of trimipramine."
}
]
},
{
"report_table": "USUAL",
"drug": "tropisetron",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP2D6",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles or one normal function allele and a duplication of a decreased function allele with an activity value of 0.5 or two alleles with a duplication of a decreased function allele with an activity value of 0.5"
}
],
"qg_recommendation": "Initiate therapy with recommended starting dose [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-ondansetron-and-tropisetron-and-cyp2d6-genotype/",
"original_recommendation": {
"drugid": "RxNorm:27392",
"drugname": "tropisetron",
"guidelinename": "CYP2D6 and Ondansetron and Tropisetron",
"url": "https://cpicpgx.org/guidelines/guideline-for-ondansetron-and-tropisetron-and-cyp2d6-genotype/",
"guidelinepharmgkbids": [
"PA166161954",
"PA166161955"
],
"genes": [
"CYP2D6"
],
"citations": [
{
"id": 110013,
"guidelineid": 100417,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 Genotype and Use of Ondansetron and Tropisetron",
"authors": [
"Bell Gillian C",
"Caudle Kelly E",
"Whirl-Carrillo Michelle",
"Gordon Ronald J",
"Hikino Keiko",
"Prows Cynthia A",
"Gaedigk Andrea",
"Agundez Jose A G",
"Sadhasivam Senthilkumar",
"Klein Teri E",
"Schwab Matthias"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 12,
"page": "",
"volume": "",
"year": 2016,
"pmid": "28002639",
"pmcid": "PMC5479760",
"doi": "10.1002/cpt.598",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/ondansetron/2016/28002639.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Normal metabolism"
},
"drugrecommendation": "Initiate therapy with recommended starting dose.",
"classification": "Strong",
"phenotypes": {
"CYP2D6": "Normal Metabolizer"
},
"activityscore": {
"CYP2D6": "2.0"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
},
"comments": "Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.",
"population": "general",
"subgroups": "CYP2D6:Normal Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1450929867",
"annotation_text": "The CYP2D6*1 allele has been assigned as a normal function allele by CPIC. Patients carrying the *1 allele in combination with another normal function allele may have similar metabolism of tropisetron as compared to patients with alleles that result in a normal metabolizer phenotype, while patients carrying the *1 allele in combination with an increased function allele may have increased metabolism of tropisetron as compared to patients with alleles that result in a normal metabolizer phenotype. Patients carrying the *1 allele in combination with a decreased function allele or a no function allele may have decreased metabolism of tropisetron as compared to patients with alleles that result in a normal metabolizer phenotype. Be aware that the CPIC guideline for tropisetron and CYP2D6 has a 'no recommendation' for CYP2D6 intermediate and poor metabolizers. This annotation only covers the pharmacokinetic relationship between CYP2D6 and tropisetron and does not include evidence about clinical outcomes. Other genetic and clinical factors may also influence tropisetron metabolism."
}
]
},
{
"report_table": "USUAL",
"drug": "voriconazole",
"drug_url": "https://drugs.com/cons/voriconazole.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/azole-antifungals.html",
"path": [
"anti-infectives",
"antifungals",
"azole antifungals"
]
}
],
"genes": [
{
"name": "CYP2C19",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Initiate therapy with recommended standard of care dosing [CPIC]",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-voriconazole-and-cyp2c19/",
"original_recommendation": {
"drugid": "RxNorm:121243",
"drugname": "voriconazole",
"guidelinename": "CYP2C19 and Voriconazole",
"url": "https://cpicpgx.org/guidelines/guideline-for-voriconazole-and-cyp2c19/",
"guidelinepharmgkbids": [
"PA166161537"
],
"genes": [
"CYP2C19"
],
"citations": [
{
"id": 110001,
"guidelineid": 100410,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Voriconazole Therapy",
"authors": [
"Moriyama Brad",
"Obeng Aniwaa Owusu",
"Barbarino Julia",
"Penzak Scott R",
"Henning Stacey A",
"Scott Stuart A",
"Agundez Jose A G",
"Wingard John R",
"McLeod Howard L",
"Klein Teri E",
"Cross Shane",
"Caudle Kelly E",
"Walsh Thomas J"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 12,
"page": "",
"volume": "",
"year": 2016,
"pmid": "27981572",
"pmcid": "PMC5474211",
"doi": "10.1002/cpt.583",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/voriconazole/2016/27981572.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C19": "Normal voriconazole metabolism"
},
"drugrecommendation": "Initiate therapy with recommended standard of care dosing",
"classification": "Strong",
"phenotypes": {
"CYP2C19": "Normal Metabolizer"
},
"activityscore": {},
"allelestatus": {},
"lookupkey": {
"CYP2C19": "Normal Metabolizer"
},
"comments": "Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.",
"population": "adults",
"subgroups": "CYP2C19:Normal Metabolizer"
}
},
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-voriconazole-and-cyp2c19/",
"original_recommendation": {
"drugid": "RxNorm:121243",
"drugname": "voriconazole",
"guidelinename": "CYP2C19 and Voriconazole",
"url": "https://cpicpgx.org/guidelines/guideline-for-voriconazole-and-cyp2c19/",
"guidelinepharmgkbids": [
"PA166161537"
],
"genes": [
"CYP2C19"
],
"citations": [
{
"id": 110001,
"guidelineid": 100410,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Voriconazole Therapy",
"authors": [
"Moriyama Brad",
"Obeng Aniwaa Owusu",
"Barbarino Julia",
"Penzak Scott R",
"Henning Stacey A",
"Scott Stuart A",
"Agundez Jose A G",
"Wingard John R",
"McLeod Howard L",
"Klein Teri E",
"Cross Shane",
"Caudle Kelly E",
"Walsh Thomas J"
],
"journal": "Clinical pharmacology and therapeutics",
"month": 12,
"page": "",
"volume": "",
"year": 2016,
"pmid": "27981572",
"pmcid": "PMC5474211",
"doi": "10.1002/cpt.583",
"url": null,
"version": 3,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/voriconazole/2016/27981572.pdf"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP2C19": "Normal voriconazole metabolism"
},
"drugrecommendation": "Initiate therapy with recommended standard of care dosing",
"classification": "Strong",
"phenotypes": {
"CYP2C19": "Normal Metabolizer"
},
"activityscore": {},
"allelestatus": {},
"lookupkey": {
"CYP2C19": "Normal Metabolizer"
},
"comments": "Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.",
"population": "pediatrics",
"subgroups": "CYP2C19:Normal Metabolizer"
}
}
]
},
{
"report_table": "MAJOR",
"drug": "warfarin",
"drug_url": "https://drugs.com/warfarin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/coumarins-and-indandiones.html",
"path": [
"coagulation modifiers",
"anticoagulants",
"coumarins and indandiones"
]
}
],
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*2",
"phenotype": "Intermediate Metabolizer",
"genotype_description": "One normal function allele and one decreased function allele"
}
],
"qg_recommendation": "Alters systemic concentrations and dosage requirements. Select initial dosage, taking into account clinical and genetic factors. Monitor and adjust dosages based on INR [FDA].",
"qg_phenotype_statement": "Standard Dose recommended [FDA]",
"FDA level": 1.0,
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
{
"name": "FDA (Therapeutic Management Recommendations)",
"level": 1.0,
"url": "https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations",
"gene_drug_interaction": "Alters systemic concentrations and dosage requirements. Select initial dosage, taking into account clinical and genetic factors. Monitor and adjust dosages based on INR."
},
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451148920",
"annotation_text": "Patients carrying the *1 allele in addition to another normal function allele may have increased metabolism of warfarin as compared to patients with at least one copy of a decreased or no function allele. Other genetic and clinical factors may also affect warfarin metabolism. This annotation only covers the pharmacokinetic relationship between CYP2C9 and warfarin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MAJOR",
"drug": "acenocoumarol",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "VKORC1",
"genotype": "rs9923231 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs9923231 TT genotype may require a decreased dose as of acenocoumarol compared to patients with the CC genotype. However, conflicting evidence has been reported. Other genetic and clinical factors may also influence acenocoumarol dose requirements. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/981204044",
"annotation_text": "Patients with the rs9923231 TT genotype may require a decreased dose as of acenocoumarol compared to patients with the CC genotype. However, conflicting evidence has been reported. Other genetic and clinical factors may also influence acenocoumarol dose requirements."
}
]
},
{
"report_table": "MAJOR",
"drug": "atorvastatin",
"drug_url": "https://drugs.com/atorvastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "SLCO1B1",
"genotype": "rs4149056 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may have increased exposure to atorvastatin as compared to patients with the TT genotype. Other genetic and clinical factors may also affect a patient's exposure to atorvastatin. This annotation only covers the pharmacokinetic relationship between rs4149056 and atorvastatin and does not include evidence about clinical outcomes. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451244800",
"annotation_text": "Patients with the CT genotype may have increased exposure to atorvastatin as compared to patients with the TT genotype. Other genetic and clinical factors may also affect a patient's exposure to atorvastatin. This annotation only covers the pharmacokinetic relationship between rs4149056 and atorvastatin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MAJOR",
"drug": "fluvastatin",
"drug_url": "https://drugs.com/mtm/fluvastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "SLCO1B1",
"genotype": "rs4149056 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs4149056 CT genotype may have increased concentrations of fluvastatin as compared to patients with the TT genotype. However, conflicting evidence has been reported. Other genetic and clinical factors may also affect fluvastatin concentrations. This annotation only covers the pharmacokinetic relationship between rs4149056 and fluvastatin and does not include evidence about clinical outcomes. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451244700",
"annotation_text": "Patients with the rs4149056 CT genotype may have increased concentrations of fluvastatin as compared to patients with the TT genotype. However, conflicting evidence has been reported. Other genetic and clinical factors may also affect fluvastatin concentrations. This annotation only covers the pharmacokinetic relationship between rs4149056 and fluvastatin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MAJOR",
"drug": "lovastatin",
"drug_url": "https://drugs.com/mtm/lovastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "SLCO1B1",
"genotype": "rs4149056 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs4149056 CT genotype may have increased concentration of lovastatin acid as compared to patients with the TT genotype. Other genetic and clinical factors may also influence the metabolism of lovastatin. This annotation only covers the pharmacokinetic relationship between rs4149056 and lovastatin acid or lovastatin and does not include evidence about clinical outcomes. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451678112",
"annotation_text": "Patients with the rs4149056 CT genotype may have increased concentration of lovastatin acid as compared to patients with the TT genotype. Other genetic and clinical factors may also influence the metabolism of lovastatin. This annotation only covers the pharmacokinetic relationship between rs4149056 and lovastatin acid or lovastatin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MAJOR",
"drug": "pitavastatin",
"drug_url": "https://drugs.com/mtm/pitavastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "SLCO1B1",
"genotype": "rs4149056 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs4149056 CT genotype may have increased concentrations of pitavastatin when treated with pitavastatin as compared to patients with TT genotype. Other genetic and clinical factors may also influence the metabolism of pitavastatin. This annotation only covers the pharmacokinetic relationship between rs4149056 and pitavastatin and does not include evidence about clinical outcomes. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451678210",
"annotation_text": "Patients with the rs4149056 CT genotype may have increased concentrations of pitavastatin when treated with pitavastatin as compared to patients with TT genotype. Other genetic and clinical factors may also influence the metabolism of pitavastatin. This annotation only covers the pharmacokinetic relationship between rs4149056 and pitavastatin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MAJOR",
"drug": "lovastatin acid",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "SLCO1B1",
"genotype": "rs4149056 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs4149056 CT genotype may have increased concentration of lovastatin acid as compared to patients with the TT genotype. Other genetic and clinical factors may also influence the metabolism of lovastatin. This annotation only covers the pharmacokinetic relationship between rs4149056 and lovastatin acid or lovastatin and does not include evidence about clinical outcomes. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451678112",
"annotation_text": "Patients with the rs4149056 CT genotype may have increased concentration of lovastatin acid as compared to patients with the TT genotype. Other genetic and clinical factors may also influence the metabolism of lovastatin. This annotation only covers the pharmacokinetic relationship between rs4149056 and lovastatin acid or lovastatin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MINOR",
"drug": "paclitaxel",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP2C8",
"genotype": "rs10509681 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may have decreased metabolism of paclitaxel as compared to patients with the TT genotype, however this has not been shown in vivo. Other genetic and clinical factors may also influence clearance of paclitaxel. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/655384838",
"annotation_text": "Patients with the CT genotype may have decreased metabolism of paclitaxel as compared to patients with the TT genotype, however this has not been shown in vivo. Other genetic and clinical factors may also influence clearance of paclitaxel."
}
]
},
{
"report_table": "MINOR",
"drug": "oxycodone",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs4680 AG genotype may have an increased subjective response to oxycodone as compared to patients with the GG genotype. This drug-variant pair has been assigned a 'no recommendation' by CPIC, as it was determined to be not clinically actionable. Other genetic and clinical factors may also affect subjective response to oxycodone. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451244980",
"annotation_text": "Patients with the rs4680 AG genotype may have an increased subjective response to oxycodone as compared to patients with the GG genotype. This drug-variant pair has been assigned a \u201cno recommendation\u201d by CPIC, as it was determined to be not clinically actionable. Other genetic and clinical factors may also affect subjective response to oxycodone."
}
]
},
{
"report_table": "MINOR",
"drug": "fentanyl",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP3A4",
"genotype": "rs2740574 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs2740574 CT genotype (CYP3A4*1B allele) may have decreased clearance of fentanyl as compared to patients with the rs2740574 TT genotype. This annotation only covers the pharmacokinetic relationship between rs2740574 and fentanyl and does not include evidence about clinical outcomes. Other genetic and clinical factors may also affect clearance of fentanyl in a patient. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451100100",
"annotation_text": "Patients with the rs2740574 CT genotype (CYP3A4*1B allele) may have decreased clearance of fentanyl as compared to patients with the rs2740574 TT genotype. This annotation only covers the pharmacokinetic relationship between rs2740574 and fentanyl and does not include evidence about clinical outcomes. Other genetic and clinical factors may also affect clearance of fentanyl in a patient."
}
]
},
{
"report_table": "MINOR",
"drug": "sumatriptan",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype with substance withdrawal syndrome may have an increased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AA genotype. Other clinical and genetic factors may also influence likelihood of headache in patients with withdrawal syndrome who discontinue the use of analgesics. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1184987573",
"annotation_text": "Patients with the AG genotype with substance withdrawal syndrome may have an increased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AA genotype. Other clinical and genetic factors may also influence likelihood of headache in patients with withdrawal syndrome who discontinue the use of analgesics."
}
]
},
{
"report_table": "MINOR",
"drug": "opioids",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype with substance withdrawal syndrome may have an increased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AA genotype. Other clinical and genetic factors may also influence likelihood of headache in patients with withdrawal syndrome who discontinue the use of analgesics. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1184987573",
"annotation_text": "Patients with the AG genotype with substance withdrawal syndrome may have an increased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AA genotype. Other clinical and genetic factors may also influence likelihood of headache in patients with withdrawal syndrome who discontinue the use of analgesics."
}
]
},
{
"report_table": "MINOR",
"drug": "Ergot alkaloids",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype with substance withdrawal syndrome may have an increased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AA genotype. Other clinical and genetic factors may also influence likelihood of headache in patients with withdrawal syndrome who discontinue the use of analgesics. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1184987573",
"annotation_text": "Patients with the AG genotype with substance withdrawal syndrome may have an increased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AA genotype. Other clinical and genetic factors may also influence likelihood of headache in patients with withdrawal syndrome who discontinue the use of analgesics."
}
]
},
{
"report_table": "MINOR",
"drug": "repaglinide",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP2C8",
"genotype": "rs10509681 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Individuals with the CT (CYP2C8*3/*1) genotype may have increased metabolism of repaglinide compared to patients with the TT genotype (CYP2C8*1/*1). No association was found with differences in blood glucose lowering efficacy. Please note, the study supporting this annotation was carried out in healthy volunteers. Other genetic and clinical factors may also influence metabolism of repaglinide. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/978639596",
"annotation_text": "Individuals with the CT (CYP2C8*3/*1) genotype may have increased metabolism of repaglinide compared to patients with the TT genotype (CYP2C8*1/*1). No association was found with differences in blood glucose lowering efficacy. Please note, the study supporting this annotation was carried out in healthy volunteers. Other genetic and clinical factors may also influence metabolism of repaglinide."
}
]
},
{
"report_table": "MINOR",
"drug": "atazanavir",
"drug_url": "https://drugs.com/mtm/atazanavir.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/protease-inhibitors.html",
"path": [
"anti-infectives",
"antiviral agents",
"protease inhibitors"
]
}
],
"genes": [
{
"name": "CYP3A4",
"genotype": "rs2740574 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may have decreased clearance of atazanavir as compared to patients with the TT genotype and increased clearance as compared to patients with the CC genotype. Other clinical and genetic factors may also influence clearance of atazanavir. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448617757",
"annotation_text": "Patients with the CT genotype may have decreased clearance of atazanavir as compared to patients with the TT genotype and increased clearance as compared to patients with the CC genotype. Other clinical and genetic factors may also influence clearance of atazanavir."
}
]
},
{
"report_table": "MINOR",
"drug": "atorvastatin",
"drug_url": "https://drugs.com/atorvastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "CYP3A4",
"genotype": "rs2740574 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may be less likely to require a decrease in dose or switch to a different drug when treated with atorvastatin or simvastatin as compared to patients with the TT genotype. Other genetic and clinical factors may also influence dose of simvastatin or atorvastatin, or likelihood of switching to a different drug. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1447964091",
"annotation_text": "Patients with the CT genotype may be less likely to require a decrease in dose or switch to a different drug when treated with atorvastatin or simvastatin as compared to patients with the TT genotype. Other genetic and clinical factors may also influence dose of simvastatin or atorvastatin, or likelihood of switching to a different drug."
}
]
},
{
"report_table": "MINOR",
"drug": "simvastatin",
"drug_url": "https://drugs.com/simvastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "CYP3A4",
"genotype": "rs2740574 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may be less likely to require a decrease in dose or switch to a different drug when treated with atorvastatin or simvastatin as compared to patients with the TT genotype. Other genetic and clinical factors may also influence dose of simvastatin or atorvastatin, or likelihood of switching to a different drug. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1447964091",
"annotation_text": "Patients with the CT genotype may be less likely to require a decrease in dose or switch to a different drug when treated with atorvastatin or simvastatin as compared to patients with the TT genotype. Other genetic and clinical factors may also influence dose of simvastatin or atorvastatin, or likelihood of switching to a different drug."
}
]
},
{
"report_table": "MINOR",
"drug": "amodiaquine",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP2C8",
"genotype": "rs10509681 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may have increased risk of side effects to amodiaquine as compared to patients with the TT genotype. Other genetic and clinical factors may also influence a patient's risk for side effects. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/637879595",
"annotation_text": "Patients with the CT genotype may have increased risk of side effects to amodiaquine as compared to patients with the TT genotype. Other genetic and clinical factors may also influence a patient's risk for side effects."
}
]
},
{
"report_table": "MINOR",
"drug": "Vitamin K",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP4F2",
"genotype": "rs2108622 CC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CC genotype may have decreased concentrations of Vitamin K as compared to patients with the CT or TT genotype. Other clinical and genetic factors may also influence concentrations of Vitamin K. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1449269960",
"annotation_text": "Patients with the CC genotype may have decreased concentrations of Vitamin K as compared to patients with the CT or TT genotype. Other clinical and genetic factors may also influence concentrations of Vitamin K."
}
]
},
{
"report_table": "MINOR",
"drug": "folic acid",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "MTHFR",
"genotype": "rs1801133 AA",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AA genotype may have decreased metabolism of folic acid as compared to patients with the GG genotype. Other genetic and clinical factors may also affect folic acid metabolism in patients. This annotation only covers the pharmacokinetic relationship between rs1801133 and folic acid and does not include evidence about clinical outcomes. This drug-variant pair has been assigned a 'no recommendation' by DPWG, as it was determined to be not clinically actionable. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1449296314",
"annotation_text": "Patients with the AA genotype may have decreased metabolism of folic acid as compared to patients with the GG genotype. Other genetic and clinical factors may also affect folic acid metabolism in patients. This annotation only covers the pharmacokinetic relationship between rs1801133 and folic acid and does not include evidence about clinical outcomes. This drug-variant pair has been assigned a \u201cno recommendation\u201d by DPWG, as it was determined to be not clinically actionable."
}
]
},
{
"report_table": "MINOR",
"drug": "warfarin",
"drug_url": "https://drugs.com/warfarin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/coumarins-and-indandiones.html",
"path": [
"coagulation modifiers",
"anticoagulants",
"coumarins and indandiones"
]
}
],
"genes": [
{
"name": "CYP4F2",
"genotype": "rs2108622 CC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CC genotype may have increased international normalized ratio variability (INR-var) when treated with warfarin as compared to patients with genotype TT or CT in European-Americans after the warfarin dose-titration phase. Other genetic and clinical factors may also influence the response to warfarin. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448262901",
"annotation_text": "Patients with the CC genotype may have increased international normalized ratio variability (INR-var) when treated with warfarin as compared to patients with genotype TT or CT in European-Americans after the warfarin dose-titration phase. Other genetic and clinical factors may also influence the response to warfarin."
}
]
},
{
"report_table": "MINOR",
"drug": "Antiinflammatory agents, non-steroids",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype with substance withdrawal syndrome may have an increased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AA genotype. Other clinical and genetic factors may also influence likelihood of headache in patients with withdrawal syndrome who discontinue the use of analgesics. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1184987573",
"annotation_text": "Patients with the AG genotype with substance withdrawal syndrome may have an increased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AA genotype. Other clinical and genetic factors may also influence likelihood of headache in patients with withdrawal syndrome who discontinue the use of analgesics."
}
]
},
{
"report_table": "MINOR",
"drug": "vitamin b-complex, plain",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "MTHFR",
"genotype": "rs1801133 AA",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Female patients with the AA genotype and Migraine who are treated with folic acid and a vitamin b-complex may have an increased severity of pain lesser reduction in homocysteine as compared to patients with the AG or GG genotype. Other genetic and clinical factors may also influence a patient's severity of pain. This drug-variant pair has been assigned a 'no recommendation' by DPWG, as it was determined to be not clinically actionable. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1183491364",
"annotation_text": "Female patients with the AA genotype and Migraine who are treated with folic acid and a vitamin b-complex may have an increased severity of pain lesser reduction in homocysteine as compared to patients with the AG or GG genotype. Other genetic and clinical factors may also influence a patient's severity of pain. This drug-variant pair has been assigned a \u201cno recommendation\u201d by DPWG, as it was determined to be not clinically actionable."
}
]
},
{
"report_table": "MINOR",
"drug": "nitrous oxide",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "MTHFR",
"genotype": "rs1801133 AA",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AA genotype who undergo elective surgery with nitrous oxide anesthesia may have higher plasma total homocysteine concentrations as compared to patients with the GG genotype. Other genetic and clinical factors may also influence a patient's homocysteine levels after nitrous oxide anesthesia. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/655387835",
"annotation_text": "Patients with the AA genotype who undergo elective surgery with nitrous oxide anesthesia may have higher plasma total homocysteine concentrations as compared to patients with the GG genotype. Other genetic and clinical factors may also influence a patient's homocysteine levels after nitrous oxide anesthesia."
}
]
},
{
"report_table": "MINOR",
"drug": "rifampin",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "SLCO1B1",
"genotype": "rs4149056 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may have decreased plasma concentration of atorvastatin when treated concomitantly with rifampin as compared to patients with the TT genotypes. Other genetic and clinical factors may also influence a patient's metabolism and response to atorvastatin. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/981345311",
"annotation_text": "Patients with the CT genotype may have decreased plasma concentration of atorvastatin when treated concomitantly with rifampin as compared to patients with the TT genotypes. Other genetic and clinical factors may also influence a patient's metabolism and response to atorvastatin."
}
]
},
{
"report_table": "MINOR",
"drug": "letermovir",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "SLCO1B1",
"genotype": "rs4149056 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may have an increased AUC of letermovir as compared to patients with the TT genotype. Other genetic and clinical factors may also affect a patient's exposure to letermovir. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451105200",
"annotation_text": "Patients with the CT genotype may have an increased AUC of letermovir as compared to patients with the TT genotype. Other genetic and clinical factors may also affect a patient's exposure to letermovir."
}
]
},
{
"report_table": "MINOR",
"drug": "repaglinide",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "SLCO1B1",
"genotype": "rs4149056 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may have decreased exposure of repaglinide and decreased response to repaglinide as compared to patients with the CC genotype and increased exposure as compared to patients with the TT genotype. Other genetic and clinical factors may also influence a exposure of and response to repaglinide. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/655384645",
"annotation_text": "Patients with the CT genotype may have decreased exposure of repaglinide and decreased response to repaglinide as compared to patients with the CC genotype and increased exposure as compared to patients with the TT genotype. Other genetic and clinical factors may also influence a exposure of and response to repaglinide."
}
]
},
{
"report_table": "MINOR",
"drug": "simvastatin",
"drug_url": "https://drugs.com/simvastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "SLCO1B1",
"genotype": "rs4149056 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may have decreased lipid-lowering response to simvastatin as compared to patients with the TT genotype. However, conflicting evidence has been reported. The effect size may be small. Other genetic and clinical factors may also influence response to simvastatin. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451356520",
"annotation_text": "Patients with the CT genotype may have decreased lipid-lowering response to simvastatin as compared to patients with the TT genotype. However, conflicting evidence has been reported. The effect size may be small. Other genetic and clinical factors may also influence response to simvastatin."
}
]
},
{
"report_table": "MINOR",
"drug": "phenprocoumon",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP4F2",
"genotype": "rs2108622 CC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CC genotype who are treated with phenprocoumon may require a lower dose as compared to patients with the TT genotype. Other genetic and clinical factors may also influence a patient's required phenprocoumon dose. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1184661207",
"annotation_text": "Patients with the CC genotype who are treated with phenprocoumon may require a lower dose as compared to patients with the TT genotype. Other genetic and clinical factors may also influence a patient's required phenprocoumon dose."
}
]
},
{
"report_table": "MINOR",
"drug": "Analgesics",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype with substance withdrawal syndrome may have an increased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AA genotype. Other clinical and genetic factors may also influence likelihood of headache in patients with withdrawal syndrome who discontinue the use of analgesics. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1184987573",
"annotation_text": "Patients with the AG genotype with substance withdrawal syndrome may have an increased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AA genotype. Other clinical and genetic factors may also influence likelihood of headache in patients with withdrawal syndrome who discontinue the use of analgesics."
}
]
},
{
"report_table": "MINOR",
"drug": "Dabigatran",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "People with the AG genotype may have increased exposure to dabigatran compared to patients with the GG genotype, when also assessed with the rs2032582 allele. Other clinical and genetic factors may affect exposure to dabigatran. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448532190",
"annotation_text": "People with the AG genotype may have increased exposure to dabigatran compared to patients with the GG genotype, when also assessed with the rs2032582 allele. Other clinical and genetic factors may affect exposure to dabigatran."
}
]
},
{
"report_table": "MINOR",
"drug": "rivaroxaban",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs1045642 AG genotype may have decreased risk of Thromboembolism when treated with rivaroxaban as compared to patients with genotype GG. Other genetic and clinical factors may also influence the toxicity to rivaroxaban. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451510621",
"annotation_text": "Patients with the rs1045642 AG genotype may have decreased risk of Thromboembolism when treated with rivaroxaban as compared to patients with genotype GG. Other genetic and clinical factors may also influence the toxicity to rivaroxaban."
}
]
},
{
"report_table": "MINOR",
"drug": "Dabigatran",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs2032582 AC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "People with the AC genotype may have increased exposure to dabigatran compared to patients with the CC genotype when assessed in conjunction with a variant at position rs1045642. Other clinical and genetic factors may affect exposure to dabigatran. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448532202",
"annotation_text": "People with the AC genotype may have increased exposure to dabigatran compared to patients with the CC genotype when assessed in conjunction with a variant at position rs1045642. Other clinical and genetic factors may affect exposure to dabigatran."
}
]
},
{
"report_table": "MINOR",
"drug": "clozapine",
"drug_url": "https://drugs.com/clozapine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/atypical-antipsychotics.html",
"path": [
"psychotherapeutic agents",
"antipsychotics",
"atypical antipsychotics"
]
}
],
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype may have decreased clozapine plasma concentrations, as well as a decreased risk for clozapine-induced agranulocytosis or neutropenia, as compared to patients with the AA genotype. Other genetic and clinical factors may also influence concentrations and risk of clozapine-induced toxicity. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448427559",
"annotation_text": "Patients with the AG genotype may have decreased clozapine plasma concentrations, as well as a decreased risk for clozapine-induced agranulocytosis or neutropenia, as compared to patients with the AA genotype. Other genetic and clinical factors may also influence concentrations and risk of clozapine-induced toxicity."
}
]
},
{
"report_table": "MINOR",
"drug": "codeine",
"drug_url": "https://drugs.com/codeine.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/antitussives.html",
"path": [
"respiratory agents",
"antitussives"
]
},
{
"href": "https://drugs.com/drug-class/narcotic-analgesics.html",
"path": [
"central nervous system agents",
"analgesics",
"narcotic analgesics"
]
}
],
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype may have increased likelihood of CNS depression in breast-feeding infants as compared to patients with the GG genotype or may have decreased likelihood of CNS depression in breast-feeding infants as compared to patients with the AA genotype. Other genetic and clinical factors may also influence a patient's response to codeine. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1444704818",
"annotation_text": "Patients with the AG genotype may have increased likelihood of CNS depression in breast-feeding infants as compared to patients with the GG genotype or may have decreased likelihood of CNS depression in breast-feeding infants as compared to patients with the AA genotype. Other genetic and clinical factors may also influence a patient's response to codeine."
}
]
},
{
"report_table": "MINOR",
"drug": "cyclosporine",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs2032582 AC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AC genotype may have higher blood trough concentrations of cyclosporine compared to patients with the CC genotype, and may have lower blood trough concentrations of cyclosporine compared to patients with the AA genotype, and may require dose adjustments. Other genetic and clinical factors may also influence cyclosporine blood concentrations. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/827831435",
"annotation_text": "Patients with the AC genotype may have higher blood trough concentrations of cyclosporine compared to patients with the CC genotype, and may have lower blood trough concentrations of cyclosporine compared to patients with the AA genotype, and may require dose adjustments. Other genetic and clinical factors may also influence cyclosporine blood concentrations."
}
]
},
{
"report_table": "MINOR",
"drug": "daptomycin",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype may increased clearance of daptomycin, resulting in decreased concentrations of the drug, as compared to patients with the AA genotype. Other genetic and clinical factors may also influence clearance of daptomycin. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1445585156",
"annotation_text": "Patients with the AG genotype may increased clearance of daptomycin, resulting in decreased concentrations of the drug, as compared to patients with the AA genotype. Other genetic and clinical factors may also influence clearance of daptomycin."
}
]
},
{
"report_table": "MINOR",
"drug": "dicloxacillin",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Genotype AG may be associated with decreased clearance of dicloxacillin when treated with dicloxacillin and probenecid as compared to genotype GG. however, another report showed no association between this variant and PK of dicloxacillin. Other genetic and clinical factors may also influence the pharmacokinetics of dicloxacillin. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/981204455",
"annotation_text": "Genotype AG may be associated with decreased clearance of dicloxacillin when treated with dicloxacillin and probenecid as compared to genotype GG. however, another report showed no association between this variant and PK of dicloxacillin. Other genetic and clinical factors may also influence the pharmacokinetics of dicloxacillin."
}
]
},
{
"report_table": "MINOR",
"drug": "digoxin",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with AG genotype may have decreased metabolism and increased serum concentration of digoxin as compared to patients with the GG genotype. Other genetic and clinical factors may also impact the metabolism of digoxin. This annotation only covers the pharmacokinetic relationship between rs1045642 and digoxin and does not include evidence about clinical outcomes. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/981204372",
"annotation_text": "Patients with AG genotype may have decreased metabolism and increased serum concentration of digoxin as compared to patients with the GG genotype. Other genetic and clinical factors may also impact the metabolism of digoxin. This annotation only covers the pharmacokinetic relationship between rs1045642 and digoxin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "MINOR",
"drug": "digoxin",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs2032582 AC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with genotype AC may have increased metabolism of digoxin as compared to patients with genotype AA. Other genetic and clinical factors may also influence the metabolism of digoxin. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/981238108",
"annotation_text": "Patients with genotype AC may have increased metabolism of digoxin as compared to patients with genotype AA. Other genetic and clinical factors may also influence the metabolism of digoxin."
}
]
},
{
"report_table": "MINOR",
"drug": "fexofenadine",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Healthy individuals with the AG genotype who are treated with fexofenadine may have higher plasma drug levels as compared to healthy individuals with the AA genotype. Another study found no association with fexofenadine plasma concentrations. Other genetic and clinical factors may also influence plasma concentrations of fexofenadine and dose requirements. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/655386028",
"annotation_text": "Healthy individuals with the AG genotype who are treated with fexofenadine may have higher plasma drug levels as compared to healthy individuals with the AA genotype. Another study found no association with fexofenadine plasma concentrations. Other genetic and clinical factors may also influence plasma concentrations of fexofenadine and dose requirements."
}
]
},
{
"report_table": "MINOR",
"drug": "hmg coa reductase inhibitors",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype may have decreased serum creatine kinase levels when treated with hmg CoA reductase inhibitors as compared to patients with the AA genotype. Other genetic and clinical factors may also influence serum creatine kinase levels. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1184472550",
"annotation_text": "Patients with the AG genotype may have decreased serum creatine kinase levels when treated with hmg CoA reductase inhibitors as compared to patients with the AA genotype. Other genetic and clinical factors may also influence serum creatine kinase levels."
}
]
},
{
"report_table": "MINOR",
"drug": "phenytoin",
"drug_url": "https://drugs.com/phenytoin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/group-i-antiarrhythmics.html",
"path": [
"cardiovascular agents",
"antiarrhythmic agents",
"group I antiarrhythmics"
]
},
{
"href": "https://drugs.com/drug-class/hydantoin-anticonvulsants.html",
"path": [
"central nervous system agents",
"anticonvulsants",
"hydantoin anticonvulsants"
]
}
],
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with genotype AG may have increased plasma drug levels of phenytoin in people with no disease as compared to genotype GG. However, another study reported no association between this variant and increased dose of phenytoin in people with Epilepsy. Other genetic and clinical factors may influence a patient's dose of phenytoin. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/981204317",
"annotation_text": "Patients with genotype AG may have increased plasma drug levels of phenytoin in people with no disease as compared to genotype GG. However, another study reported no association between this variant and increased dose of phenytoin in people with Epilepsy. Other genetic and clinical factors may influence a patient's dose of phenytoin."
}
]
},
{
"report_table": "MINOR",
"drug": "remifentanil",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "There is currently no evidence of a difference in remifentanil requirements between patients with the AG genotype and patients with the AA or GG genotypes. Other genetic and clinical factors may also affect a patient's remifentanil requirements. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451118760",
"annotation_text": "There is currently no evidence of a difference in remifentanil requirements between patients with the AG genotype and patients with the AA or GG genotypes. Other genetic and clinical factors may also affect a patient's remifentanil requirements."
}
]
},
{
"report_table": "MINOR",
"drug": "rhodamine 123",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Genotype AG may be associated with decreased efflux of rhodamine from CD56+ natural killer cells when exposed to rhodamine 123 as compared to genotypes GG. However, contradictory finding has been reported. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/981204444",
"annotation_text": "Genotype AG may be associated with decreased efflux of rhodamine from CD56+ natural killer cells when exposed to rhodamine 123 as compared to genotypes GG. However, contradictory finding has been reported."
}
]
},
{
"report_table": "MINOR",
"drug": "spironolactone",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ACE",
"genotype": "rs4343 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype are associated with improvement in left ventricular ejection fraction, end-systolic and end-diastolic volume in people with chronic heart failure treated with spironolactone as compared to patients with the GG genotype. Other genetic and clinical factors may also influence a patient's response. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/769143802",
"annotation_text": "Patients with the AG genotype are associated with improvement in left ventricular ejection fraction, end-systolic and end-diastolic volume in people with chronic heart failure treated with spironolactone as compared to patients with the GG genotype. Other genetic and clinical factors may also influence a patient's response."
}
]
},
{
"report_table": "MINOR",
"drug": "rivaroxaban",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs2032582 AC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "People with the AC genotype may have increased exposure to rivaroxaban compared to patients with the CC genotype, when assessed in conjunction with a variant at position rs1045642. Other clinical and genetic factors may affect exposure to rivaroxaban. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448532211",
"annotation_text": "People with the AC genotype may have increased exposure to rivaroxaban compared to patients with the CC genotype, when assessed in conjunction with a variant at position rs1045642. Other clinical and genetic factors may affect exposure to rivaroxaban."
}
]
},
{
"report_table": "MINOR",
"drug": "silibinin",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "People with genotype AG may have decreased exposure to silibinin compared to people with genotypes GG. Other clinical and genetic factors may affect a person's exposure to silibinin. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1447943713",
"annotation_text": "People with genotype AG may have decreased exposure to silibinin compared to people with genotypes GG. Other clinical and genetic factors may affect a person's exposure to silibinin."
}
]
},
{
"report_table": "MINOR",
"drug": "talinolol",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype may have decreased clearance of talinolol as compared to patients with the AA genotype. Other genetic and clinical factors may also influence clearance of talinolol. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1183631480",
"annotation_text": "Patients with the AG genotype may have decreased clearance of talinolol as compared to patients with the AA genotype. Other genetic and clinical factors may also influence clearance of talinolol."
}
]
},
{
"report_table": "MINOR",
"drug": "tramadol",
"drug_url": "https://drugs.com/tramadol.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/narcotic-analgesics.html",
"path": [
"central nervous system agents",
"analgesics",
"narcotic analgesics"
]
}
],
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype may have an increased exposure to tramadol as compared to patients with the GG genotype, but a decreased exposure as compared to patients with the AA genotype. Other genetic and clinical factors may also influence a patient's exposure to tramadol. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1449162866",
"annotation_text": "Patients with the AG genotype may have an increased exposure to tramadol as compared to patients with the GG genotype, but a decreased exposure as compared to patients with the AA genotype. Other genetic and clinical factors may also influence a patient's exposure to tramadol."
}
]
},
{
"report_table": "MINOR",
"drug": "tramadol",
"drug_url": "https://drugs.com/tramadol.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/narcotic-analgesics.html",
"path": [
"central nervous system agents",
"analgesics",
"narcotic analgesics"
]
}
],
"genes": [
{
"name": "ABCB1",
"genotype": "rs2032582 AC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "There is currently no evidence to show whether the AC genotype affects a patient's exposure to tramadol. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1449162899",
"annotation_text": "There is currently no evidence to show whether the AC genotype affects a patient's exposure to tramadol."
}
]
},
{
"report_table": "MINOR",
"drug": "verapamil",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype may have increased metabolism of verapamil as compared to patients with the GG genotype. Other genetic and clinical factors may also impact the metabolism of verapamil. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/982036238",
"annotation_text": "Patients with the AG genotype may have increased metabolism of verapamil as compared to patients with the GG genotype. Other genetic and clinical factors may also impact the metabolism of verapamil."
}
]
},
{
"report_table": "MINOR",
"drug": "verapamil",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs2032582 AC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AC genotype may have increased metabolism of verapamil as compared to patients with the CC genotype. Other genetic and clinical factors may also impact the metabolism of verapamil. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/982036249",
"annotation_text": "Patients with the AC genotype may have increased metabolism of verapamil as compared to patients with the CC genotype. Other genetic and clinical factors may also impact the metabolism of verapamil."
}
]
},
{
"report_table": "MINOR",
"drug": "voriconazole",
"drug_url": "https://drugs.com/cons/voriconazole.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/azole-antifungals.html",
"path": [
"anti-infectives",
"antifungals",
"azole antifungals"
]
}
],
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype may have decreased clearance of voriconazole as compared to patients with the GG genotype, or increased clearance of voriconazole as compared to patients with the AA genotype. Other genetic and clinical factors, such as variants within the CYP2C19 gene, may also influence metabolism of voriconazole. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1447960218",
"annotation_text": "Patients with the AG genotype may have decreased clearance of voriconazole as compared to patients with the GG genotype, or increased clearance of voriconazole as compared to patients with the AA genotype. Other genetic and clinical factors, such as variants within the CYP2C19 gene, may also influence metabolism of voriconazole."
}
]
},
{
"report_table": "MINOR",
"drug": "pravastatin",
"drug_url": "https://drugs.com/pravastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "ACE",
"genotype": "rs1799752 ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the insert/del genotype may be less likely to benefit from pravastatin treatment as compared to patients with the del/del genotype. Other genetic and clinical factors may also influence a patient's response to pravastatin treatment. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1043880255",
"annotation_text": "Patients with the insert/del genotype may be less likely to benefit from pravastatin treatment as compared to patients with the del/del genotype. Other genetic and clinical factors may also influence a patient's response to pravastatin treatment."
}
]
},
{
"report_table": "MINOR",
"drug": "nitroprusside",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ACE",
"genotype": "rs1799752 ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del genotype may experience greater vasodilation as compared to patients with the del/del genotype but lesser vasodilation as compared to patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC genotype when treated with nitroprusside. Other genetic and clinical factors may also influence a patient's response to nitroprusside. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/982034899",
"annotation_text": "Patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del genotype may experience greater vasodilation as compared to patients with the del/del genotype but lesser vasodilation as compared to patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC genotype when treated with nitroprusside. Other genetic and clinical factors may also influence a patient's response to nitroprusside."
}
]
},
{
"report_table": "MINOR",
"drug": "acetylcholine",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ACE",
"genotype": "rs1799752 ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del genotype may experience greater vasodilation as compared to patients with the del/del genotype but lesser vasodilation as compared to patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC genotype when treated with acetylcholine. Other genetic and clinical factors may also influence a patient's response to acetylcholine. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/982034888",
"annotation_text": "Patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del genotype may experience greater vasodilation as compared to patients with the del/del genotype but lesser vasodilation as compared to patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC genotype when treated with acetylcholine. Other genetic and clinical factors may also influence a patient's response to acetylcholine."
}
]
},
{
"report_table": "MINOR",
"drug": "bumetanide",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ACE",
"genotype": "rs1799752 ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Healthy males with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del genotype may have an increased response when given bumetanide, furosemide or torasemide as compared to patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC genotype, or a decreased response as compared to patients with the del/del genotype. Other genetic and clinical factors may also influence response to bumetanide, furosemide, torasemide. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1183614614",
"annotation_text": "Healthy males with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del genotype may have an increased response when given bumetanide, furosemide or torasemide as compared to patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC genotype, or a decreased response as compared to patients with the del/del genotype. Other genetic and clinical factors may also influence response to bumetanide, furosemide, torasemide."
}
]
},
{
"report_table": "MINOR",
"drug": "furosemide",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ACE",
"genotype": "rs1799752 ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Healthy males with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del genotype may have an increased response when given bumetanide, furosemide or torasemide as compared to patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC genotype, or a decreased response as compared to patients with the del/del genotype. Other genetic and clinical factors may also influence response to bumetanide, furosemide, torasemide. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1183614614",
"annotation_text": "Healthy males with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del genotype may have an increased response when given bumetanide, furosemide or torasemide as compared to patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC genotype, or a decreased response as compared to patients with the del/del genotype. Other genetic and clinical factors may also influence response to bumetanide, furosemide, torasemide."
}
]
},
{
"report_table": "MINOR",
"drug": "torasemide",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ACE",
"genotype": "rs1799752 ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Healthy males with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del genotype may have an increased response when given bumetanide, furosemide or torasemide as compared to patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC genotype, or a decreased response as compared to patients with the del/del genotype. Other genetic and clinical factors may also influence response to bumetanide, furosemide, torasemide. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1183614614",
"annotation_text": "Healthy males with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del genotype may have an increased response when given bumetanide, furosemide or torasemide as compared to patients with the ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC genotype, or a decreased response as compared to patients with the del/del genotype. Other genetic and clinical factors may also influence response to bumetanide, furosemide, torasemide."
}
]
},
{
"report_table": "MINOR",
"drug": "simvastatin",
"drug_url": "https://drugs.com/simvastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype who are treated with simvastatin may have a better response to treatment (measured by a higher reduction in total cholesterol) compared to patients with the GG genotype or may have a reduced response (measured by a lower reduction in total cholesterol) as compared to patients with the AA genotype. In another study no association was seen. Other genetic and clinical factors may also influence a patient's response to simvastatin treatment. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "4",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1142234402",
"annotation_text": "Patients with the AG genotype who are treated with simvastatin may have a better response to treatment (measured by a higher reduction in total cholesterol) compared to patients with the GG genotype or may have a reduced response (measured by a lower reduction in total cholesterol) as compared to patients with the AA genotype. In another study no association was seen. Other genetic and clinical factors may also influence a patient's response to simvastatin treatment."
}
]
},
{
"report_table": "MINOR",
"drug": "warfarin",
"drug_url": "https://drugs.com/warfarin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/coumarins-and-indandiones.html",
"path": [
"coagulation modifiers",
"anticoagulants",
"coumarins and indandiones"
]
}
],
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AG genotype may require an increased dose of warfarin as compared to patients with the GG genotype and a decreased dose as compared to the AA genotype, although this is contradicted in one study which found the opposite (the GG genotype was associated with a higher dose as compared to the AA or AG genotypes), as well as two studies which found no association. Other clinical and genetic factors may also influence warfarin dose. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "4",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1449575745",
"annotation_text": "Patients with the AG genotype may require an increased dose of warfarin as compared to patients with the GG genotype and a decreased dose as compared to the AA genotype, although this is contradicted in one study which found the opposite (the GG genotype was associated with a higher dose as compared to the AA or AG genotypes), as well as two studies which found no association. Other clinical and genetic factors may also influence warfarin dose."
}
]
},
{
"report_table": "MINOR",
"drug": "rosuvastatin",
"drug_url": "https://drugs.com/mtm/rosuvastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
"metabolic agents",
"antihyperlipidemic agents",
"statins"
]
}
],
"genes": [
{
"name": "SLCO1B1",
"genotype": "rs4149056 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "The current evidence base suggests that there is no association between the rs4149056 CT genotype and the LDL-lowering response to rosuvastatin. Some studies report an association, however the majority of the studies documented no association. Other genetic and clinical factors may also influence response to rosuvastatin. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "4",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451358900",
"annotation_text": "The current evidence base suggests that there is no association between the rs4149056 CT genotype and the LDL-lowering response to rosuvastatin. Some studies report an association, however the majority of the studies documented no association. Other genetic and clinical factors may also influence response to rosuvastatin."
}
]
}
],
"called_genotypes": {
"BCHE": [
"rs1799807 TT",
"rs1803274 CC"
],
"CYP4F2": [
"rs2108622 CC"
],
"DPYD": [
"Reference/Reference",
"rs67376798 TT"
],
"G6PD": [
"rs1050828 CC",
"rs1050829 TT",
"rs5030868 GG"
],
"HLA-B": [
"*15:02 negative (inferred)",
"*57:01 negative (inferred)",
"rs144012689 TT",
"rs2395029 TT"
],
"IFNL4": [
"rs12979860 CC"
],
"RYR1": [
"Reference/Reference",
"rs111888148 GG",
"rs112563513 GG",
"rs118192116 CC",
"rs118192122 GG",
"rs118192124 CC",
"rs118192161 CC",
"rs118192162 AA",
"rs118192163 GG",
"rs118192167 AA",
"rs118192168 GG",
"rs118192170 TT",
"rs118192172 CC",
"rs118192175 CC",
"rs118192176 GG",
"rs118192177 CC",
"rs118192178 CC",
"rs121918592 GG",
"rs121918593 GG",
"rs121918594 GG",
"rs121918595 CC",
"rs121918596 TGGATGGA",
"rs144336148 GG",
"rs1801086 GG",
"rs193922747 TT",
"rs193922748 CC",
"rs193922753 GG",
"rs193922762 CC",
"rs193922764 CC",
"rs193922768 CC",
"rs193922770 CC",
"rs193922772 GG",
"rs193922802 GG",
"rs193922803 CC",
"rs193922807 GG",
"rs193922809 GG",
"rs193922816 CC",
"rs193922818 GG",
"rs193922832 GG",
"rs193922843 GG",
"rs193922876 CC",
"rs193922878 CC",
"rs28933396 GG",
"rs28933397 CC",
"rs63749869 GG"
],
"SLCO1B1": [
"*1/*5",
"rs4149056 CT"
],
"VKORC1": [
"rs9923231 TT"
],
"ABCB1": [
"rs1045642 AG",
"rs2032582 AC"
],
"ACE": [
"rs1799752 ATACAGTCACTTTTTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCC/del (inferred)",
"rs4343 AG"
],
"ANKK1": [
"rs1800497 GG"
],
"APOE": [
"rs7412 CC"
],
"ATM": [
"rs11212617 AA"
],
"CES1": [
"rs71647871 CC"
],
"COMT": [
"rs13306278 CC",
"rs4680 AG"
],
"CYP2C8": [
"rs10509681 CT"
],
"CYP3A4": [
"*1/*1",
"rs2242480 CT",
"rs2740574 CT"
],
"DRD2": [
"rs1799978 TT"
],
"ERCC1": [
"rs11615 AA",
"rs3212986 CC"
],
"F2": [
"rs1799963 GG"
],
"F5": [
"rs6025 CC"
],
"GGCX": [
"rs11676382 CC"
],
"GRIK4": [
"rs1954787 CT"
],
"GSTP1": [
"rs1695 AA"
],
"HTR1A": [
"rs6295 CG"
],
"HTR2A": [
"rs7997012 AG"
],
"HTR2C": [
"rs1414334 GG",
"rs3813929 CC"
],
"ITPA": [
"rs1127354 CC",
"rs7270101 AC"
],
"KIF6": [
"rs20455 AG"
],
"MTHFR": [
"rs1801133 AA"
],
"NQO1": [
"rs1800566 AG"
],
"OPRM1": [
"rs1799971 AA"
],
"UGT1A4": [
"rs2011425 TT"
],
"XRCC1": [
"rs25487 CC"
],
"CACNA1S": [
"rs1800559 CC",
"rs772226819 GG"
],
"HLA-A": [
"*31:01 negative (inferred)",
"rs1061235 AA"
],
"ABCG2": [
"rs2231142 GG"
],
"CFTR": [
"ivacaftor non-responsive CFTR sequence/ivacaftor non-responsive CFTR sequence"
],
"CYP2B6": [
"*6/*6"
],
"CYP2C19": [
"*1/*1"
],
"CYP2C9": [
"*1/*2"
],
"CYP3A5": [
"*1/*3"
],
"IFNL3": [
"rs12979860 CC"
],
"NAT2": [
"*5D/*5D"
],
"NUDT15": [
"*1/*1"
],
"TPMT": [
"*1/*1"
],
"UGT1A1": [
"*1/*80"
],
"CYP2D6": [
"*1/*1"
]
}
}
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