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reproduce_setup/pgx-main/pgx_results/CAN-NA24385-2-29Mar2025_S23_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"
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},
{
"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",
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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": []
},
{
"report_table": "",
"drug": "primidone",
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"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",
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"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",
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{
"href": "https://drugs.com/drug-class/dibenzazepine-anticonvulsants.html",
"path": [
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}
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"genes": [
{
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"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": [
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"PA166176623"
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"genes": [
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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",
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"version": 3,
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"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/carbamazepine/2013/23695185.pdf"
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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": [
"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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"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-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",
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"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": [
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"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": {
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},
"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",
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"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].",
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"CPIC level": "A",
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"sources": [
{
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"level": "A",
"url": "https://cpicpgx.org/guidelines/guideline-for-abacavir-and-hla-b/",
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"drugname": "abacavir",
"guidelinename": "HLA-B and Abacavir",
"url": "https://cpicpgx.org/guidelines/guideline-for-abacavir-and-hla-b/",
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"genes": [
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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"
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{
"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",
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"drugrecommendation": "Use abacavir per standard dosing guidelines",
"classification": "Strong",
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"activityscore": {},
"allelestatus": {
"HLA-B": "HLA-B*57:01 negative"
},
"lookupkey": {
"HLA-B": "*57:01 negative"
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"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",
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{
"href": "https://drugs.com/drug-class/tricyclic-antidepressants.html",
"path": [
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"genes": [
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"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
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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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"CPIC level": "",
"PharmGKB level": "",
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{
"name": "CPIC",
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"url": "https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/",
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"genes": [
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"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,
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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"
}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
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"CYP2C19": "Normal metabolism of tertiary amines"
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"drugrecommendation": "Initiate therapy with recommended starting dose.",
"classification": "Strong",
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"CYP2D6": "Normal Metabolizer",
"CYP2C19": "Normal Metabolizer"
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"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": "USUAL",
"drug": "atazanavir",
"drug_url": "https://drugs.com/mtm/atazanavir.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/protease-inhibitors.html",
"path": [
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"antiviral agents",
"protease inhibitors"
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}
],
"genes": [
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"name": "UGT1A1",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
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],
"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"
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"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"
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"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": "Reference UGT1A1 activity; very 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": "Normal Metabolizer"
},
"activityscore": {
"UGT1A1": "n/a"
},
"allelestatus": {},
"lookupkey": {
"UGT1A1": "Normal 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. \"reference\" function refers to the UGT1A1 allele to which other alleles are compared.",
"population": "general",
"subgroups": "UGT1A1:Normal 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": [
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"CNS stimulants"
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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"
}
],
"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]",
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"CPIC level": "A",
"PharmGKB level": "1A",
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{
"name": "CPIC",
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"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-atomoxetine-based-on-cyp2d6-genotype/",
"original_recommendation": {
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"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-atomoxetine-based-on-cyp2d6-genotype/",
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"genes": [
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"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",
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"journal": "Clinical pharmacology and therapeutics",
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"page": "",
"volume": "",
"year": 2019,
"pmid": "30801677",
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"doi": null,
"url": null,
"version": 5,
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"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/atomoxetine/2019/30801677.pdf"
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"cpicVersion": "v.1.17.1",
"implications": {
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"classification": "Moderate",
"phenotypes": {
"CYP2D6": "Normal Metabolizer"
},
"activityscore": {
"CYP2D6": "2.0"
},
"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
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"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/",
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"drugname": "atomoxetine",
"guidelinename": "CYP2D6 and Atomoxetine",
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"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"
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"month": 2,
"page": "",
"volume": "",
"year": 2019,
"pmid": "30801677",
"pmcid": null,
"doi": null,
"url": null,
"version": 5,
"highlightedonsite": false,
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"implications": {
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"phenotypes": {
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"activityscore": {
"CYP2D6": "2.0"
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"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
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"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": "USUAL",
"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/*1",
"phenotype": "Normal Function",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Prescribe desired starting dose and adjust doses based on disease-specific guidelines [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-statins/",
"original_recommendation": {
"drugid": "RxNorm:83367",
"drugname": "atorvastatin",
"guidelinename": "SLCO1B1, ABCG2, CYP2C9, and Statins",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"guidelinepharmgkbids": [
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"PA166262241",
"PA166262261",
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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": "Typical myopathy risk and statin exposure"
},
"drugrecommendation": "Prescribe desired starting dose and adjust doses based on disease-specific guidelines.",
"classification": "Strong",
"phenotypes": {
"SLCO1B1": "Normal Function"
},
"activityscore": {},
"allelestatus": {},
"lookupkey": {
"SLCO1B1": "Normal Function"
},
"comments": "The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.",
"population": "population general",
"subgroups": "SLCO1B1:Normal 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": "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"
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},
{
"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": [
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"PA166104965"
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"genes": [
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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"
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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"
},
{
"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, 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"
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}
],
"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"
],
"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": "",
"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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"PA166176623"
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"genes": [
"HLA-A",
"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"
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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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],
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"cpicVersion": "v.1.17.1",
"implications": {
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"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"
},
"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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"genes": [
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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",
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"Pirmohamed Munir"
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"month": 5,
"page": "",
"volume": "",
"year": 2013,
"pmid": "23695185",
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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",
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"Pirmohamed Munir"
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"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"
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"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 use >3mos ",
"subgroups": "HLA-A:*31:01 negative|HLA-B:*15:02 negative"
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"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/",
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"genes": [
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"id": 110009,
"guidelineid": 100423,
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"Kelsoe John R",
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"George Alfred L",
"Tran Eric",
"Berger Reisel",
"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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"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",
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"Klein Teri",
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"month": 4,
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"allelestatus": {
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},
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"comments": "For neurovascular indications. Neurovascular disease includes acute ischemic stroke or transient ischemic attack, secondary prevention of stroke, or prevention of thromboembolic events following neurointerventional procedures such as carotid artery stenting and stent-assisted coiling of intracranial aneurysms.",
"population": "NVI",
"subgroups": "CYP2C19:Normal Metabolizer"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1043858794",
"annotation_text": "The CYP2C19*1 allele is assigned as a normal function allele by CPIC. Patients carrying the CYP2C19*1 allele in combination with a normal function allele may have increased metabolism of clopidogrel as compared to patients with 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 clopidogrel and does not include evidence about clinical outcomes. Other genetic and clinical factors may also influence the metabolism of clopidogrel."
},
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1184753976",
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]
},
{
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"drug_class": [
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"href": "https://drugs.com/drug-class/antitussives.html",
"path": [
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},
{
"href": "https://drugs.com/drug-class/narcotic-analgesics.html",
"path": [
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"genes": [
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"CPIC level": "A",
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"journal": "Clinical pharmacology and therapeutics",
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"page": "",
"volume": "",
"year": 2011,
"pmid": "22205192",
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"page": "",
"volume": "",
"year": 2014,
"pmid": "24458010",
"pmcid": "PMC3975212",
"doi": "10.1038/clpt.2013.254",
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"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6, OPRM1, and COMT genotype and select opioid therapy.",
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"Nagy Mohamed",
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"drugrecommendation": "Use codeine label recommended age- or weight-specific dosing.",
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"activityscore": {
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},
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448999385",
"annotation_text": "Patients with the CYP2D6*1 allele may have increased clearance of codeine or decreased clearance of dextromethorphan or similar clearance of n-desmethyltamoxifen as compared to patients with the CYP2D6*24 allele. Other genetic and clinical factors may also influence the metabolism of codeine or dextromethorphan or n-desmethyltamoxifen."
}
]
},
{
"report_table": "USUAL",
"drug": "desipramine",
"drug_url": "https://drugs.com/mtm/desipramine.html",
"drug_class": [
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"href": "https://drugs.com/drug-class/tricyclic-antidepressants.html",
"path": [
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"genes": [
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"url": "https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/",
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"id": 110011,
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"journal": "Clinical pharmacology and therapeutics",
"month": 1,
"page": "",
"volume": "",
"year": 2013,
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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.",
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},
{
"report_table": "USUAL",
"drug": "dexlansoprazole",
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"genes": [
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],
"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].",
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"CPIC level": "B",
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"id": 571447,
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{
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},
{
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{
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"pmid": "31006110",
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"doi": null,
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"version": 2,
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],
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"activityscore": {
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}
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},
{
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"drug_class": [
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],
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"CPIC level": "A/B",
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},
{
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"CPIC level": "A",
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"sources": [
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"level": "A",
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"page": "",
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{
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"FDA level": "",
"CPIC level": "A",
"PharmGKB level": "1A",
"sources": [
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"url": "https://cpicpgx.org/guidelines/guideline-for-fluoropyrimidines-and-dpyd/",
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"genes": [
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"citations": [
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"title": "Clinical Pharmacogenetics Implementation Consortium Guidelines for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing",
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"Thorn Caroline F",
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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",
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"version": 3,
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"journal": "Clinical pharmacology and therapeutics",
"month": 11,
"page": "",
"volume": "",
"year": 2017,
"pmid": "29152729",
"pmcid": "PMC5760397",
"doi": "10.1002/cpt.911",
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"version": 3,
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"cpicVersion": "v.1.17.1",
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"drugrecommendation": "Based on genotype, there is no indication to change dose or therapy. Use label-recommended dosage and administration.",
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"phenotypes": {
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"activityscore": {
"DPYD": "2.0"
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"allelestatus": {},
"lookupkey": {
"DPYD": "2"
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"comments": "n/a",
"population": "general",
"subgroups": "DPYD:Normal Metabolizer"
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},
{
"report_table": "USUAL",
"drug": "flurbiprofen",
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"path": [
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}
],
"genes": [
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"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
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],
"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": [
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"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-nsaids-based-on-cyp2c9-genotype/",
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"id": 571448,
"guidelineid": 110058,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and Nonsteroidal Anti-inflammatory Drugs.",
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"Lee Craig R",
"Gong Li",
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"page": null,
"volume": null,
"year": 2020,
"pmid": "32189324",
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"doi": "10.1002/cpt.1830",
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},
{
"name": "PharmGKB",
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]
},
{
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"drug_class": [
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{
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"Ramsey L B",
"Johnson S G",
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"McLeod H L",
"Voora D",
"Krauss R M",
"Roden D M",
"Feng Q",
"Cooper-Dehoff R M",
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"Klein T E",
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"month": 5,
"page": "",
"volume": "",
"year": 2012,
"pmid": "22617227",
"pmcid": "PMC3384438",
"doi": "10.1038/clpt.2012.57",
"url": null,
"version": 3,
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"id": 110022,
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"title": "The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1 and simvastatin-induced myopathy: 2014 update",
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"Johnson Samuel G",
"Caudle Kelly E",
"Haidar Cyrine E",
"Voora Deepak",
"Wilke Russell A",
"Maxwell Whitney D",
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"Krauss Ronald M",
"Roden Dan M",
"Feng Qiping",
"Cooper-DeHoff Rhonda M",
"Gong Li",
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"Wadelius Mia",
"Niemi Mikko"
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"journal": "Clinical pharmacology and therapeutics",
"month": 6,
"page": "",
"volume": "",
"year": 2014,
"pmid": "24918167",
"pmcid": "PMC4169720",
"doi": "10.1038/clpt.2014.125",
"url": null,
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"id": 1508721,
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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",
"Ramsey Laura B",
"Luzum Jasmine A",
"Tarkiainen E Katriina",
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"Gong Li",
"Tuteja Sony",
"Wilke Russell A",
"Wadelius Mia",
"Larson Eric A",
"Roden Dan M",
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"Yee Sook Wah",
"Krauss Ronald M",
"Turner Richard M",
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"page": null,
"volume": null,
"year": 2022,
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"drugrecommendation": "Prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines.",
"classification": "Strong",
"phenotypes": {
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"activityscore": {
"CYP2C9": "2.0"
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"comments": "The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.",
"population": "general",
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}
},
{
"name": "PharmGKB",
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"url": "https://www.pharmgkb.org/clinicalAnnotation/1451678600",
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},
{
"name": "PharmGKB",
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{
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"url": "https://www.pharmgkb.org/clinicalAnnotation/1451678620",
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},
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"activityscore": {
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},
{
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"drug": "fosphenytoin",
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"drug_class": [
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"path": [
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{
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"Gaedigk A",
"Dunnenberger H M",
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"page": "",
"volume": "",
"year": 2011,
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"pmcid": "PMC3289963",
"doi": "10.1038/clpt.2011.287",
"url": null,
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"Gaedigk Andrea",
"Dunnenberger Henry M",
"Leeder J Steve",
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"Caudle Kelly E",
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"Shen Danny D",
"Callaghan John T",
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"Prows Cynthia A",
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"page": "",
"volume": "",
"year": 2014,
"pmid": "24458010",
"pmcid": "PMC3975212",
"doi": "10.1038/clpt.2013.254",
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"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6, OPRM1, and COMT genotype and select opioid therapy.",
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"Monte Andrew A",
"Huddart Rachel",
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"phenotypes": {
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"activityscore": {
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"allelestatus": {},
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"phenotype": "Normal Metabolizer",
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"Lee Craig R",
"Gong Li",
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"page": null,
"volume": null,
"year": 2020,
"pmid": "32189324",
"pmcid": null,
"doi": "10.1002/cpt.1830",
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{
"name": "PharmGKB",
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"url": "https://www.pharmgkb.org/clinicalAnnotation/1451092720",
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"volume": "",
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"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"
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"page": "",
"volume": "",
"year": 2013,
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"pmcid": "PMC3689226",
"doi": "10.1038/clpt.2013.2",
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}
]
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"phenotypes": {
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"activityscore": {
"CFTR": "n/a"
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"allelestatus": {},
"lookupkey": {
"CFTR": "ivacaftor non-responsive in CF patients"
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"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": [
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],
"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,
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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"
}
}
]
},
{
"report_table": "USUAL",
"drug": "lornoxicam",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP2C9",
"genotype": "*1/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"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": "Normal 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": "Strong",
"phenotypes": {
"CYP2C9": "Normal Metabolizer"
},
"activityscore": {
"CYP2C9": "2.0"
},
"allelestatus": {},
"lookupkey": {
"CYP2C9": "2"
},
"comments": "n/a",
"population": "general",
"subgroups": "CYP2C9:Normal 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": "USUAL",
"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"
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}
],
"genes": [
{
"name": "SLCO1B1",
"genotype": "*1/*1",
"phenotype": "Normal Function",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Prescribe desired starting dose and adjust doses based on disease-specific guidelines [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-statins/",
"original_recommendation": {
"drugid": "RxNorm:6472",
"drugname": "lovastatin",
"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,
"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": "Typical myopathy risk and statin exposure"
},
"drugrecommendation": "Prescribe desired starting dose and adjust doses based on disease-specific guidelines.",
"classification": "Strong",
"phenotypes": {
"SLCO1B1": "Normal Function"
},
"activityscore": {},
"allelestatus": {},
"lookupkey": {
"SLCO1B1": "Normal Function"
},
"comments": "The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.",
"population": "population general",
"subgroups": "SLCO1B1:Normal 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": "USUAL",
"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/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"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:41493",
"drugname": "meloxicam",
"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": "Normal 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": "Strong",
"phenotypes": {
"CYP2C9": "Normal Metabolizer"
},
"activityscore": {
"CYP2C9": "2.0"
},
"allelestatus": {},
"lookupkey": {
"CYP2C9": "2"
},
"comments": "n/a",
"population": "general",
"subgroups": "CYP2C9:Normal 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": [
"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, 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., 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"
},
"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": "nortriptyline",
"drug_url": "https://drugs.com/nortriptyline.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/tricyclic-antidepressants.html",
"path": [
"psychotherapeutic agents",
"antidepressants",
"tricyclic antidepressants"
]
}
],
"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-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/",
"original_recommendation": {
"drugid": "RxNorm:7531",
"drugname": "nortriptyline",
"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": [
"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",
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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"
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"page": "",
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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.",
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"subgroups": "CYP2D6:Normal Metabolizer"
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}
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"Scott Stuart A",
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"implications": {
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"activityscore": {
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"lookupkey": {
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{
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]
},
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"Bell Gillian C",
"Caudle Kelly E",
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"journal": "Clinical pharmacology and therapeutics",
"month": 12,
"page": "",
"volume": "",
"year": 2016,
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"activityscore": {
"CYP2D6": "2.0"
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"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
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"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"
}
}
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},
{
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"genes": [
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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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"title": "Clinical Pharmacogenetics Implementation Consortium Guideline for HLA Genotype and Use of Carbamazepine and Oxcarbazepine: 2017 Update.",
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"cpicVersion": "v.1.17.1",
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"lookupkey": {
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"comments": "n/a",
"population": "OXC naive",
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"url": "https://cpicpgx.org/guidelines/guideline-for-carbamazepine-and-hla-b/",
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{
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"activityscore": {
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},
{
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},
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{
"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": "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 [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-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": [
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"genes": [
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"id": 110003,
"guidelineid": 100412,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C9 and HLA-B Genotype and Phenytoin Dosing",
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"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"
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"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": "",
"volume": "",
"year": 2014,
"pmid": "25099164",
"pmcid": "PMC4206662",
"doi": "10.1038/clpt.2014.159",
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"guidelineid": 100412,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and HLA-B Genotypes and Phenytoin Dosing: 2020 Update.",
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"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"
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"journal": "Clinical pharmacology and therapeutics",
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"page": "",
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"pmid": "32779747",
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"doi": null,
"url": null,
"version": 3,
"highlightedonsite": false,
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}
],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
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"CYP2C9": "Normal phenytoin metabolism"
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"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": "Strong",
"phenotypes": {
"CYP2C9": "Normal Metabolizer"
},
"activityscore": {
"CYP2C9": "2.0"
},
"allelestatus": {
"HLA-B": "HLA-B*15:02 negative"
},
"lookupkey": {
"HLA-B": "*15:02 negative",
"CYP2C9": "2"
},
"comments": "n/a",
"population": "PHT naive",
"subgroups": "CYP2C9:Normal 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": [
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"genes": [
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"HLA-B"
],
"citations": [
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"id": 110003,
"guidelineid": 100412,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for CYP2C9 and HLA-B Genotype and Phenytoin Dosing",
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"Caudle Kelly E",
"Rettie Allan E",
"Whirl-Carrillo Michelle",
"Smith Lisa H",
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"Callaghan J Thomas"
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"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": "",
"volume": "",
"year": 2014,
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{
"id": 110077,
"guidelineid": 100412,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and HLA-B Genotypes and Phenytoin Dosing: 2020 Update.",
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"Karnes Jason H",
"Rettie Allan E",
"Somogyi Andrew A",
"Huddart Rachel",
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"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"
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"journal": "Clinical pharmacology and therapeutics",
"month": 8,
"page": "",
"volume": "",
"year": 2020,
"pmid": "32779747",
"pmcid": null,
"doi": null,
"url": null,
"version": 3,
"highlightedonsite": false,
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],
"notesonusage": null,
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"CYP2C9": "Normal phenytoin metabolism"
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"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": "Strong",
"phenotypes": {
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"activityscore": {
"CYP2C9": "2.0"
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"allelestatus": {
"HLA-B": "HLA-B*15:02 negative"
},
"lookupkey": {
"HLA-B": "*15:02 negative",
"CYP2C9": "2"
},
"comments": "n/a",
"population": "PHT use >3mos",
"subgroups": "CYP2C9:Normal 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": "USUAL",
"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/*1",
"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
}
],
"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: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.",
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"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": "Normal 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": "Strong",
"phenotypes": {
"CYP2C9": "Normal Metabolizer"
},
"activityscore": {
"CYP2C9": "2.0"
},
"allelestatus": {},
"lookupkey": {
"CYP2C9": "2"
},
"comments": "n/a",
"population": "general",
"subgroups": "CYP2C9:Normal Metabolizer"
}
},
{
"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": "USUAL",
"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/*1",
"phenotype": "Normal Function",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Prescribe desired starting dose and adjust doses based on disease-specific guidelines [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-statins/",
"original_recommendation": {
"drugid": "RxNorm:861634",
"drugname": "pitavastatin",
"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": [
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"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"
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"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"
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{
"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"
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"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",
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"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": "Typical myopathy risk and statin exposure"
},
"drugrecommendation": "Prescribe desired starting dose and adjust doses based on disease-specific guidelines.",
"classification": "Strong",
"phenotypes": {
"SLCO1B1": "Normal Function"
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"activityscore": {},
"allelestatus": {},
"lookupkey": {
"SLCO1B1": "Normal Function"
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"comments": "The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.",
"population": "population general",
"subgroups": "SLCO1B1:Normal Function"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1450814813",
"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 exposure to pitavastatin as compared to patients with a no function allele in combination with a normal or increased function allele or with two no function alleles. Other genetic or clinical factors may also affect a patient's exposure to pitavastatin. This annotation only covers the pharmacokinetic relationship between SLCO1B1 and pitavastatin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "USUAL",
"drug": "pravastatin",
"drug_url": "https://drugs.com/pravastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
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"antihyperlipidemic agents",
"statins"
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}
],
"genes": [
{
"name": "SLCO1B1",
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"phenotype": "Normal Function",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Prescribe desired starting dose and adjust doses based on disease-specific guidelines [CPIC].",
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"FDA level": "",
"CPIC level": "A",
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"sources": [
{
"name": "CPIC",
"level": "A",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"original_recommendation": {
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"drugname": "pravastatin",
"guidelinename": "SLCO1B1, ABCG2, CYP2C9, and Statins",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
"guidelinepharmgkbids": [
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"PA166262221",
"PA166262241",
"PA166262261",
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"citations": [
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"Ramsey L B",
"Johnson S G",
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"McLeod H L",
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"Krauss R M",
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"Klein T E",
"Wadelius M",
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"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"
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{
"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"
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"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,
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"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",
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"Krauss Ronald M",
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"journal": "Clinical pharmacology and therapeutics",
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"page": null,
"volume": null,
"year": 2022,
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"doi": "10.1002/cpt.2557",
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"version": 4,
"highlightedonsite": false,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/statins/2022/publication.pdf"
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],
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"drugrecommendation": "Prescribe desired starting dose and adjust doses based on disease-specific guidelines.",
"classification": "Strong",
"phenotypes": {
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"activityscore": {},
"allelestatus": {},
"lookupkey": {
"SLCO1B1": "Normal Function"
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"comments": "The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.",
"population": "population general",
"subgroups": "SLCO1B1:Normal Function"
}
}
]
},
{
"report_table": "USUAL",
"drug": "rosuvastatin",
"drug_url": "https://drugs.com/mtm/rosuvastatin.html",
"drug_class": [
{
"href": "https://drugs.com/drug-class/hmg-coa-reductase-inhibitors.html",
"path": [
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"antihyperlipidemic agents",
"statins"
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}
],
"genes": [
{
"name": "ABCG2",
"genotype": "rs2231142 reference (G)/rs2231142 reference (G)",
"phenotype": "Normal Function",
"genotype_description": "Two normal function alleles"
},
{
"name": "SLCO1B1",
"genotype": "*1/*1",
"phenotype": "Normal Function",
"genotype_description": "Two normal function alleles"
}
],
"qg_recommendation": "Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines [CPIC].",
"qg_phenotype_statement": "Standard 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:301542",
"drugname": "rosuvastatin",
"guidelinename": "SLCO1B1, ABCG2, CYP2C9, and Statins",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-statins/",
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"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",
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"year": 2012,
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"id": 110022,
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"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",
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"page": "",
"volume": "",
"year": 2014,
"pmid": "24918167",
"pmcid": "PMC4169720",
"doi": "10.1038/clpt.2014.125",
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{
"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"
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"page": null,
"volume": null,
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],
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"cpicVersion": "v.1.17.1",
"implications": {
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"subgroups": "ABCG2:Normal Function|SLCO1B1:Normal Function"
}
},
{
"name": "PharmGKB",
"level": "1A",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451666660",
"annotation_text": "The T allele of this variant, when measured on the plus chromosomal strand, is assigned decreased function by CPIC. Patients with the rs2231142 GG genotype may have decreased plasma concentrations of rosuvastatin when treated with rosuvastatin as compared to patients with the TT or GT genotype. Other genetic and clinical factors may also influence the metabolism of rosuvastatin. This annotation only covers the pharmacokinetic relationship between rs2231142 and rosuvastatin and does not include evidence about clinical outcomes."
}
]
},
{
"report_table": "USUAL",
"drug": "sertraline",
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"href": "https://drugs.com/drug-class/ssri-antidepressants.html",
"path": [
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],
"genes": [
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"name": "CYP2C19",
"genotype": "*1/*1",
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{
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],
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"CPIC level": "B",
"PharmGKB level": "1A",
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},
{
"report_table": "USUAL",
"drug": "simvastatin",
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"drug_class": [
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"drugname": "simvastatin",
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"title": "The Clinical Pharmacogenomics Implementation Consortium: Guideline for SLCO1B1 and Simvastatin-Induced Myopathy",
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"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",
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"month": 5,
"page": "",
"volume": "",
"year": 2012,
"pmid": "22617227",
"pmcid": "PMC3384438",
"doi": "10.1038/clpt.2012.57",
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{
"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",
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"McLeod Howard L",
"Krauss Ronald M",
"Roden Dan M",
"Feng Qiping",
"Cooper-DeHoff Rhonda M",
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"journal": "Clinical pharmacology and therapeutics",
"month": 6,
"page": "",
"volume": "",
"year": 2014,
"pmid": "24918167",
"pmcid": "PMC4169720",
"doi": "10.1038/clpt.2014.125",
"url": null,
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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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"implications": {
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"comments": "The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.",
"population": "general",
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}
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},
{
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"path": [
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"calcineurin inhibitors"
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}
],
"genes": [
{
"name": "CYP3A5",
"genotype": "*3/*3",
"phenotype": "Poor Metabolizer",
"genotype_description": "Two no function alleles"
}
],
"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]. Initiate therapy with standard recommended dose. Use therapeutic drug monitoring to guide dose adjustments [CPIC].",
"qg_phenotype_statement": "Standard Dose recommended [CPIC]",
"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"
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"genes": [
"CYP3A5"
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"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"
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],
"notesonusage": null,
"cpicVersion": "v.1.17.1",
"implications": {
"CYP3A5": "Higher (\"normal\") dose-adjusted trough concentrations of tacrolimus and increased chance of achieving target tacrolimus concentrations."
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"drugrecommendation": "Initiate therapy with standard recommended dose. Use therapeutic drug monitoring to guide dose adjustments.",
"classification": "Strong",
"phenotypes": {
"CYP3A5": "Poor Metabolizer"
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"activityscore": {
"CYP3A5": "n/a"
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"allelestatus": {},
"lookupkey": {
"CYP3A5": "Poor Metabolizer"
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"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. 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:Poor Metabolizer"
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},
{
"name": "FDA (Therapeutic Management Recommendations)",
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"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."
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},
{
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"drug": "tamoxifen",
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"href": "https://drugs.com/drug-class/hormones-antineoplastics.html",
"path": [
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},
{
"href": "https://drugs.com/drug-class/selective-estrogen-receptor-modulators.html",
"path": [
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],
"genes": [
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"name": "CYP2D6",
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],
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"CPIC level": "A",
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"original_recommendation": {
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"drugname": "tamoxifen",
"guidelinename": "CYP2D6 and Tamoxifen",
"url": "https://cpicpgx.org/guidelines/cpic-guideline-for-tamoxifen-based-on-cyp2d6-genotype/",
"guidelinepharmgkbids": [
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"genes": [
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"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,
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"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/tamoxifen/2017/29385237.pdf"
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"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Therapeutic endoxifen concentrations"
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"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"
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"activityscore": {
"CYP2D6": "2.0"
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"allelestatus": {},
"lookupkey": {
"CYP2D6": "2"
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"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": "USUAL",
"drug": "tenoxicam",
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"drug_class": null,
"genes": [
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"phenotype": "Normal Metabolizer",
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],
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"CPIC level": "A",
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"name": "CPIC",
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"drugname": "tenoxicam",
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"genes": [
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"citations": [
{
"id": 571448,
"guidelineid": 110058,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and Nonsteroidal Anti-inflammatory Drugs.",
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"Lee Craig R",
"Gong Li",
"Caudle Kelly E",
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"journal": "Clinical pharmacology and therapeutics",
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"volume": null,
"year": 2020,
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"doi": "10.1002/cpt.1830",
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"version": 4,
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"activityscore": {
"CYP2C9": "2.0"
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"lookupkey": {
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"comments": "n/a",
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}
},
{
"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",
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"drug_class": [
{
"href": "https://drugs.com/drug-class/antimetabolites.html",
"path": [
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}
],
"genes": [
{
"name": "NUDT15",
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"genotype_description": "Two normal function alleles"
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{
"name": "TPMT",
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],
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"CPIC level": "",
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"name": "CPIC",
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"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"
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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"
},
{
"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": [
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"analgesics",
"narcotic analgesics"
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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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],
"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/",
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"genes": [
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"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"
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"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"
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{
"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"
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"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"
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"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"
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],
"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"
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"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": [
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"href": "https://drugs.com/drug-class/tricyclic-antidepressants.html",
"path": [
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"genes": [
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"phenotype": "Normal Metabolizer",
"genotype_description": "Two normal function alleles"
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{
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"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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],
"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": {
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"drugname": "trimipramine",
"guidelinename": "CYP2D6, CYP2C19 and Tricyclic Antidepressants",
"url": "https://cpicpgx.org/guidelines/guideline-for-tricyclic-antidepressants-and-cyp2d6-and-cyp2c19/",
"guidelinepharmgkbids": [
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"PA166105000",
"PA166105001",
"PA166105002",
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"PA166105007"
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"genes": [
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"CYP2D6"
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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"
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],
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"cpicVersion": "v.1.17.1",
"implications": {
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"CYP2C19": "Normal metabolism of tertiary amines"
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"drugrecommendation": "Initiate therapy with recommended starting dose.",
"classification": "Strong",
"phenotypes": {
"CYP2D6": "Normal Metabolizer",
"CYP2C19": "Normal Metabolizer"
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"activityscore": {
"CYP2D6": "2.0",
"CYP2C19": "n/a"
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"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": [
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"PA166161955"
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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,
"fulltextfile": "https://files.cpicpgx.org/data/guideline/publication/ondansetron/2016/28002639.pdf"
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"cpicVersion": "v.1.17.1",
"implications": {
"CYP2D6": "Normal metabolism"
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"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."
}
]
},
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"drug": "voriconazole",
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"path": [
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}
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"name": "CYP2C19",
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"phenotype": "Normal Metabolizer",
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"CPIC level": "A",
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"name": "CPIC",
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"url": "https://cpicpgx.org/guidelines/guideline-for-voriconazole-and-cyp2c19/",
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"url": "https://cpicpgx.org/guidelines/guideline-for-voriconazole-and-cyp2c19/",
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"id": 110001,
"guidelineid": 100410,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Voriconazole Therapy",
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"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",
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"page": "",
"volume": "",
"year": 2016,
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"pmcid": "PMC5474211",
"doi": "10.1002/cpt.583",
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"version": 3,
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"drugrecommendation": "Initiate therapy with recommended standard of care dosing",
"classification": "Strong",
"phenotypes": {
"CYP2C19": "Normal Metabolizer"
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"activityscore": {},
"allelestatus": {},
"lookupkey": {
"CYP2C19": "Normal Metabolizer"
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"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/",
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"drugid": "RxNorm:121243",
"drugname": "voriconazole",
"guidelinename": "CYP2C19 and Voriconazole",
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"citations": [
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"id": 110001,
"guidelineid": 100410,
"title": "Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Voriconazole Therapy",
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"Moriyama Brad",
"Obeng Aniwaa Owusu",
"Barbarino Julia",
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"Henning Stacey A",
"Scott Stuart A",
"Agundez Jose A G",
"Wingard John R",
"McLeod Howard L",
"Klein Teri E",
"Cross Shane",
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"month": 12,
"page": "",
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"lookupkey": {
"CYP2C19": "Normal Metabolizer"
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"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",
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}
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},
{
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"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": "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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs4149056 TT genotype may have decreased concentrations of pitavastatin when treated with pitavastatin as compared to patients with CC or CT 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 TT genotype may have decreased concentrations of pitavastatin when treated with pitavastatin as compared to patients with CC or CT 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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs4149056 TT genotype may have decreased concentration of lovastatin acid as compared to patients with the CC or CT 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 TT genotype may have decreased concentration of lovastatin acid as compared to patients with the CC or CT 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": "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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs4149056 TT genotype may have decreased concentration of lovastatin acid as compared to patients with the CC or CT 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 TT genotype may have decreased concentration of lovastatin acid as compared to patients with the CC or CT 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": "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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs4149056 TT genotype may have decreased concentrations of fluvastatin as compared to patients with the CC or CT genotypes. 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 TT genotype may have decreased concentrations of fluvastatin as compared to patients with the CC or CT genotypes. 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": "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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the TT genotype may have decreased exposure to atorvastatin as compared to patients with the CC or CT genotypes. 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 TT genotype may have decreased exposure to atorvastatin as compared to patients with the CC or CT genotypes. 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": "MINOR",
"drug": "oxycodone",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AA",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs4680 AA 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 AA 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": "amodiaquine",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP2C8",
"genotype": "rs10509681 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the TT genotype may have decreased but not non-existent risk of side effects to amodiaquine as compared to patients with the CC or CT 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 TT genotype may have decreased but not non-existent risk of side effects to amodiaquine as compared to patients with the CC or CT genotype. Other genetic and clinical factors may also influence a patient's risk for side effects."
}
]
},
{
"report_table": "MINOR",
"drug": "paclitaxel",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP2C8",
"genotype": "rs10509681 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the TT genotype may have increased metabolism of paclitaxel as compared to patients with the CT or CC genotypes, 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 TT genotype may have increased metabolism of paclitaxel as compared to patients with the CT or CC genotypes, however this has not been shown in vivo. Other genetic and clinical factors may also influence clearance of paclitaxel."
}
]
},
{
"report_table": "MINOR",
"drug": "repaglinide",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP2C8",
"genotype": "rs10509681 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Individuals with the TT (CYP2C8*1/*1) genotype may have decreased metabolism of repaglinide compared to patients with the CT genotype (CYP2C8*3/*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 TT (CYP2C8*1/*1) genotype may have decreased metabolism of repaglinide compared to patients with the CT genotype (CYP2C8*3/*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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the TT genotype may have increased clearance of atazanavir as compared to patients with the CT or CC genotypes. 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 TT genotype may have increased clearance of atazanavir as compared to patients with the CT or CC genotypes. 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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the TT genotype may be more 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 CC or CT 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 TT genotype may be more 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 CC or CT 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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the TT genotype may be more 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 CC or CT 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 TT genotype may be more 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 CC or CT 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": "fentanyl",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP3A4",
"genotype": "rs2740574 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the rs2740574 TT genotype may have increased clearance of fentanyl as compared to patients with the rs2740574 CT genotype (CYP3A4*1B allele). 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 TT genotype may have increased clearance of fentanyl as compared to patients with the rs2740574 CT genotype (CYP3A4*1B allele). 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": "Vitamin K",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP4F2",
"genotype": "rs2108622 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may have increased concentrations of Vitamin K as compared to patients with the CC. 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 CT genotype may have increased concentrations of Vitamin K as compared to patients with the CC. Other clinical and genetic factors may also influence concentrations of Vitamin K."
}
]
},
{
"report_table": "MINOR",
"drug": "phenprocoumon",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "CYP4F2",
"genotype": "rs2108622 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype who are treated with phenprocoumon may require a higher dose as compared to patients with the CC genotype or 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 CT genotype who are treated with phenprocoumon may require a higher dose as compared to patients with the CC genotype or 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": "folic acid",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "MTHFR",
"genotype": "rs1801133 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Female patients with the AG genotype and Migraine who are treated with folic acid and a vitamin b-complex may have a decreased severity of pain greater reduction in homocysteine as compared to patients with the AA 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 AG genotype and Migraine who are treated with folic acid and a vitamin b-complex may have a decreased severity of pain greater reduction in homocysteine as compared to patients with the AA 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": "sumatriptan",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AA",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AA genotype with substance withdrawal syndrome may have a decreased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AG and GG genotypes. 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 AA genotype with substance withdrawal syndrome may have a decreased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AG and GG genotypes. 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 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Female patients with the AG genotype and Migraine who are treated with folic acid and a vitamin b-complex may have a decreased severity of pain greater reduction in homocysteine as compared to patients with the AA 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 AG genotype and Migraine who are treated with folic acid and a vitamin b-complex may have a decreased severity of pain greater reduction in homocysteine as compared to patients with the AA 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 AG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GA 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 GA 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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the TT genotype may have increased plasma concentration of atorvastatin when treated concomitantly with rifampin as compared to patients with the CC or CT 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 TT genotype may have increased plasma concentration of atorvastatin when treated concomitantly with rifampin as compared to patients with the CC or CT 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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the TT genotype may have a decreased AUC of letermovir as compared to patients with the CC or CT genotypes. 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 TT genotype may have a decreased AUC of letermovir as compared to patients with the CC or CT genotypes. 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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the TT genotype may have decreased exposure of repaglinide and decreased response to repaglinide compared to patients with the CC 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 TT genotype may have decreased exposure of repaglinide and decreased response to repaglinide compared to patients with the CC 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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the TT genotype may have increased lipid-lowering response to simvastatin as compared to patients with the CC or CT 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 TT genotype may have increased lipid-lowering response to simvastatin as compared to patients with the CC or CT 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": "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 CT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CT genotype may have decreased international normalized ratio variability (INR-var) when treated with warfarin as compared to patients with genotype CC 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 CT genotype may have decreased international normalized ratio variability (INR-var) when treated with warfarin as compared to patients with genotype CC 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": "opioids",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AA",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AA genotype with substance withdrawal syndrome may have a decreased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AG and GG genotypes. 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 AA genotype with substance withdrawal syndrome may have a decreased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AG and GG genotypes. 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "People with the GG genotype may have decreased exposure to dabigatran compared to patients with the AA and AG genotypes, 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 GG genotype may have decreased exposure to dabigatran compared to patients with the AA and AG genotypes, when also assessed with the rs2032582 allele. Other clinical and genetic factors may affect exposure to dabigatran."
}
]
},
{
"report_table": "MINOR",
"drug": "remifentanil",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG genotype may have show decreased anesthesia efficacy of remifentanil as compared to patients with the AA genotype. Other genetic and clinical factors may also affect efficacy of remifentanil in a patient. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1451118766",
"annotation_text": "Patients with the GG genotype may have show decreased anesthesia efficacy of remifentanil as compared to patients with the AA genotype. Other genetic and clinical factors may also affect efficacy of remifentanil in a patient."
}
]
},
{
"report_table": "MINOR",
"drug": "Dabigatran",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs2032582 CC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "People with the CC genotype may have decreased exposure to dabigatran compared to patients with a variant at this position, including genotypes AA, AC, CT, and TT, 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 CC genotype may have decreased exposure to dabigatran compared to patients with a variant at this position, including genotypes AA, AC, CT, and TT, when assessed in conjunction with a variant at position rs1045642. Other clinical and genetic factors may affect exposure to dabigatran."
}
]
},
{
"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": "ABCB1",
"genotype": "rs2032582 CC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CC genotype may have increased risk of drug-induced liver injury compared to patients with the TT genotype. Other factors may affect liver toxicity when treated with atorvastatin. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448104372",
"annotation_text": "Patients with the CC genotype may have increased risk of drug-induced liver injury compared to patients with the TT genotype. Other factors may affect liver toxicity when treated with atorvastatin."
}
]
},
{
"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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG 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 GG 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG genotype 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 GG genotype 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 CC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CC genotype 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 CC genotype 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG 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 GG 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Genotype GG may be associated with increased clearance of dicloxacillin when treated with dicloxacillin and probenecid as compared to genotype AG. 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 GG may be associated with increased clearance of dicloxacillin when treated with dicloxacillin and probenecid as compared to genotype AG. 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with GG genotype may have increased metabolism and decreased serum concentration of digoxin as compared to patients with the AA 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 GG genotype may have increased metabolism and decreased serum concentration of digoxin as compared to patients with the AA 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 CC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with genotype CC 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 CC 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Healthy individuals with the GG genotype who are treated with fexofenadine may have higher plasma drug levels as compared with 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 GG genotype who are treated with fexofenadine may have higher plasma drug levels as compared with 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG 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 GG 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with genotype GG may have decreased plasma drug levels of phenytoin in people with no disease as compared to genotype AA. 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 GG may have decreased plasma drug levels of phenytoin in people with no disease as compared to genotype AA. 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": "Antiinflammatory agents, non-steroids",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AA",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AA genotype with substance withdrawal syndrome may have a decreased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AG and GG genotypes. 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 AA genotype with substance withdrawal syndrome may have a decreased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AG and GG genotypes. 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 AA",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AA genotype with substance withdrawal syndrome may have a decreased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AG and GG genotypes. 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 AA genotype with substance withdrawal syndrome may have a decreased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AG and GG genotypes. 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": "rivaroxaban",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "People with the GG genotype may have decreased exposure to rivaroxaban compared to people with the AA and AG genotypes when assessed in conjunction with the rs2032582 SNP. Other clinical and genetic factor may affect exposure to rivaroxaban. [PharmGKB]",
"qg_phenotype_statement": "",
"sources": [
{
"name": "PharmGKB",
"level": "3",
"url": "https://www.pharmgkb.org/clinicalAnnotation/1448532196",
"annotation_text": "People with the GG genotype may have decreased exposure to rivaroxaban compared to people with the AA and AG genotypes when assessed in conjunction with the rs2032582 SNP. Other clinical and genetic factor may affect exposure to rivaroxaban."
}
]
},
{
"report_table": "MINOR",
"drug": "rivaroxaban",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs2032582 CC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "People with the CC genotype may have decreased exposure to rivaroxaban compared to patients with a variant at this position, including genotypes AA, AC, CT, and TT, 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 CC genotype may have decreased exposure to rivaroxaban compared to patients with a variant at this position, including genotypes AA, AC, CT, and TT, 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "People with genotype GG may have increased exposure to silibinin compared to people with genotypes AA or AG. 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 GG may have increased exposure to silibinin compared to people with genotypes AA or AG. 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG 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 GG 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG genotype may have a decreased exposure to tramadol as compared to patients with the AA or AG genotypes. 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 GG genotype may have a decreased exposure to tramadol as compared to patients with the AA or AG genotypes. 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 CC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CC genotype may have a decreased exposure to tramadol as compared to patients with the AA genotype. However, another study found no association between this variant and exposure to tramadol. 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/1449162899",
"annotation_text": "Patients with the CC genotype may have a decreased exposure to tramadol as compared to patients with the AA genotype. However, another study found no association between this variant and exposure to tramadol. Other genetic and clinical factors may also influence a patient's exposure to tramadol."
}
]
},
{
"report_table": "MINOR",
"drug": "verapamil",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG genotype may have decreased metabolism of verapamil as compared to patients with the AA or AG 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 GG genotype may have decreased metabolism of verapamil as compared to patients with the AA or AG 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 CC",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the CC genotype may have decreased metabolism of verapamil as compared to patients with the AA or AC 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 CC genotype may have decreased metabolism of verapamil as compared to patients with the AA or AC 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG genotype may have 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 GG genotype may have 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": "Analgesics",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "COMT",
"genotype": "rs4680 AA",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the AA genotype with substance withdrawal syndrome may have a decreased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AG and GG genotypes. 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 AA genotype with substance withdrawal syndrome may have a decreased likelihood of headache when discontinuing the use of analgesics (such as opioids, NSAIDs, triptans, ergot) as compared to patients with the AG and GG genotypes. 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": "rhodamine 123",
"drug_url": null,
"drug_class": null,
"genes": [
{
"name": "ABCB1",
"genotype": "rs1045642 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Genotype GG may be associated with increased efflux of rhodamine from CD56+ natural killer cells when exposed to rhodamine 123 as compared to genotypes AA + AG. 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 GG may be associated with increased efflux of rhodamine from CD56+ natural killer cells when exposed to rhodamine 123 as compared to genotypes AA + AG. However, contradictory finding has been reported."
}
]
},
{
"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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG genotype who are treated with simvastatin may have a reduced response to treatment (measured by a lower reduction in total cholesterol) 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 GG genotype who are treated with simvastatin may have a reduced response to treatment (measured by a lower reduction in total cholesterol) 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 GG",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "Patients with the GG genotype may require a decreased dose of warfarin as compared to patients with the AG or AA genotypes, 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 GG genotype may require a decreased dose of warfarin as compared to patients with the AG or AA genotypes, 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 TT",
"phenotype": "",
"genotype_description": ""
}
],
"qg_recommendation": "The current evidence base suggests that there is no association between the rs4149056 TT 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 TT 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 CT"
],
"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/*1",
"rs4149056 TT"
],
"VKORC1": [
"rs9923231 TT"
],
"ABCB1": [
"rs1045642 GG",
"rs2032582 CC"
],
"ACE": [
"rs1799752 del/del (inferred)",
"rs4343 GG"
],
"ANKK1": [
"rs1800497 GG"
],
"APOE": [
"rs7412 CT"
],
"ATM": [
"rs11212617 AA"
],
"CES1": [
"rs71647871 CC"
],
"COMT": [
"rs13306278 CC",
"rs4680 AA"
],
"CYP2C8": [
"*1.001/*1.001",
"rs10509681 TT"
],
"CYP3A4": [
"*1/*1",
"rs2242480 CC",
"rs2740574 TT"
],
"DRD2": [
"rs1799978 TT"
],
"ERCC1": [
"rs11615 GG",
"rs3212986 AC"
],
"F2": [
"rs1799963 GG"
],
"F5": [
"rs6025 CC"
],
"GGCX": [
"rs11676382 CC"
],
"GRIK4": [
"rs1954787 CC"
],
"GSTP1": [
"rs1695 AA"
],
"HTR1A": [
"rs6295 CG"
],
"HTR2A": [
"rs7997012 GG"
],
"HTR2C": [
"rs1414334 CC",
"rs3813929 CC"
],
"ITPA": [
"rs1127354 CC",
"rs7270101 AC"
],
"KIF6": [
"rs20455 AG"
],
"MTHFR": [
"rs1801133 AG"
],
"NQO1": [
"rs1800566 GG"
],
"OPRM1": [
"rs1799971 AG"
],
"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": [
"*1/*5"
],
"CYP2C19": [
"*1/*1"
],
"CYP2C9": [
"*1/*1"
],
"CYP3A5": [
"*3/*3"
],
"IFNL3": [
"rs12979860 CC"
],
"NAT2": [
"*4/*6B"
],
"NUDT15": [
"*1/*1"
],
"TPMT": [
"*1/*1"
],
"UGT1A1": [
"*1/*1"
],
"CYP2D6": [
"*1/*1"
]
}
}
Reference in New Issue View Git Blame Copy Permalink