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PATIENT:
ACCESSION:
Doe, John
DOB:
APGX-00003
GENDER: M 01/01/1950
FACILITY:
PHYSICIAN:
Access Medical Center
Jane Smith
06/12/2017COLLECTED: REPORTED:
·
REPORTED MEDICATION LISTAripiprazole(Abilify) Clopidogrel(Plavix) Loratadine(Claritin)Metoprolol(Lopressor) Naproxen(Naprosyn) Oxycodone(Percocet)Sertraline(Zoloft)
DRUG-GENE INTERACTIONS
Use with High Caution
PhenotypeMedication Evidence Level
Clopidogrel (Plavix) CYP2C19 Poor Metabolizer Actionable
Clopidogrel (Plavix) active metabolite serum levels may decrease in CYP2C19 poor metabolizers. ACS/PCI patients may be atincreased risk for myocardial infarction, stroke, or stent thrombosis. All other patients are at lower clinical risk. For ACS/PCI patientsconsider prescribing prasugrel (Effient) or ticagrelor (Brilinta) instead. For secondary prevention of stroke or for peripheral arterydisease consider prescribing aspirin or aspirin/dipyridamole (Aggrenox) instead.
Sertraline (Zoloft) CYP2C19 Poor Metabolizer Actionable
Sertraline (Zoloft) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for CNS or GI adverseeffects. Consider initiating therapy at a 50% reduction in the recommended dose and titrating to response or prescribing duloxetine(Cymbalta), bupropion (Wellbutrin), or paroxetine (Paxil) instead.
Use with Caution
PhenotypeMedication Evidence Level
Metoprolol (Lopressor) CYP2D6 Intermediate Metabolizer Actionable
Metoprolol (Lopressor) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects such as bradycardia, hypotension, or dizziness. If clinically necessary, decrease the dose or consider prescribing atenolol(Tenormin), bisoprolol (Zebeta), or nadolol (Corgard) instead.
Aripiprazole (Abilify) CYP2D6 Intermediate Metabolizer Informative
Aripiprazole (Abilify) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects. If clinically necessary, decrease the dose or consider prescribing ziprasidone (Geodon), olanzapine (Zyprexa), or lurasidone(Latuda) instead.
Oxycodone (Percocet) CYP2D6 Intermediate Metabolizer Actionable
Oxycodone (Percocet) serum levels may increase and active metabolite oxymorphone serum levels may decrease in CYP2D6intermediate metabolizers. Patients may be at increased risk for adverse effects and drug may have decreased efficacy. If clinicallynecessary, consider prescribing morphine, oxymorphone (Opana), hydromorphone (Dilaudid), or non-opioid analgesics instead.
Genetic Marker Genotype Phenotype
5HTT-rs1042173 A/A Homozygote Wild Type
GENOTYPE/PHENOTYPE TEST RESULTS
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Genetic Marker Genotype Phenotype
5HTT-rs25531 T/T Short Form
ABCG2 A/A Homozygote Mutant
ADRA2A G/G Homozygote Wild Type
APOE E3/E3 Indeterminate Metabolizer
BDNF C/C Homozygote Wild Type
COMT G/G Homozygote Wild Type
CYP1A2 *1A/*1A Normal Metabolizer
CYP2B6 *1/*1 Normal Metabolizer
CYP2C19 *2/*2 Poor Metabolizer
CYP2C8 *1A/*1A Normal Metabolizer
CYP2C9 *1/*1 Normal Metabolizer
CYP2D6 *1/*4 Intermediate Metabolizer
CYP3A4 *1/*1 Normal Metabolizer
CYP3A5 *3/*3 Normal Metabolizer
CYP3A7 *1/*1 Normal Metabolizer
CYP4F2 C/C Homozygote Wild Type
DBH T/T Homozygote Mutant
DPYD *1/*1 High Activity
DRD1 C/C Homozygote Wild Type
DRD2 A2/A2 Homozygote Wild Type
FactorII A/A Homozygote Mutant
FactorV G/G Homozygote Wild Type
G6PD B/Asahi Heterozygote
GRIK1 A/C Heterozygote
GRIK4 C/C Homozygote Mutant
GRIN2B T/T Homozygote Wild Type
HTR2A C/T Heterozygote
HTR2C-rs1414334 G/G Homozygote Wild Type
HTR2C-rs3813929 T/T Homozygote Mutant
IFNL3 C/C Homozygote Wild Type
MTHFR-1298 A/A Homozygote Wild Type
MTHFR-677 C/C Homozygote Wild Type
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Genetic Marker Genotype Phenotype
NAT2 *4/*6 Intermediate Acetylator
OPRM1 A/A Homozygote Wild Type
SLC47A2 G/G Homozygote Wild Type
SLCO1B1 T/T Homozygote Wild Type
TPMT *1/*1 High Activity
UGT1A1 *1/*1 Normal Metabolizer
UGT2B15 *1/*1 Normal Metabolizer
UGT2B7 *1/*1 Normal Metabolizer
VKORC1 G/A Intermediate Sensitivity
ALTERNATIVE MEDICATIONS
Therapeutic Class Standard Precautions Use With Caution High Caution
Cardiology - ACEI/ARBs Irbesartan (Avapro), Losartan(Cozaar)
Cardiology - Antiarrhythmics Amiodarone (Cordarone) Mexiletine (Mexitil), Flecainide(Tambocor), Propafenone
(Rythmol), Lidocaine (Xylocaine)
Cardiology - Anticoagulants Prasugrel (Effient), Ticagrelor(Brilinta)
Warfarin (Coumadin) Clopidogrel (Plavix)
Cardiology - Antihyperlipidemics Lovastatin (Mevacor),Fluvastatin (Lescol),
Rosuvastatin (Crestor),Pitavastatin (Livalo), Fenofibrate
(Tricor), Gemfibrozil (Lopid)
Atorvastatin (Lipitor),Simvastatin (Zocor), Pravastatin
(Pravachol)
Cardiology - Beta-Blockers Bisoprolol (Zebeta) Carvedilol (Coreg), Metoprolol(Lopressor), Nebivolol (Bystolic)
Cardiology - Calcium ChannelBlockers
Diltiazem (Cardizem),Amlodipine (Norvasc),Nifedipine (Procardia),
Felodipine (Plendil), Verapamil
Cardiology - Diuretics Torsemide (Demadex),Triamterene (Component of
Dyazide)
Cardiology - Miscellaneous Clonidine (Catapres), Doxazosin(Cardura)
Hydralazine (Apresoline)
Endocrinology Metformin (Glucophage),Repaglinide (Prandin),
Rosiglitazole (Avandia),Pioglitazone (Actos), Saxagliptin
(Onglyza)
Glimepiride (Amaryl), Glyburide(Diabeta), Glipizide (Glucotrol),
Chlorpropamide (Diabinese)
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Therapeutic Class Standard Precautions Use With Caution High Caution
Gastroenterology Promethazine (Phenergan),Ondansetron (Zofran),Palonosetron (Aloxi),
Metoclopramide (Reglan),Scopolamine (Transderm-Scop)
Esomeprazole (Nexium),Lansoprazole (Prevacid),Omeprazole (Prilosec),
Pantoprazole (Protonix),Rabeprazole (Aciphex),
Sulfasalazine (Azulfidine),MoviPrep
Gynecology Medroxyprogesterone(Provera), Desogestrel,
Levonorgestrel, Norethindrone,Etonogestrel, Estrogen
(Premarin), Estradiol (Estrace),Ethinyl Estradiol
Progesterone (Prometrium)
Immunology Sirolimus (Rapamune),Tacrolimus (Prograf),
Cyclosporine (Sandimmune),Azathioprine (Azasan),
Hydroxychloroquine (Plaquenil),Dexamethasone (Decadron),
Prednisone (Deltasone),Prednisolone (Millipred),
Methylprednisolone (Medrol)
Infectious Disease - Antibiotics Clindamycin (Cleocin),Clarithromycin (Biaxin),Metronidazole (Flagyl)
Norfloxacin (Noroxin), NalidixicAcid (NegGram), Sulfisoxazole,
Sulfadiazine (Silvadene),Sulfamethoxazole (component
of Bactrim), Trimethoprim(component of Bactrim),
Erythromycin (Erythrocin),Isoniazid, Quinine (Qualaquin),
Chloroquine (Aralan),Primaquine, Dapsone
Infectious Disease - Antifungals Itraconazole (Sporanox),Ketoconazole (Nizoral),Clotrimazole (Mycelex)
Voriconazole (Vfend)
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Therapeutic Class Standard Precautions Use With Caution High Caution
Infectious Disease - Antivirals Efavirenz (Sustiva), Nevirapine(Viramune), Saquinavir
(Invirase), Ritonavir (Norvir),Atazanavir (Reyataz), Ribavirin
(Copegus), Boceprevir(Victrelis), Simeprevir (Olysio),Sofosbuvir (Sovaldi), Telaprevir
(Incivek), Ombitasvir(Component of Viekira),
Paritaprevir (Component ofViekira), Dasabuvir (Exviera),
Daclatasvir (Daklinza),Velpatasvir (Component of
Epclusa), Ledipasvir(Component of Harvoni),Elbasvir (Component ofZepatier), Grazoprevir
(Component of Zepatier),Peginterferon Alfa-2a (Pegasys),
Peginterferon Alfa-2b (PEG-Intron)
Miscellaneous Caffeine, Ethanol, Anti-CocaineVaccine, Naloxone (Narcan),
Naltrexone (Revia), Fluocinonide(Lidex), Triamcinolone
(Kenalog), Hydrocortisone(Cortef), Betamethasone
(Celestone)
Nicotine, Ascorbic Acid, VitaminC, Methylene Blue, Sodium
Nitrite
Disulfiram (Antabuse)
Neurology - Anticonvulsants Fosphenytoin (Cerebyx),Valproic Acid (Depakote),
Divalproex (Depakote),Carbamazepine (Tegretol),
Topiramate (Topamax),Lamotrigine (Lamictal)
Phenobarbital Phenytoin (Dilantin)
Neurology - Miscellaneous Ropinirole (Requip), Selegiline(Zelapar), Zolmitriptan (Zomig),
Eletriptan (Relpax)
Donepezil (Aricept)
Neurology - Sedatives Zolpidem (Ambien), Suvorexant(Belsomra), Eszopiclone
(Lunesta), Ramelteon(Rozerem), Triazolam (Halcion),
Fentanyl (Duragesic),Midazolam (Versed), Meperidine(Demerol), Propofol (Diprivan),
Ketamine (Ketalar)
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Therapeutic Class Standard Precautions Use With Caution High Caution
Oncology Cyclophosphamide (Cytoxan),Ifosfamide (Ifex), Paclitaxel
(Taxol), Anastrozole (Arimidex),Letrozole (Femara),
Capecitabine (Xeloda), Cisplatin(Platinol), Fluorouracil (Adrucil),
Irinotecan (Camptosar),Mercaptopurine, Tegafur,
Thioguanine
Dabrafenib (Tafinlar) Tamoxifen
Opthamology Timolol (Timoptic)
Otolaryngology Loratadine (Claritin),Desloratadine (Clarinex)
Chlorpheniramine (Chlor-Trimeton), Dextromethorphan(Delsym), Meclizine (Antivert)
Pain Management -Miscellaneous
Ketamine (Ketalar),Cyclobenzaprine (Flexeril),
Tizanidine (Zanaflex),Duloxetine (Cymbalta)
Lidocaine (Xylocaine), Prilocaine(Emla), Nortriptyline (Pamelor)
Carisoprodol (Soma)
Pain Management - NSAIDs Flurbiprofen (Ansaid),Diclofenac (Voltaren), Naproxen
(Naprosyn), Indomethacin(Indocin), Nabumetone
(Relafen), Celecoxib (Celebrex),Ibuprofen (Motrin), Meloxicam(Mobic), Piroxicam (Feldene)
Pain Management - Opioids Fentanyl (Duragesic),Meperidine (Demerol),
Hydromorphone (Dilaudid),Oxymorphone (Opana),
Morphine, Buprenorphine(Subutex), Methadone
(Dolophine)
Codeine, Hydrocodone(Vicodin), Oxycodone
(Percocet), Tramadol (Ultram)
Psychiatry-ADHD Guanfacine (Intuniv) Atomoxetine (Strattera),Amphetamine (Component ofAdderall), Dextroamphetamine
(Component of Adderall),Lisdexamfetamine (Vyvanse)
Psychiatry-Antidepressants Duloxetine (Cymbalta),Mirtazapine (Remeron),
Vilazodone (Viibryd)
Nortriptyline (Pamelor),Bupropion (Wellbutrin),
Fluoxetine (Prozac), Paroxetine(Paxil), Fluvoxamine (Luvox),
Venlafaxine (Effexor),Trimipramine (Surmontil),Desipramine (Norpramin),
Protriptyline (Vivactil),Trazodone (Desyrel)
Sertraline (Zoloft), Citalopram(Celexa), Escitalopram
(Lexapro), Amitriptyline (Elavil),Doxepin (Sinequan), Imipramine
(Tofranil), Clomipramine(Anafranil)
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Therapeutic Class Standard Precautions Use With Caution High Caution
Psychiatry-Antipsychotics Olanzapine (Zyprexa),Quetiapine (Seroquel),Ziprasidone (Geodon),
Lurasidone (Latuda)
Risperidone (Risperdal),Aripiprazole (Abilify),Haloperidol (Haldol)
Clozapine (Clozaril),Thioridazine (Mellaril)
Psychiatry-Anxiolytics Alprazolam (Xanax),Clonazepam (Klonopin),
Lorazepam (Ativan), Oxazepam(Serax)
Buspirone (Buspar) Diazepam (Valium)
Psychiatry-Miscellaneous Modafinil (Provigil), Armodafinil(Nuvigil)
Benztropine (Cogentin), LithiumCarbonate (Lithobid)
Pulmonology Zafirlukast (Accolate),Montelukast (Singulair),Budesonide (Pulmicort)
Rheumatology Azathioprine (Azasan),Colchicine (Colcrys), Lesinurad
(Zurampic)
Sulfasalazine (Azulfidine),Probenecid, Pegloticase
(Krystexxa), Rasburicase (Elitek)
Urology Doxazosin (Cardura),Fesoterodine (Toviaz),Oxybutynin (Ditropan),Darifenacin (Enablex),Solifenacin (Vesicare),Finasteride (Proscar),
Dutasteride (Avodart), Sildenafil(Viagra), Tadalafil (Cialis),
Vardenafil (Levitra), Avanafil(Stendra)
Tolterodine (Detrol), Tamsulosin(Flomax)
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DOSING GUIDANCE FOR ALTERNATIVE MEDICATIONS
Standard Precautions
Medication Phenotype Evidence Level
Anti-Cocaine Vaccine DBH Homozygote Mutant Informative
Anti-cocaine vaccine may be efficacious in treating cocaine dependence in cocaine and opioid dependent patients.
Azathioprine (Azasan) TPMT High Activity Actionable
Patients taking azathioprine (Azasan) with high TPMT activity have lower serums levels of thioguanine metabolites and higher serumlevels of methylTIMP, which is normal. Initiate therapy at the normal starting dose (e.g. 2-3 mg/kg daily) and adjust further doses basedupon disease-specific guidelines. Allow 2 weeks to reach steady state after each dose adjustment.
Boceprevir (Victrelis) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Bupropion (Wellbutrin) DRD2 Homozygote Wild Type Informative
Bupropion may be efficacious in smoking cessation.
Capecitabine (Xeloda) DPYD High Activity Actionable
Capecitabine (Xeloda) may be prescribed and monitored according to standard procedures in patients with normal (high) DPD activity.
Citalopram (Celexa) GRIK4 Homozygote Mutant Informative
Citalopram may have increased efficacy in depressed patients compared to GRIK4 homozygous wild-type patients.
Clonidine (Catapres) CYP2D6 Intermediate Metabolizer Informative
Clonidine (Catapres) may be prescribed and monitored according to standard procedures in CYP2D6 intermediate metabolizers.
Clozapine (Clozaril) HTR2C-rs1414334 Homozygote Wild Type Informative
Schizophrenic and schizoaffective patients are at normal risk for clozapine-induced obesity and metabolic syndrome.
Cyclophosphamide (Cytoxan) CYP2C19 Poor Metabolizer Informative
Cyclophosphamide (Cytoxan) serum levels may increase in CYP2C19 poor metabolizers. Standard dosing regimens may be considereddue to a lack of pharmacokinetic evidence.
Daclatasvir (Daklinza) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Dasabuvir (Exviera) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
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Standard Precautions
Medication Phenotype Evidence Level
Diltiazem (Cardizem) CYP2D6 Intermediate Metabolizer Informative
Diltiazem (Cardizem) may be prescribed and monitored according to standard procedures in CYP2D6 intermediate metabolizers.
Duloxetine (Cymbalta) CYP2D6 Intermediate Metabolizer Informative
Duloxetine (Cymbalta) may be prescribed and monitored according to standard procedures in CYP2D6 intermediate metabolizers.
Elbasvir (Component of Zepatier) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Fesoterodine (Toviaz) CYP2D6 Intermediate Metabolizer Informative
Fesoterodine (Toviaz) may be prescribed and monitored according to standard procedures in CYP2D6 intermediate metabolizers.
Fluorouracil (Adrucil) DPYD High Activity Actionable
Fluorouracil (Adrucil) may be prescribed and monitored according to standard procedures in patients with normal (high) DPD activity.
Fluoxetine (Prozac) CYP2D6 Intermediate Metabolizer Informative
Fluoxetine (Prozac) serum levels may increase and norfluoxetine serum levels may decrease in CYP2D6 intermediate metabolizers.Standard dosing regimens may be considered due to conflicting evidence demonstrating negative outcomes.
Grazoprevir (Component of Zepatier) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Ledipasvir (Component of Harvoni) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Mercaptopurine TPMT High Activity Actionable
Patients taking mercaptopurine with high TPMT activity have lower serum levels of thioguanine metabolites and higher serum levels ofmethylTIMP, which is normal. Initiate therapy at the normal starting dose (e.g. 75 mg/m2 daily or 1.5 mg/kg daily) and adjust furtherdoses based upon disease-specific guidelines. Allow 2 weeks to reach steady state after each dose adjustment.
Metformin (Glucophage) SLC47A2 Homozygote Wild Type Informative
Metformin (Glucophage) may be prescribed and monitored according to standard procedures in SLC47A2 homozygous wild-typepatients.
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Standard Precautions
Medication Phenotype Evidence Level
Metoclopramide (Reglan) CYP2D6 Intermediate Metabolizer Informative
Metoclopramide (Reglan) may be prescribed and monitored according to standard procedures in CYP2D6 intermediate metabolizers.
Mirtazapine (Remeron) CYP2D6 Intermediate Metabolizer Informative
Mirtazapine (Remeron) serum levels may increase in CYP2D6 intermediate metabolizers. Standard dosing regimens may be considereddue to conflicting evidence demonstrating negative outcomes.
Naltrexone (Revia) OPRM1 Homozygote Wild Type Informative
Average (normal) clinical response to naltrexone in alcoholic patients.
Olanzapine (Zyprexa) HTR2C-rs3813929 Homozygote Mutant Informative
The T allele (rs3813929) may protect against olanzapine-induced weight gain in schizophrenic patients.
Ombitasvir (Component of Viekira) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Palonosetron (Aloxi) CYP2D6 Intermediate Metabolizer Informative
Palonosetron (Aloxi) may be prescribed and monitored according to standard procedures in CYP2D6 intermediate metabolizers.
Paritaprevir (Component of Viekira) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Peginterferon Alfa-2a (Pegasys) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Peginterferon Alfa-2b (PEG-Intron) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Pitavastatin (Livalo) SLCO1B1 Homozygote Wild Type Actionable
Prescribe desired statin starting dose and adjust doses based upon disease-specific guidelines.
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Standard Precautions
Medication Phenotype Evidence Level
Prasugrel (Effient) CYP2C19 Poor Metabolizer Actionable
There is no relevant effect of genetic variation in CYP2C19 on the pharmacokinetics of prasugrel (Effient) active metabolite or itsinhibition of platelet aggregation. Prasugrel may be prescribed and monitored according to standard procedures.
Pravastatin (Pravachol) SLCO1B1 Homozygote Wild Type Actionable
Prescribe desired statin starting dose and adjust doses based upon disease-specific guidelines.
Promethazine (Phenergan) CYP2D6 Intermediate Metabolizer Informative
Promethazine (Phenergan) may be prescribed and monitored according to standard procedures in CYP2D6 intermediate metabolizers.
Quetiapine (Seroquel) CYP2D6 Intermediate Metabolizer Informative
Quetiapine (Seroquel) may be prescribed and monitored according to standard procedures in CYP2D6 intermediate metabolizers.
Ribavirin (Copegus) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Risperidone (Risperdal) HTR2C-rs1414334 Homozygote Wild Type Informative
Schizophrenic and schizoaffective patients are at normal risk for risperidone-induced obesity and metabolic syndrome.
Ritonavir (Norvir) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Rosuvastatin (Crestor) ABCG2 Homozygote Mutant Informative
Preliminary evidence suggests that rosuvastatin (Crestor) may have increased efficacy in reducing LDL cholesterol in patients with theA allele.
Rosuvastatin (Crestor) SLCO1B1 Homozygote Wild Type Actionable
Prescribe desired statin starting dose and adjust doses based upon disease-specific guidelines.
Simeprevir (Olysio) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Simvastatin (Zocor) SLCO1B1 Homozygote Wild Type Actionable
Prescribe desired statin starting dose and adjust doses based upon disease-specific guidelines.
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Standard Precautions
Medication Phenotype Evidence Level
Sofosbuvir (Sovaldi) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Sulfamethoxazole (component ofBactrim)
NAT2 Intermediate Acetylator Informative
Sulfamethoxazole (component of Bactrim) may be prescribed and monitored according to standard procedures in NAT2 intermediateacetylators.
Tegafur DPYD High Activity Actionable
Tegafur may be prescribed and monitored according to standard procedures in patients with normal (high) DPD activity.
Telaprevir (Incivek) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Thioguanine TPMT High Activity Actionable
Patients taking thioguanine with high TPMT activity have lower serum levels of thioguanine (TGN) metabolites, but note that TGN levelsafter thioguanine are 5-10x higher than after mercaptopurine or azathioprine. Initiate therapy at the normal starting dose and adjustfurther doses based upon disease-specific guidelines. Allow 2 weeks to reach steady state after each dose adjustment.
Topiramate (Topamax) GRIK1 Heterozygote Informative
Topiramate may be prescribed and monitored according to standard procedures in GRIK1 heterozygote patients.
Velpatasvir (Component of Epclusa) IFNL3 Homozygote Wild Type Actionable
For patients treated with pegylated-interferon alpha 2a or 2b (PEG-IFN alpha) and ribavirin (RBV) alone, approximately 70% chance forsustained virologic response (SVR) after 48 weeks of treatment. For patients treated with protease inhibitor combinations with PEG-IFNalpha and RBV therapy, approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients areeligible for shortened therapy (24-28 weeks vs. 48 weeks).
Use with Caution
Medication Phenotype Evidence Level
Amitriptyline (Elavil) CYP2D6 Intermediate Metabolizer Actionable
Amitriptyline (Elavil) and metabolite nortriptyline serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be atincreased risk for anticholinergic adverse effects. Consider prescribing a non-tricyclic antidepressant instead. If amitriptyline iswarranted, consider a 25% reduction in the recommended starting dose and utilize therapeutic drug monitoring to further guide dosageadjustment.
Amphetamine (Component of Adderall) CYP2D6 Intermediate Metabolizer Informative
Amphetamine (Component of Adderall) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increasedrisk for adverse effects such as decreased appetite, weight loss, xerostomia, or insomnia. If clinically necessary, decrease the dose orconsider prescribing methylphenidate (Ritalin), dexmethylphenidate (Focalin), or guanfacine (Intuniv) instead.
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Medication Phenotype Evidence Level
Aripiprazole (Abilify) CYP2D6 Intermediate Metabolizer Informative
Aripiprazole (Abilify) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects. If clinically necessary, decrease the dose or consider prescribing ziprasidone (Geodon), olanzapine (Zyprexa), or lurasidone(Latuda) instead.
Ascorbic Acid G6PD Heterozygote Actionable
Ascorbic acid (vitamin C) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Atomoxetine (Strattera) CYP2D6 Intermediate Metabolizer Informative
Atomoxetine (Strattera) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects. If clinically necessary, decrease the dose or consider prescribing guanfacine (Intuniv), methylphenidate (Ritalin), ordexmethylphenidate (Focalin) instead.
Benztropine (Cogentin) CYP2D6 Intermediate Metabolizer Informative
Benztropine (Cogentin) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk foranticholinergic adverse effects. If clinically necessary, decrease the dose or consider prescribing trihexyphenidyl (Artane) instead.
Bupropion (Wellbutrin) CYP2D6 Intermediate Metabolizer Informative
Bupropion (Wellbutrin) active metabolite hydroxybupropion serum levels may increase in CYP2D6 intermediate metabolizers. Patientsmay be at increased risk for adverse effects. If clinically necessary, decrease the dose or consider prescribing escitalopram (Lexapro),sertraline (Zoloft), or varenicline (Chantix) instead.
Buspirone (Buspar) CYP2D6 Intermediate Metabolizer Informative
Buspirone (Buspar) active metabolite 1-PP serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be atincreased risk for adverse effects. If clinically necessary, decrease the dose or consider prescribing an alternative instead.
Carvedilol (Coreg) CYP2D6 Intermediate Metabolizer Informative
Carvedilol (Coreg) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects such as bradycardia, hypotension, or dizziness. If clinically necessary, decrease the dose or consider prescribing an alternativeinstead.
Chloroquine (Aralan) G6PD Heterozygote Actionable
Chloroquine (Aralan) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Chlorpheniramine (Chlor-Trimeton) CYP2D6 Intermediate Metabolizer Informative
Chlorpheniramine (Chlor-Trimeton) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased riskfor anticholinergic adverse effects. If clinically necessary, decrease the dose or consider prescribing diphenhydramine (Benadryl)instead.
Chlorpropamide (Diabinese) G6PD Heterozygote Actionable
Chlorpropamide (Diabinese) should be used with caution in patients at unknown risk of acute hemolytic anemia. Consider prescribing anon-sulfonylurea instead.
Clomipramine (Anafranil) CYP2D6 Intermediate Metabolizer Actionable
Clomipramine (Anafranil) and metabolite desmethylclomipramine serum levels may increase in CYP2D6 intermediate metabolizers.Patients may be at increased risk for anticholinergic adverse effects. Consider prescribing a non-tricyclic antidepressant instead. If
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Medication Phenotype Evidence Level
Clomipramine (Anafranil) CYP2D6 Intermediate Metabolizer Actionable
clomipramine is warranted, consider a 25% reduction in the recommended starting dose and utilize therapeutic drug monitoring tofurther guide dosage adjustment.
Codeine CYP2D6 Intermediate Metabolizer Actionable
Codeine active metabolite (morphine) serum levels may decrease in CYP2D6 intermediate metabolizers. Drug may have decreasedefficacy. If patients do not respond to recommended doses, consider prescribing morphine, oxymorphone (Opana), hydromorphone(Dilaudid), or non-opioid analgesics instead.
Dabrafenib (Tafinlar) G6PD Heterozygote Actionable
Dabrafenib (Tafinlar) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Dapsone G6PD Heterozygote Actionable
Dapsone should be used with caution in patients at unknown risk of acute hemolytic anemia.
Desipramine (Norpramin) CYP2D6 Intermediate Metabolizer Actionable
Desipramine (Norpramin) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk foranticholinergic adverse effects. Consider prescribing a non-tricyclic antidepressant instead. If desipramine is warranted, consider a 25%reduction in the recommended starting dose and utilize therapeutic drug monitoring to further guide dosage adjustment.
Dextroamphetamine (Component ofAdderall)
CYP2D6 Intermediate Metabolizer Informative
Dextroamphetamine (Component of Adderall) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be atincreased risk for adverse effects such as decreased appetite, weight loss, xerostomia, or insomnia. If clinically necessary, decrease thedose or consider prescribing methylphenidate (Ritalin), dexmethylphenidate (Focalin), or guanfacine (Intuniv) instead.
Dextromethorphan (Delsym) CYP2D6 Intermediate Metabolizer Informative
Dextromethorphan (Delsym) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk foradverse effects. If clinically necessary, decrease the dose or consider prescribing an alternative instead.
Donepezil (Aricept) CYP2D6 Intermediate Metabolizer Informative
Donepezil (Aricept) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects such as headache, insomnia, nausea, or diarrhea. If clinically necessary, decrease the dose or consider prescribing an alternativeinstead.
Doxepin (Sinequan) CYP2D6 Intermediate Metabolizer Actionable
Doxepin (Sinequan) and metabolite nordoxepin serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be atincreased risk for anticholinergic adverse effects. Consider prescribing a non-tricyclic antidepressant instead. If doxepin is warranted,consider a 25% reduction in the recommended starting dose and utilize therapeutic drug monitoring to further guide dosageadjustment.
Erythromycin (Erythrocin) G6PD Heterozygote Actionable
Erythromycin (Erythrocin) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Esomeprazole (Nexium) CYP2C19 Poor Metabolizer Actionable
Esomeprazole (Nexium) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverseeffects. Drug may have increased efficacy. If clinically necessary, decrease the dose or consider prescribing ranitidine (Zantac) or
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Medication Phenotype Evidence Level
Esomeprazole (Nexium) CYP2C19 Poor Metabolizer Actionable
famotidine (Pepcid) instead.
Flecainide (Tambocor) CYP2D6 Intermediate Metabolizer Actionable
Flecainide (Tambocor) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects such as dizziness, dyspnea, headache, or nausea. Consider reducing the dose by 25%, monitoring ECG, and adjusting basedupon flecainide serum levels. If clinically necessary, consider prescribing an alternative instead.
Fluoxetine (Prozac) CYP2C19 Poor Metabolizer Informative
Fluoxetine (Prozac) serum levels may increase and norfluoxetine serum levels may decrease in CYP2C19 poor metabolizers. Patientsmay be at increased risk for adverse effects such as anxiety, asthenia, nausea, or sleep disturbances. If clinically necessary, decreasethe dose or consider prescribing duloxetine (Cymbalta), bupropion (Wellbutrin), or paroxetine (Paxil) instead.
Fluvoxamine (Luvox) CYP2D6 Intermediate Metabolizer Informative
Fluvoxamine (Luvox) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects. If clinically necessary, decrease the dose or consider prescribing escitalopram (Lexapro), sertraline (Zoloft), or desvenlafaxine(Pristiq) instead.
Glimepiride (Amaryl) G6PD Heterozygote Actionable
Glimepiride (Amaryl) should be used with caution in patients at unknown risk of acute hemolytic anemia. Consider prescribing a non-sulfonylurea instead.
Glipizide (Glucotrol) G6PD Heterozygote Actionable
Glipizide (Glucotrol) should be used with caution in patients at unknown risk of acute hemolytic anemia. Consider prescribing a non-sulfonylurea instead.
Glyburide (Diabeta) G6PD Heterozygote Actionable
Glyburide (Diabeta) should be used with caution in patients at unknown risk of acute hemolytic anemia. Consider prescribing a non-sulfonylurea instead.
Haloperidol (Haldol) CYP2D6 Intermediate Metabolizer Informative
Haloperidol (Haldol) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects. If clinically necessary, decrease the dose or consider prescribing an alternative instead.
Hydralazine (Apresoline) NAT2 Intermediate Acetylator Informative
Hydralazine (Apresoline) serum levels may increase in NAT2 intermediate acetylators. Patients may be at increased risk for adverseeffects such as headache, tachycardia, or angina. If clinically necessary, decrease the dose or consider prescribing an alternativeinstead.
Hydrocodone (Vicodin) CYP2D6 Intermediate Metabolizer Informative
Hydrocodone (Vicodin) serum levels may increase and active metabolite hydromorphone serum levels may decrease in CYP2D6intermediate metabolizers. Patients may be at increased risk for adverse effects and drug may have decreased efficacy. If clinicallynecessary, consider prescribing morphine, oxymorphone (Opana), hydromorphone (Dilaudid), or non-opioid analgesics instead.
Imipramine (Tofranil) CYP2D6 Intermediate Metabolizer Actionable
Imipramine (Tofranil) and metabolite desipramine serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at
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Medication Phenotype Evidence Level
Imipramine (Tofranil) CYP2D6 Intermediate Metabolizer Actionable
increased risk for anticholinergic adverse effects. Consider prescribing a non-tricyclic antidepressant instead. If imipramine iswarranted, consider a 25% reduction in the recommended starting dose and utilize therapeutic drug monitoring to further guide dosageadjustment.
Isoniazid NAT2 Intermediate Acetylator Informative
Isoniazid serum levels may increase in NAT2 intermediate acetylators. Patients may be at increased risk for adverse effects such asnausea, vomiting, peripheral neuropathy, or hepatotoxicity. If clinically necessary, decrease the dose or consider prescribing analternative instead.
Lansoprazole (Prevacid) CYP2C19 Poor Metabolizer Actionable
Lansoprazole (Prevacid) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverseeffects. Drug may have increased efficacy. If clinically necessary, decrease the dose or consider prescribing ranitidine (Zantac) orfamotidine (Pepcid) instead.
Lidocaine (Xylocaine) G6PD Heterozygote Actionable
Lidocaine (Xylocaine) should be used with caution in patients with variable (unknown) G6PD function due to increased susceptibility todrug-induced methemoglobinemia in G6PD deficient patients. Use is contraindicated in patients with congenital methemoglobinemia(cytochrome b5 reductase deficiency).
Lisdexamfetamine (Vyvanse) CYP2D6 Intermediate Metabolizer Informative
Lisdexamfetamine (Vyvanse) active metabolite dextroamphetamine serum levels may increase in CYP2D6 intermediate metabolizers.Patients may be at increased risk for adverse effects such as decreased appetite, weight loss, xerostomia, or insomnia. If clinicallynecessary, decrease the dose or consider prescribing methylphenidate (Ritalin), dexmethylphenidate (Focalin), or guanfacine (Intuniv)instead.
Meclizine (Antivert) CYP2D6 Intermediate Metabolizer Informative
Meclizine (Antivert) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk foranticholinergic adverse effects. If clinically necessary, decrease the dose or consider prescribing dimenhydrinate (Dramamine),diphenhydramine (Benadryl), or a scopolamine patch (Transderm-Scop) instead.
Methylene Blue G6PD Heterozygote Actionable
Methylene Blue should be used with caution in patients at unknown risk of acute hemolytic anemia.
Metoprolol (Lopressor) CYP2D6 Intermediate Metabolizer Actionable
Metoprolol (Lopressor) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects such as bradycardia, hypotension, or dizziness. If clinically necessary, decrease the dose or consider prescribing atenolol(Tenormin), bisoprolol (Zebeta), or nadolol (Corgard) instead.
Mexiletine (Mexitil) CYP2D6 Intermediate Metabolizer Informative
Mexiletine (Mexitil) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects such as nausea, vomiting, heartburn, or dizziness. If clinically necessary, decrease the dose or consider prescribing an alternativeinstead.
MoviPrep G6PD Heterozygote Actionable
MoviPrep should be used with caution in patients at unknown risk of acute hemolytic anemia due to it containing vitamin C (ascorbic
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Medication Phenotype Evidence Level
MoviPrep G6PD Heterozygote Actionable
acid).
Nalidixic Acid (NegGram) G6PD Heterozygote Actionable
Nalidixic acid (NegGram) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Nebivolol (Bystolic) CYP2D6 Intermediate Metabolizer Informative
Nebivolol (Bystolic) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects such as bradycardia, hypotension, or dizziness. If clinically necessary, decrease the dose or consider prescribing atenolol(Tenormin), bisoprolol (Zebeta), or nadolol (Corgard) instead.
nitrofurantion G6PD Heterozygote Actionable
Nitrofurantion (Macrobid) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Norfloxacin (Noroxin) G6PD Heterozygote Actionable
Norfloxacin (Noroxin) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Nortriptyline (Pamelor) CYP2D6 Intermediate Metabolizer Actionable
Nortriptyline (Pamelor) serum levels may increase and metabolite 10-hydroxynortriptyline serum levels may decrease in CYP2D6intermediate metabolizers. Patients may be at increased risk for anticholinergic adverse effects. Consider prescribing a non-tricyclicantidepressant instead. If nortriptyline is warranted, consider a 25% reduction in the recommended starting dose and utilize therapeuticdrug monitoring to further guide dosage adjustment.
Omeprazole (Prilosec) CYP2C19 Poor Metabolizer Actionable
Omeprazole (Prilosec) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverse effects.Drug may have increased efficacy. If clinically necessary, decrease the dose or consider prescribing ranitidine (Zantac) or famotidine(Pepcid) instead.
Oxycodone (Percocet) CYP2D6 Intermediate Metabolizer Actionable
Oxycodone (Percocet) serum levels may increase and active metabolite oxymorphone serum levels may decrease in CYP2D6intermediate metabolizers. Patients may be at increased risk for adverse effects and drug may have decreased efficacy. If clinicallynecessary, consider prescribing morphine, oxymorphone (Opana), hydromorphone (Dilaudid), or non-opioid analgesics instead.
Pantoprazole (Protonix) CYP2C19 Poor Metabolizer Actionable
Pantoprazole (Protonix) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverseeffects. Drug may have increased efficacy. If clinically necessary, decrease the dose or consider prescribing ranitidine (Zantac) orfamotidine (Pepcid) instead.
Paroxetine (Paxil) CYP2D6 Intermediate Metabolizer Informative
Paroxetine (Paxil) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects. If clinically necessary, decrease the dose or consider prescribing escitalopram (Lexapro), sertraline (Zoloft), or desvenlafaxine(Pristiq) instead.
Pegloticase (Krystexxa) G6PD Heterozygote Actionable
In patients taking pegloticase (Krystexxa) at unknown risk of acute hemolytic anemia, G6PD enzyme activity must be measured.
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Medication Phenotype Evidence Level
Phenobarbital CYP2C19 Poor Metabolizer Informative
Phenobarbital serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverse effects. Ifclinically necessary, decrease the dose or consider prescribing an alternative instead.
Prilocaine (Emla) G6PD Heterozygote Actionable
Prilocaine should be used with caution in patients with variable (unknown) G6PD function due to increased susceptibility to drug-induced methemoglobinemia in G6PD deficient patients. Use is contraindicated in patients with congenital methemoglobinemia(cytochrome b5 reductase deficiency).
Primaquine G6PD Heterozygote Actionable
In patients taking primaquine at unknown risk of acute hemolytic anemia, G6PD enzyme activity must be measured.
Probenecid G6PD Heterozygote Actionable
Probenecid should be used with caution in patients at unknown risk of acute hemolytic anemia.
Progesterone (Prometrium) CYP2C19 Poor Metabolizer Informative
Progesterone (Prometrium) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverseeffects such as breast tenderness, mood changes, dizziness, headache, or abdominal bloating. If clinically necessary, decrease the doseor consider prescribing an alternative instead.
Propafenone (Rythmol) CYP2D6 Intermediate Metabolizer Actionable
Propafenone (Rythmol) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects such as altered taste perception, nausea, vomiting, or dizziness. Monitor ECG and consider adjusting the dose based uponpropafenone serum levels. If clinically necessary, consider prescribing an alternative instead.
Protriptyline (Vivactil) CYP2D6 Intermediate Metabolizer Actionable
Protriptyline (Vivactil) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk foranticholinergic adverse effects. Consider prescribing a non-tricyclic antidepressant instead. If protriptyline is warranted, consider a 25%reduction in the recommended starting dose and utilize therapeutic drug monitoring to further guide dosage adjustment.
Quinine (Qualaquin) G6PD Heterozygote Actionable
In patients taking quinine (Qualaquin) at unknown risk of acute hemolytic anemia, G6PD enzyme activity must be measured.
Rabeprazole (Aciphex) CYP2C19 Poor Metabolizer Informative
Rabeprazole (Aciphex) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverse effects.Drug may have increased efficacy. If clinically necessary, decrease the dose or consider prescribing ranitidine (Zantac) or famotidine(Pepcid) instead.
Rasburicase (Elitek) G6PD Heterozygote Actionable
In patients taking rasburicase (Elitek) at unknown risk of acute hemolytic anemia, G6PD enzyme activity must be measured. If analternative is desired, consider prescribing allopurinol instead.
Risperidone (Risperdal) CYP2D6 Intermediate Metabolizer Actionable
Risperidone (Risperdal) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects. If clinically necessary, decrease the dose or consider prescribing ziprasidone (Geodon), olanzapine (Zyprexa), or lurasidone(Latuda) instead.
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Medication Phenotype Evidence Level
Sodium Nitrite G6PD Heterozygote Actionable
Sodium nitrite should be used with caution in patients at unknown risk of acute hemolytic anemia. Monitor patients for an acute drop inhematocrit or consider prescribing an alternative instead.
Sulfadiazine (Silvadene) G6PD Heterozygote Actionable
Sulfadiazine (Silvadene) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Sulfamethoxazole (component ofBactrim)
G6PD Heterozygote Actionable
Sulfamethoxazole (component of Bactrim) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Sulfasalazine (Azulfidine) NAT2 Intermediate Acetylator Informative
Sulfasalazine (Azulfidine) active metabolite sulfapyridine serum levels may increase in NAT2 intermediate acetylators. Patients may beat increased risk for adverse effects such as nausea, dyspepsia, or dermatitis. If clinically necessary, decrease the dose or considerprescribing an alternative instead.
Sulfasalazine (Azulfidine) G6PD Heterozygote Actionable
Sulfasalazine (Azulfidine) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Sulfisoxazole G6PD Heterozygote Actionable
Sulfisoxazole should be used with caution in patients at unknown risk of acute hemolytic anemia.
Tamsulosin (Flomax) CYP2D6 Intermediate Metabolizer Informative
Tamsulosin (Flomax) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverseeffects such as orthostatic hypotension, dizziness, headache, or ejaculatory dysfunction. If clinically necessary, decrease the dose orconsider prescribing an alternative instead.
Timolol (Timoptic) CYP2D6 Intermediate Metabolizer Informative
Timolol serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk for adverse effects such asbradycardia, dizziness, or fatigue. If clinically necessary, decrease the dose or consider prescribing an alternative instead.
Tolterodine (Detrol) CYP2D6 Intermediate Metabolizer Informative
Tolterodine (Detrol) serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be at increased risk foranticholinergic adverse effects such as QTc prolongation. If clinically necessary, decrease the dose or consider prescribing oxybutynin(Ditropan), solifenacin (Vesicare), or mirabegron (Myrbetriq) instead.
Tramadol (Ultram) CYP2D6 Intermediate Metabolizer Actionable
Tramadol (Ultram) active metabolite M1 serum levels may decrease in CYP2D6 intermediate metabolizers. Drug may have decreasedefficacy. If clinically necessary, increase the dose or consider prescribing morphine, oxymorphone (Opana), hydromorphone (Dilaudid),or non-opioid analgesics instead.
Trazodone (Desyrel) CYP2D6 Intermediate Metabolizer Informative
Trazodone (Desyrel) active metabolite mCPP serum levels may increase in CYP2D6 intermediate metabolizers. Patients may be atincreased risk for adverse effects such as dizziness, anxiety, seizures, or exacerbation of psychiatric symptoms. If clinically necessary,decrease the dose or consider prescribing an alternative instead.
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Trimethoprim (component of Bactrim) G6PD Heterozygote Actionable
Trimethoprim should be used with caution in patients at unknown risk of acute hemolytic anemia.
Trimipramine (Surmontil) CYP2D6 Intermediate Metabolizer Actionable
Trimipramine (Surmontil) and metabolite desmethyltrimipramine serum levels may increase in CYP2D6 intermediate metabolizers.Patients may be at increased risk for anticholinergic adverse effects. Consider prescribing a non-tricyclic antidepressant instead. Iftrimipramine is warranted, consider a 25% reduction in the recommended starting dose and utilize therapeutic drug monitoring tofurther guide dosage adjustment.
Venlafaxine (Effexor) CYP2D6 Intermediate Metabolizer Actionable
Venlafaxine (Effexor) serum levels may increase and active metabolite desvenlafaxine serum levels may decrease in CYP2D6intermediate metabolizers. Patients may be at increased risk for adverse effects and drug may have decreased efficacy. If clinicallynecessary, consider prescribing escitalopram (Lexapro), sertraline (Zoloft), or desvenlafaxine (Pristiq) instead.
Vitamin C G6PD Heterozygote Actionable
Vitamin C (ascorbic acid) should be used with caution in patients at unknown risk of acute hemolytic anemia.
Warfarin (Coumadin) CYP4F2 Homozygote Wild Type Actionable
Patients may require lower doses of warfarin on average. These results should be taken into account with CYP2C9, VKORC1, andlifestyle factors at warfarindosing.org.
Warfarin (Coumadin) VKORC1 Intermediate Sensitivity Actionable
Patients may need lower doses of warfarin on average. These results should be taken into account with CYP2C9 and lifestyle factors atwarfarindosing.org.
Use with High Caution
Medication Phenotype Evidence Level
Amitriptyline (Elavil) CYP2C19 Poor Metabolizer Actionable
Amitriptyline (Elavil) serum levels may increase and nortriptyline serum levels may decrease in CYP2C19 poor metabolizers. Patientsmay be at increased risk for anticholinergic adverse effects. Consider prescribing an alternative tricyclic antidepressant such asnortriptyline (Pamelor), desipramine (Norpramin), or protriptyline (Vivactil) instead. If amitriptyline is warranted, consider a 50%reduction in the recommended starting dose and utilize therapeutic drug monitoring to further guide dosage adjustment.
Carisoprodol (Soma) CYP2C19 Poor Metabolizer Actionable
Carisoprodol (Soma) serum levels may increase and meprobamate serum levels may decrease in CYP2C19 poor metabolizers. Patientsmay be at increased risk for adverse effects such as dizziness, drowsiness, or headache. If clinically necessary, consider prescribingcyclobenzaprine (Flexeril), tizanidine (Zanaflex), or baclofen (Lioresal) instead.
Citalopram (Celexa) CYP2C19 Poor Metabolizer Actionable
Citalopram (Celexa) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverse effectssuch as nausea, xerostomia, sleep disturbances, or QTc prolongation. Consider initiating therapy at a 50% reduction in therecommended dose and titrating to response, with a maximum dose of 20mg daily, or prescribing duloxetine (Cymbalta), bupropion(Wellbutrin), or paroxetine (Paxil) instead.
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Medication Phenotype Evidence Level
Clomipramine (Anafranil) CYP2C19 Poor Metabolizer Actionable
Clomipramine (Anafranil) serum levels may increase and desmethylclomipramine serum levels may decrease in CYP2C19 poormetabolizers. Patients may be at increased risk for anticholinergic adverse effects. Consider prescribing an alternative tricyclicantidepressant such as nortriptyline (Pamelor), desipramine (Norpramin), or protriptyline (Vivactil) instead. If clomipramine is warranted,consider a 50% reduction in the recommended starting dose and utilize therapeutic drug monitoring to further guide dosageadjustment.
Clopidogrel (Plavix) CYP2C19 Poor Metabolizer Actionable
Clopidogrel (Plavix) active metabolite serum levels may decrease in CYP2C19 poor metabolizers. ACS/PCI patients may be atincreased risk for myocardial infarction, stroke, or stent thrombosis. All other patients are at lower clinical risk. For ACS/PCI patientsconsider prescribing prasugrel (Effient) or ticagrelor (Brilinta) instead. For secondary prevention of stroke or for peripheral arterydisease consider prescribing aspirin or aspirin/dipyridamole (Aggrenox) instead.
Clozapine (Clozaril) CYP2C19 Poor Metabolizer Informative
Clozapine (Clozaril) and active metabolite norclozapine serum levels may increase in CYP2C19 poor metabolizers. Patients may be atincreased risk for adverse effects. If clinically necessary, decrease the dose or consider prescribing ziprasidone (Geodon), quetiapine(Seroquel), or lurasidone (Latuda) instead.
Diazepam (Valium) CYP2C19 Poor Metabolizer Actionable
Diazepam (Valium) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverse effectssuch as drowsiness, fatigue, or ataxia. If clinically necessary, decrease the dose or consider prescribing lorazepam (Ativan), clonazepam(Klonopin), or alprazolam (Xanax) instead.
Disulfiram (Antabuse) DBH Homozygote Mutant Informative
Disulfiram may be ineffective in treating cocaine dependence in cocaine- and opioid-codependent patients stabilized on methadone fortwo weeks.
Doxepin (Sinequan) CYP2C19 Poor Metabolizer Actionable
Doxepin (Sinequan) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for anticholinergicadverse effects. Consider prescribing an alternative tricyclic antidepressant such as nortriptyline (Pamelor), desipramine (Norpramin), orprotriptyline (Vivactil) instead. If doxepin is warranted, consider a 50% reduction in the recommended starting dose and utilizetherapeutic drug monitoring to further guide dosage adjustment.
Escitalopram (Lexapro) CYP2C19 Poor Metabolizer Actionable
Escitalopram (Lexapro) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverse effectssuch as nausea, diarrhea, sleep disturbances, or sexual dysfunction. Consider initiating therapy at a 50% reduction in the recommendeddose and titrating to response or prescribing duloxetine (Cymbalta), bupropion (Wellbutrin), or paroxetine (Paxil) instead.
Imipramine (Tofranil) CYP2C19 Poor Metabolizer Actionable
Imipramine (Tofranil) serum levels may increase and desipramine serum levels may decrease in CYP2C19 poor metabolizers. Patientsmay be at increased risk for anticholinergic adverse effects. Consider prescribing an alternative tricyclic antidepressant such asnortriptyline (Pamelor), desipramine (Norpramin), or protriptyline (Vivactil) instead. If imipramine is warranted, consider a 50% reductionin the recommended starting dose and utilize therapeutic drug monitoring to further guide dosage adjustment.
Phenytoin (Dilantin) CYP2C19 Poor Metabolizer Actionable
Phenytoin (Dilantin) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverse effectssuch as ataxia, dizziness, nystagmus, or dermatologic reactions. Adjust dose based upon phenytoin serum levels or consider prescribing
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Use with High Caution
Medication Phenotype Evidence Level
Phenytoin (Dilantin) CYP2C19 Poor Metabolizer Actionable
carbamazepine (Tegretol), lamotrigine (Lamictal), or levetiracetam (Keppra) instead.
Sertraline (Zoloft) CYP2C19 Poor Metabolizer Actionable
Sertraline (Zoloft) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for CNS or GI adverseeffects. Consider initiating therapy at a 50% reduction in the recommended dose and titrating to response or prescribing duloxetine(Cymbalta), bupropion (Wellbutrin), or paroxetine (Paxil) instead.
Tamoxifen CYP2D6 Intermediate Metabolizer Actionable
Tamoxifen active metabolite endoxifen serum levels may decrease in CYP2D6 intermediate metabolizers. Drug may have decreasedefficacy. In postmenopausal women, consider prescribing an aromatase inhibitor instead.
Thioridazine (Mellaril) CYP2D6 Intermediate Metabolizer Actionable
Thioridazine (Mellaril) is contraindicated in CYP2D6 intermediate metabolizers due to an increased risk of QTc prolongation, Torsadesde pointes, and sudden death.
Voriconazole (Vfend) CYP2C19 Poor Metabolizer Actionable
Voriconazole (Vfend) serum levels may increase in CYP2C19 poor metabolizers. Patients may be at increased risk for adverse effects.Consider prescribing posaconazole (Noxafil), itraconazole (Sporanox), or liposomal amphotericin B (Ambisome) as primary therapy. Inthe event that voriconazole is considered to be the most appropriate agent, administer at a lower than standard dosage with carefultherapeutic drug monitoring.
DRUG TO DRUG INTERACTIONS
Use with Caution
AmitriptylineAmiodarone Artemisinin Carbamazepine Celecoxib
Chloramphenicol Chlorpheniramine Chlorpromazine Cimetidine
Citalopram Clemastine Clomipramine Cocaine
Delavirdine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Efavirenz Escitalopram
Esomeprazole Felbamate Fluoxetine Fluvoxamine
Halofantrine Haloperidol Hydroxyzine Imipramine
Indomethacin Ketoconazole Levomepromazine Methadone
Metoclopramide Mibefradil Midodrine Moclobemide
Modafinil Norethindrone Oral Contraceptives Oxcarbazepine
Pantoprazole Perphenazine Pimozide Prednisone
Probenicid Promethazine Quinine Rabeprazole
Ranitidine Rifampicin Rifampin Ritonavir
Sertraline St john's wort Terbinafine Ticlopidine
Topiramate Tripelennamine
Amphetamine
Below are known drug to drug interactions that may effect the patient.
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Use with CautionAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
Moclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
AripiprazoleAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
Moclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
AtomoxetineAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
Moclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
CelecoxibAprepitant Carbamazepine Cimetidine Efavirenz
Fenofibrate Fluoxetine Fluvastatin Fluvoxamine
Isoniazid Ketoconazole Lovastatin Modafinil
Phenobarbital Phenylbutazone Probenicid Rifampin
Secobarbital Sertraline St john's wort Sulfamethoxazole
Sulfaphenazole Teniposide Voriconazole Zafirlukast
CitalopramArtemisinin Carbamazepine Chloramphenicol Cimetidine
Delavirdine Efavirenz Esomeprazole Felbamate
Fluoxetine Fluvoxamine Indomethacin Ketoconazole
Modafinil Norethindrone Oral Contraceptives Oxcarbazepine
Pantoprazole Prednisone Probenicid Rabeprazole
Rifampicin St john's wort Ticlopidine Topiramate
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Use with Caution
ClomipramineAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
Moclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
ClozapineAmiodarone Beta-naphthoflavone Broccoli (food) Brussel sprouts (food)
Carbamazepine Char-grilled meat (food) Charbroiled meat Cimetidine
Ciprofloxacin Danshen tincture Fluoroquinolones Fluvoxamine
Furafylline Griseofulvin Insulin Interferon
Marijuana (smoke) Methoxsalen Methylcholanthrene Mibefradil
Modafinil Nafcillin Norfloxacin Ofloxacin
Omeprazole Ritonavir Ticlopidine Tobacco (smoke)
Verapamil Zileuton
CodeineAmiodarone Amitriptyline Androsterone Canrenone
Celecoxib Chlorpheniramine Chlorpromazine Cimetidine
Citalopram Clemastine Clomipramine Cocaine
Diclofenac Diphenhydramine Doxepin Doxorubicin
Duloxetine Efavirenz Escitalopram Fluconazole
Halofantrine Haloperidol Hydroxyzine Imipramine
Levomepromazine Medroxyprogesterone acetate Methadone Metoclopramide
Mibefradil Midodrine Moclobemide Perphenazine
Pimozide Promethazine Quinidine Quinine
Ranitidine Ritonavir Sertraline Spironolactone
Terbinafine Ticlopidine Tripelennamine
DesipramineAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
Moclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
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Use with Caution
DiazepamArtemisinin Barbiturates Carbamazepine Chloramphenicol
Cimetidine Delavirdine Efavirenz Esomeprazole
Felbamate Felbamate Fluoxetine Fluvoxamine
Glucocorticoids Indomethacin Ketoconazole Modafinil
Modafinil Nevirapine Norethindrone Oral Contraceptives
Oxcarbazepine Oxcarbazepine Pantoprazole Phenobarbital
Phenytoin Pioglitazone Prednisone Primidone
Probenicid Rabeprazole Rifabutin Rifampicin
Rifampin St john's wort Ticlopidine Topiramate
Topiramate Troglitazone
DiclofenacAmiodarone Aprepitant Carbamazepine Cimetidine
Efavirenz Fenofibrate Fluconazole Fluoxetine
Fluvastatin Fluvoxamine Isoniazid Ketoconazole
Lovastatin Modafinil Phenobarbital Phenylbutazone
Probenicid Rifampin Secobarbital Sertraline
St john's wort Sulfamethoxazole Sulfaphenazole Teniposide
Voriconazole Zafirlukast
DihydrocodeineAmiodarone Amitriptyline Androsterone Canrenone
Celecoxib Chlorpheniramine Chlorpromazine Cimetidine
Citalopram Clemastine Clomipramine Cocaine
Diclofenac Diphenhydramine Doxepin Doxorubicin
Duloxetine Efavirenz Escitalopram Fluconazole
Halofantrine Haloperidol Hydroxyzine Imipramine
Levomepromazine Medroxyprogesterone acetate Methadone Metoclopramide
Mibefradil Midodrine Moclobemide Perphenazine
Pimozide Promethazine Quinidine Quinine
Ranitidine Ritonavir Sertraline Spironolactone
Terbinafine Ticlopidine Tripelennamine
DoxepinAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
Moclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
Escitalopram
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Use with CautionArtemisinin Carbamazepine Chloramphenicol Cimetidine
Delavirdine Efavirenz Esomeprazole Felbamate
Fluoxetine Fluvoxamine Indomethacin Ketoconazole
Modafinil Norethindrone Oral Contraceptives Oxcarbazepine
Pantoprazole Prednisone Probenicid Rabeprazole
Rifampicin St john's wort Ticlopidine Topiramate
FentanylBarbiturates Carbamazepine Efavirenz Felbamate
Glucocorticoids Modafinil Nevirapine Oxcarbazepine
Phenobarbital Phenytoin Pioglitazone Primidone
Rifabutin Rifampin St john's wort Topiramate
Troglitazone
FluoxetineAmiodarone Aprepitant Carbamazepine Celecoxib
Chlorpheniramine Chlorpromazine Cimetidine Citalopram
Clemastine Clomipramine Cocaine Dexamethasone
Diphenhydramine Doxepin Doxorubicin Duloxetine
Escitalopram Halofantrine Haloperidol Hydroxyzine
Imipramine Levomepromazine Methadone Metoclopramide
Mibefradil Midodrine Moclobemide Perphenazine
Phenobarbital Pimozide Promethazine Quinine
Ranitidine Rifampin Ritonavir Secobarbital
Sertraline St john's wort Terbinafine Ticlopidine
Tripelennamine
FluvoxamineAmiodarone Beta-naphthoflavone Broccoli (food) Brussel sprouts (food)
Carbamazepine Char-grilled meat (food) Charbroiled meat Cimetidine
Ciprofloxacin Danshen tincture Fluoroquinolones Fluvoxamine
Furafylline Griseofulvin Insulin Interferon
Marijuana (smoke) Methoxsalen Methylcholanthrene Mibefradil
Modafinil Nafcillin Norfloxacin Ofloxacin
Omeprazole Ritonavir Ticlopidine Tobacco (smoke)
Verapamil Zileuton
HaloperidolAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
Moclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
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Use with Caution
HydrocodoneAmiodarone Aprepitant Barbiturates Boceprevir
Carbamazepine Cimetidine Ciprofloxacin Clarithromycin
Delavirdine Diethyl-dithiocarbamate Diltiazem Efavirenz
Erythromycin Felbamate Fluconazole Fluvoxamine
Gestodene Glucocorticoids Grapefruit (food) Imatinib
Indinavir Itraconazole Ketoconazole Mibefradil
Miconazole Mifepristone Modafinil Nefazodone
Nelfinavir Nevirapine Norfloxacin Norfluoxetine
Oxcarbazepine Phenobarbital Phenytoin Pioglitazone
Primidone Rifabutin Rifampin Ritonavir
Saquinavir St john's wort Starfruit (food) Telaprevir
Telithromycin Topiramate Troglitazone Verapamil
Voriconazole
HydromorphoneAmitriptyline Androsterone Canrenone Diclofenac
Efavirenz Fluconazole Medroxyprogesterone acetate Quinidine
Quinine Rifampin Spironolactone
IbuprofenAmiodarone Aprepitant Carbamazepine Cimetidine
Efavirenz Fenofibrate Fluconazole Fluoxetine
Fluvastatin Fluvoxamine Isoniazid Ketoconazole
Lovastatin Modafinil Phenobarbital Phenylbutazone
Probenicid Rifampin Secobarbital Sertraline
St john's wort Sulfamethoxazole Sulfaphenazole Teniposide
Voriconazole Zafirlukast
ImipramineAmiodarone Artemisinin Carbamazepine Celecoxib
Chloramphenicol Chlorpheniramine Chlorpromazine Cimetidine
Citalopram Clemastine Clomipramine Cocaine
Delavirdine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Efavirenz Escitalopram
Esomeprazole Felbamate Fluoxetine Fluvoxamine
Halofantrine Haloperidol Hydroxyzine Imipramine
Indomethacin Ketoconazole Levomepromazine Methadone
Metoclopramide Mibefradil Midodrine Moclobemide
Modafinil Norethindrone Oral Contraceptives Oxcarbazepine
Pantoprazole Perphenazine Pimozide Prednisone
Probenicid Promethazine Quinine Rabeprazole
Ranitidine Rifampicin Rifampin Ritonavir
Sertraline St john's wort Terbinafine Ticlopidine
Topiramate Tripelennamine
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Use with Caution
LornoxicamAmiodarone Aprepitant Carbamazepine Cimetidine
Efavirenz Fenofibrate Fluconazole Fluoxetine
Fluvastatin Fluvoxamine Isoniazid Ketoconazole
Lovastatin Modafinil Phenobarbital Phenylbutazone
Probenicid Rifampin Secobarbital Sertraline
St john's wort Sulfamethoxazole Sulfaphenazole Teniposide
Voriconazole Zafirlukast
MeloxicamAmiodarone Aprepitant Carbamazepine Cimetidine
Efavirenz Fenofibrate Fluconazole Fluoxetine
Fluvastatin Fluvoxamine Isoniazid Ketoconazole
Lovastatin Modafinil Phenobarbital Phenylbutazone
Probenicid Rifampin Secobarbital Sertraline
St john's wort Sulfamethoxazole Sulfaphenazole Teniposide
Voriconazole Zafirlukast
MethadoneEfavirenz Nelfinavir Phenobarbital Phenytoin
Rifampin Ritonavir
MorphineAmitriptyline Androsterone Canrenone Diclofenac
Efavirenz Fluconazole Medroxyprogesterone acetate Quinidine
Quinine Spironolactone
NaloxoneAmitriptyline Androsterone Canrenone Diclofenac
Efavirenz Fluconazole Medroxyprogesterone acetate Quinidine
Quinine Spironolactone
NaproxenAmiodarone Aprepitant Carbamazepine Cimetidine
Efavirenz Fenofibrate Fluconazole Fluoxetine
Fluvastatin Fluvoxamine Isoniazid Ketoconazole
Lovastatin Modafinil Phenobarbital Phenylbutazone
Probenicid Rifampin Secobarbital Sertraline
St john's wort Sulfamethoxazole Sulfaphenazole Teniposide
Voriconazole Zafirlukast
NortriptylineAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
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Use with CautionMoclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
OlanzepineAmiodarone Beta-naphthoflavone Broccoli (food) Brussel sprouts (food)
Carbamazepine Char-grilled meat (food) Charbroiled meat Cimetidine
Ciprofloxacin Danshen tincture Fluoroquinolones Fluvoxamine
Furafylline Griseofulvin Insulin Interferon
Marijuana (smoke) Methoxsalen Methylcholanthrene Mibefradil
Modafinil Nafcillin Norfloxacin Ofloxacin
Omeprazole Ritonavir Ticlopidine Tobacco (smoke)
Verapamil Zileuton
OxycodoneAmiodarone Aprepitant Barbiturates Boceprevir
Carbamazepine Cimetidine Ciprofloxacin Clarithromycin
Delavirdine Diethyl-dithiocarbamate Diltiazem Efavirenz
Erythromycin Felbamate Fluconazole Fluvoxamine
Gestodene Glucocorticoids Grapefruit (food) Imatinib
Indinavir Itraconazole Ketoconazole Mibefradil
Miconazole Mifepristone Modafinil Nefazodone
Nelfinavir Nevirapine Norfloxacin Norfluoxetine
Oxcarbazepine Phenobarbital Phenytoin Pioglitazone
Primidone Rifabutin Rifampin Ritonavir
Saquinavir St john's wort Starfruit (food) Telaprevir
Telithromycin Topiramate Troglitazone Verapamil
Voriconazole
OxymorphoneAmitriptyline Androsterone Canrenone Diclofenac
Efavirenz Fluconazole Medroxyprogesterone acetate Quinidine
Quinine Rifampin Spironolactone
ParoxetineAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
Moclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
PiroxicamAmiodarone Aprepitant Carbamazepine Cimetidine
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Use with CautionEfavirenz Fenofibrate Fluconazole Fluoxetine
Fluvastatin Fluvoxamine Isoniazid Ketoconazole
Lovastatin Modafinil Phenobarbital Phenylbutazone
Probenicid Rifampin Secobarbital Sertraline
St john's wort Sulfamethoxazole Sulfaphenazole Teniposide
Voriconazole Zafirlukast
RisperidoneAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
Moclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
SertralineArtemisinin Carbamazepine Chloramphenicol Cimetidine
Delavirdine Efavirenz Esomeprazole Felbamate
Fluoxetine Fluvoxamine Indomethacin Ketoconazole
Modafinil Norethindrone Oral Contraceptives Oxcarbazepine
Pantoprazole Prednisone Probenicid Rabeprazole
Rifampicin St john's wort Ticlopidine Topiramate
SufentanilBarbiturates Carbamazepine Efavirenz Felbamate
Glucocorticoids Modafinil Nevirapine Oxcarbazepine
Phenobarbital Phenytoin Pioglitazone Primidone
Rifabutin Rifampin St john's wort Topiramate
Troglitazone
SuprofenAmiodarone Aprepitant Carbamazepine Cimetidine
Efavirenz Fenofibrate Fluconazole Fluoxetine
Fluvastatin Fluvoxamine Isoniazid Ketoconazole
Lovastatin Modafinil Phenobarbital Phenylbutazone
Probenicid Rifampin Secobarbital Sertraline
St john's wort Sulfamethoxazole Sulfaphenazole Teniposide
Voriconazole Zafirlukast
TacrineBeta-naphthoflavone Broccoli (food) Brussel sprouts (food) Carbamazepine
Char-grilled meat (food) Charbroiled meat Cimetidine Danshen tincture
Fluoroquinolones Furafylline Griseofulvin Insulin
Interferon Marijuana (smoke) Methoxsalen Methylcholanthrene
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Use with CautionMibefradil Modafinil Nafcillin Norfloxacin
Ofloxacin Omeprazole Ritonavir Ticlopidine
Tobacco (smoke) Verapamil Zileuton
TramadolAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Diphenhydramine Doxepin Doxorubicin
Duloxetine Escitalopram Halofantrine Haloperidol
Hydroxyzine Imipramine Levomepromazine Methadone
Metoclopramide Mibefradil Midodrine Moclobemide
Perphenazine Pimozide Promethazine Quinine
Ranitidine Ritonavir Sertraline Terbinafine
Ticlopidine Tripelennamine
VenlafaxineAmiodarone Celecoxib Chlorpheniramine Chlorpromazine
Cimetidine Citalopram Clemastine Clomipramine
Cocaine Dexamethasone Diphenhydramine Doxepin
Doxorubicin Duloxetine Escitalopram Halofantrine
Haloperidol Hydroxyzine Imipramine Levomepromazine
Methadone Metoclopramide Mibefradil Midodrine
Moclobemide Perphenazine Pimozide Promethazine
Quinine Ranitidine Rifampin Ritonavir
Sertraline Terbinafine Ticlopidine Tripelennamine
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