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Rapid, Accurate, Personalized, Pharmacogenetic Testing on a National Scale.


What is Pharmacogenetics?

The study of how the actions of and reactions to drugs vary with the patient's genes.

Therapeutic Outcome Clinically expected response Suboptimal Response

Non-responder

Side Eects

Toxicity/ADR


What is Pharmacogenetics? • Diagnose cause for drug related side effects. • Assist healthcare provider to select appropriate drug and dose for their patient. • Achieve optimal therapeutic response. • Minimize side effects and toxicity. • Avoid therapeutic failure.


New title


Warfarin Package Insert Excerpt


www.warfarindosing.org


Dosing Algorithm Comparison Clinical Only

Clinical + PGx


Black Box Warning


CYP450 2C9      

Carvedilol (Coreg®) Irbesartan (Avapro®) Losartan (Cozaar®) Rosuvastatin (Crestor®) Torsemide (Demadex)® Warfarin (Various)

CYP450 2C19   

CYP450 2D6 Beta-Blockers

Cilostazol (Pletal ®) Clopidogrel (Plavix®) Propranolol (Inderal®)

     

VKORC1 

Bisoprolol (Zebeta®) Carvedilol (Coreg®) Metoprolol(Various) Nebivolol (Bystolic®) Propranolol (Inderal®) Timolol (Blocadren®)

Anti-arrhythmics

Warfarin (Various)

  

Flecainide (Tambocor®) Mexiletene (Mexitil®) Propafenone(Rythmol®)

CYP450 3A4/3A5        

Aliskiren (Tekturna®) Apixaban (Eliquis®) Bisoprolol (Zebeta®) Cilostazol (Pletal®) Isosorbide (Various) Ranolazine (Ranexa®) Rivaroxaban (Xarelto®) Warfarin (Various)

Calcium Channel Blockers- Dihydropyridines    

Amlodipine (Norvasc®) Felodipine (Plendil®) Isradipine (DynaCirc CR®) Nifedipine (Various)

Calcium Channel Blockers- Non-Dihydropyridines  

Diltiazem (Various) Verapamil (Various

Statins   

Atorvastatin (Lipitor®) Lovastatin (Mevacor®) Simvastatin (Zocor®)

Anti-arrhythmics     

Amiodarone (Various) Disopyramide (Norpace®) Dronedarone (Multaq Lidocaine (Xylocaine®) Propafenone (Rythmol®)


CYP450 2C9 

Codeine (Various)

Diclofenac (Voltaren® Pennsaid®)

Flurbiprofen (Ansaid®)

Ibuprofen (Advil® Motrin®)

Indomethacin (Indocin®)

Mefenamic Acid (Ponstel®)

Meloxicam (Mobic®)

  

CYP450 2C19 

Buprenorphine (Butrans®

Indomethacin (Indocin®)

Methadone (Various)

Methadone (Various) Naproxen (Anaprox® Naprosyn®) Piroxicam (Feldene®)

CYP450 2C19

CYP450 3A4/3A5

Codeine (Various)

Lidocaine (Various)

Cyclobenzaprine (Flexeril® Amrix®)

Duloxetine (Cymbalta®)

Fentanyl (Duragesic®)

Dextromethorphan (Various)

Hydrocodone (Lortab® Vicodin®)

Hydrocodone (Lortab® Vicodin®)

Lidocaine (Xylocaine® Lidoderm®)

Meperidine (Demerol®)

Methadone (Various)

Methadone (Various)

Oxycodone (Oxycontin® Oxy IR®)

Oxycodone (Oxycontin®,Oxy IR®)

Tramadol (Ultram®)

Buprenorphine (Butrans® Buprenex, Subutex)  Cyclobenzaprine (Flexeril® Amrix®) 

Tramadol (Ultram®)

Antidepressants, antipsychotics, benzodiazepines, and mood stabilizers are sometimes added to a pain management regimen as adjuvants. Please consult the metabolizing status for these medications if they are part of the regimen when interpreting and applying these Tables.



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