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.