Table 3.
Summary of proton pump inhibitor (PPI) dose selection recommendations from the Clinical Pharmacogenetics Implementation Consortium (CPIC®).
| CYP2C19 Phenotype | Implications for Phenotypic Measures | Therapeutic Recommendations | Classification of Recommendation-Omeprazole, Lansoprazole, Pantoprazole |
Classification of Recommendation-Dexlansoprazole |
|---|---|---|---|---|
| CYP2C19 UM | Decreased plasma concentrations of PPIs compared to CYP2C19 NMs; increased risk of therapeutic failure | Increase starting daily dose by 100%. Daily dose may be given in divided doses. Monitor for efficacy. | Optional | Optional |
| CYP2C19 RM | Decreased plasma concentrations of PPIs compared to CYP2C19 NMs; increased risk of therapeutic failure | 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. | Moderate | Optional |
| CYP2C19 NM | Normal PPI metabolism; may be at increased risk of therapeutic failure compared to CYP2C19 IMs and PMs | 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. | Moderate | Optional |
| CYP2C19 (likely) IM | Increased plasma concentration of PPI compared to CYP2C19 NMs; increased chance of efficacy and potentially toxicity | Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved consider 50% reduction in daily dose and monitor for continued efficacy. | Optional | Optional |
| CYP2C19 (likely) PM | Likely increased plasma concentration of PPI compared to CYP2C19 NMs; likely increased chance of efficacy and potentially toxicity | Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy. | Moderate | Optional |