Table 6. Recommendations for actionable pharmacogenomic markers based on CPIC guidelines.

Gene	Actionable SNP	MAF	Clinical Pharmacogenetics Implementation Consortium
			Evidence level	Drug	Dosing guidelines
CYP2C9	rs1799853	0.015	1A	Warfarin	Pharmacogenetic algorithm-based dosing available on http://www.warfarindosing.org is used for patients with different combinations of CYP2C9 and VKORC1 genotypes.
	rs1057910	0.072	1A
VKORC1	rs9923231	0.597	1A
CYP2C19	rs4244285	0.342	1A	Clopidogrel, Amitriptyline	An alternative antiplatelet therapy to clopidogrel is recommended for CYP2C19 poor or intermediate metabolizers.
	rs4986893	0.025	1A
	rs72552267	0.002	1A		An alternative drug to amitriptyline is recommended for CYP2C19 ultrarapid metabolizers.
	rs12248560	0.062	1A
CYP2D6	rs16947	0.207	1A	Codeine, Amitriptyline, Nortiptyline	Alternate analgesics to codeine are recommended for CYP2D6 ultrarapid and poor metabolizers due to potential toxicity and lack of efficacy, respectively.
	rs1135840	0.617	1A
	rs1080985	0.146	1A		Alternative drugs to amitriptyline and nortriptyline are recommended for CYP2D6 ultrarapid metabolizers and poor metabolizers.
	rs3892097	0.040	1A
	rs1065852	0.411	1A
	rs28371725	0.069	1A
CYP3A5	rs776746	0.653	1A	Tacrolimus	Increasing the starting dose by 1.5 to 2 times is recommended for CYP3A5 intermediate or extensive metabolizers.

SNP, single-nucleotide polymorphism; MAF, minor allele frequency.