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. Author manuscript; available in PMC: 2017 Apr 7.
Published in final edited form as: Genet Med. 2016 Sep 22;19(4):421–429. doi: 10.1038/gim.2016.120

Table 1.

Drug-gene interactions reviewed and approved by the pharmacogenomics governance and implemented in the EHR as pharmacogenomics clinical decision support.

Drug-gene interaction Number of
days in
production		 Implementation
time		 Delay
time		 Main
challengesa 		Clinical review and
approval
1 Abacavir – HLA-B*57:01 885 157 26 A Infection Disease (HIV
Clinic)
2 Peginterferon – IL28B - - - - Hepatology. It was not
approved for implementation
3 Carbamazepine – HLA-
B*15:02 		807 226 14 B Neurology
4 Azathioprine - TPMT 740 293 0 B, C, D Gastroenterology,
Dermatology,
Rheumatology, Hematology
5 6-Mercaptopurine - TPMT 740 293 0 B, C, D Gastroenterology,
Dermatology,
Rheumatology, Hematology
6 Thioguanine - TPMT 740 293 0 B, C, D Gastroenterology,
Dermatology,
Rheumatology, Hematology
7 Codeine - CYP2D6 612 134 46 F, G Anesthesia. Pain Clinic
8 Tramadol - CYP2D6 612 134 46 F, G Anesthesia. Pain Clinic
9 Tamoxifen - CYP2D6 558 175 23 F, G Oncology (Breast Clinic)
10 Clopidogrel – CYP2C9 285 392 148 C, E, G Cardiology
11 Simvastatin – SLCO1B1 432 231 78 F, G Cardiology
12 Allopurinol - HLA-B*58:01 222 189 92 E Internal Medicine
13 Warfarin –
CYP2C9/VKORC1 		285 98 29 C, F, G Hematology (Anticoagulation
Clinic)
14 Fluoxetine – CYP2D6 40 203 113 D, E, H Psychiatry
15 Fluvoxamine – CYP2D6 40 203 113 D, E, H Psychiatry
16 Paroxetine – CYP2D6 40 203 113 D, E, H Psychiatry
17 Venlafaxine – CYP2D6 40 203 113 D, E, H Psychiatry
18 Citalopram – CYP2C19 40 203 113 D, E, H Psychiatry
19 Escitalopram – CYP2C19 40 203 113 D, E, H Psychiatry
20 5-fluorouracil - DPYD - - - D Hematology-Oncology.
Approved, pending
implementation
21 Tacrolimus -CYP3A5 - - - D Transplant. Approved,
pending implementation
a

Main challenges: A = Coordination with EHR software update. B =Identification of clinical champions. C = Approval by clinical practice. D = Availability of PGx results in the EHR. E = Limited IT staff and/or conflict with other IT priorities. F = Complexity of rule development. G = Interpretation of clinical guidelines and PGx recommendations. H = Coordination between PGx governance and clinical practice.

Number of days in production = time between EHR implementation and 6/30/2015. Implementation time = time between clinical approval and EHR implementation. Delay time = time between targeted implementation and EHR implementation

EHR = Electronic health record. IT = Information technology. PGx = Pharmacogenomics