Table 2.

Summary of the gene-drug pairs and clinical guidelines relevant to nephrology

Drug	Gene	Clinical Guidance Summary	Ref.
Warfarin	CYP2C9	Use lower dose if a poor or intermediate metabolizer (e.g., *2/*2, *1/*2)	23
Warfarin	CYP4F2	Use lower dose if decreased activity (*3)	23
Warfarin	VKORC1	Use lower dose if increased sensitivity (−1639G>A)	23
Clopidogrel	CYP2C19	Use alternative antiplatelet agent if poor or intermediate metabolizer (e.g., *2/*2, *1/*2); monitor for bleeding if ultrarapid metabolizer (*1/*17, *17/*17)	35
Simvastatin	SLCO1B1	Use lower dose or alternative agent in patients with decreased transporter activity (*5, *15, *17)	37
Azathioprine	TPMT	Patients with decreased TPMT function have higher risk for toxicity	39
Tacrolimus	CYP3A5	Carriers of at least one functional (*1) allele may require higher doses	13
Voriconazole	CYP2C19	Use an alternative agent in CYP2C19 rapid/ultrarapid metabolizer (*1/*17, *17/*17); use alternative agent or lower dose in CYP2C19 poor metabolizer (*2/*2, *3/*3)	40
Allopurinol	HLA-B	User an alternative uric acid–lowering agent in patients who carry at least one *58:01 allele	53

TPMT, thiopurine methyltransferase.