Table 3.

Clinical decision-making process for integrating pharmacogenomics in practice

Factor	Questions
Patient or population	Is the variant likely relevant in the patient or population?
	How common is the variant?
Quality of evidence	What is the strength of the evidence for the use of data?
	Are clinical guidelines or FDA recommendations available?
Testing	Is testing available?
	Is the coverage appropriate?
	What is the turnaround time of results?
Data availability	Does pharmacogenomics data already exist?
	Is the data quality sufficient to use?
Drug factors	How important is the gene/variant for the pharmacokinetics or pharmacodynamics of the drug?
	Does the drug have a narrow therapeutic index?
	Is the drug a prodrug or active?
	Will the variant decrease efficacy and/or increase toxicity?
Clinical factors	Are there other factors relevant to the decision, like timing of drug start or previous use of the medication?
	How do comorbid clinical conditions affect expected phenotypes?
	Are there drug-drug interactions that affect expected phenotypes?

FDA, Food and Drug Administration.