Table 2.
Clinical Pharmacogenetics Implementation Consortium level for opioids.
| Medication | Drug class | Gene(s) involved | CPIC level† |
|---|---|---|---|
| Amitriptyline‡ | TCA | CYP2C19 | A |
| CYP2D6 | A | ||
| Celecoxib | NSAID | CYP2C9 | B |
| Codeine | Weak opioid | CYP2D6 | A |
| Methadone | Strong opioid | CYP2B6 | B |
| Nortriptyline‡ | TCA | CYP2D6 | A |
| Oxycodone | Strong opioid | CYP2D6 | A |
| Tramadol | Weak opioid SNRI | CYP2D6 | A |
| Venlafaxine | SNRI | CYP2D6 | B |
Level A: genetic information should be used to change prescribing of affected drug; Level B: genetic information could be used to change prescribing of the affected drug because alternative therapies/dosing are extremely likely to be as effective and as safe as nongenetically based dosing. Level C or D: there are published studies at varying levels of evidence and no prescribing actions are recommended. Additional information can be found via [22].
Evidence for other TCAs is based on amitriptyline and nortriptyline, therefore CPIC has assigned a Level B for CYP2D6 and CYP2C19 for tertiary amines (e.g., clomipramine) and a Level
B for CYP2D6 and secondary amines (e.g., desipramine) [24].
CPIC: Clinical Pharmacogenetics Implementation Consortium; SNRI: Serotonin–norepinephrine reuptake inhibitor; TCA: Tricyclic antidepressant.