Table 4:

High risk medications in elderly patients per Beers Criteria with an associated pharmacogenetic contraindication [59,103]

Drug	Rationale for inclusion in Beers Criteria [59]	Gene(s) associated with altered phenotype [103]
Dabigatran	Increased risk of gastrointestinal bleeding	ABCB1, CES1
Rivaroxaban	Increased risk of gastrointestinal bleeding	F5, ABCB1
Prasugrel	Increased risk of bleeding	CYP2C19, CYP2B6, CYP2C9, CYP3A5, PEAR1
Carbamazepine	May cause/exacerbate hyponatremia or SIADH	HLA-A, HLA-B
Mirtazapine	May cause/exacerbate hyponatremia or SIADH	CYP2D6, CYP2C19
Oxcarbazepine	May cause/exacerbate hyponatremia or SIADH	HLA-B
Tramadol	May cause/exacerbate hyponatremia or SIADH	CYP2D6, SULT1A3
Dextromethorphan/quinidine	Increased risk of fall; concerns for drug interactions	CYP2D6
Trimethoprimsulfamethoxazole	Increased risk of hyperkalemia when used with ACE inhibitors	G6PD, NAT2