Table 3.

Drugs that have guidelines/actionable labels by all four agencies (CPIC, DPWG, EMA (or FIDMD/MEB))

Drug	Gene	CPIC	DPWG	EMA	FIDMD	MEB	FDA
Abacavir	HLA‐B	Abacavir is not recommended due to the risk of hypersensitivity reactions	Contraindicated due to the risk of hypersensitivity reactions	Mandatory: HLA‐B*5701 status must always be documented prior to initiating therapy			Recommendation dealing with contraindication
Allopurinol	HLA‐B	Contraindicated due to the risk of hypersensitivity reactions	Consider alternative drug (febuxostat) or dose adjustment	Recommendation: Screening for HLA‐B*5801 should be considered before starting treatment with allopurinol in patient subgroups where the prevalence of this allele is known to be high			Recommendation: Immediately discontinue at first signs of skin rash or allergic reactions
Atomoxetine	CYP2D6	Consider dose adjustment	In case of efficacy with adverse reactions, lower the dose and monitor if efficacy is maintained or consider alternative (clonidine)	N.A.	Recommendation: A lower initial dose and a slower titration may be considered	Recommendation: Consider a lower starting dose and slower up titration of the dose	Strong recommendation: Specific dose adjustment
Azathioprine	TPMT	Consider alternative drug or dose adjustment	Consider alternative drug or dose adjustment	N.A.	Recommendation: Dose adjustment	Recommendation: Dose adjustment	Recommendation: Alternative drug or dose reduction is recommended
	NUDT15	Consider alternative drug or dose adjustment	Consider alternative drug or dose adjustment	N.A.	Recommendation: Dose adjustment and monitoring of blood levels	Recommendation: Dose adjustment	Recommendation: Consider alternative drug
Capecitabine/5‐fluorouracil	DPYD	Select alternative drug or dose adjustment	Select alternative drug or dose adjustment	Mandatory: Patients with partial G6PD deficiency must be treated with extreme caution and frequent monitoring with dose adjustment according to toxicity			Recommendation: Select alternative drug
Carbamazepine	HLA‐B	If patient is carbamazepine‐naive, do not use carbamazepine	Choose alternative drug	N.A.	Recommendation: Do not use carbamazepine unless no alternative drug is available	Recommendation: Do not use carbamazepine unless no alternative drug is available	Recommendation dealing with contraindication
Citalopram	CYP2C19	Consider dose adjustment or alternative drug	Consider dose adjustment	N.A.	Strong recommendation: Specific dose adjustment	Strong recommendation: Specific dose adjustment	Strong recommendation: Specific dose adjustment
Codeine	CYP2D6	Avoid codeine use due to potential for toxicity	Codeine is contraindicated in CYP2D6 ultra‐rapid metabolizers due to the risk of overdose	N.A.	Pharmacogenomic information	Recommendation dealing with contraindication	Recommendation dealing with contraindication
Mercaptopurine	TPMT	Consider alternative drug or dose adjustment	Select alternative drug or dose adjustment	Recommendation: Consider a substantial dose reduction			Strong recommendation: Specific dose adjustment
	NUDT15	Dose adjustment or alternative drug	Select alternative drug or dose adjustment	Recommendation: Dose adjustment			Strong recommendation: Specific dose adjustment
Thioguanine	TPMT	Consider dose adjustment	Select alternative drug or dose adjustment	N.A.	Recommendation: Consider dose adjustment	Recommendation: Dose reduction is usually necessary. Monitor blood count closely.	Strong recommendation: Specific dose adjustment
	NUDT15	Consider dose adjustment	Consider alternative drug or dose adjustment	N.A.	Recommendation: Genotypic analysis should be considered before initiation of thiopurine therapy to determine the NUDT15 genotype	Recommendation: Dose adjustment	Strong recommendation: Specific dose adjustment

CPIC, Clinical Pharmacogenetics Implementation Consortium; DPWG, Dutch Pharmacogenetics Working Group; EMA, European Medicines Agency; FIDMD, Federal Institute for Drugs and Medical Devices; MEB, Medicines Evaluation Board; N.A., not available.