Table 2.
Gene-drug pairs with sufficient evidence for at least 1 prescribing action to be recommended
| Author | Gene | Medication | Pharmacogenetics implications |
|---|---|---|---|
| Birdwell et al114CPIC166 | CYP3A5 | Tacrolimus | Higher starting dose at 1.5–2 times standard dose, not exceeding 0.3 mg/kg/d in CYP3A5 extensive metabolizer or intermediate metabolizer. |
| Birdwell et al114CPIC166 | CYP3A4 | Tacrolimus | Higher starting dose as above |
| Elens and Haufroid117 | POR | Tacrolimus | POR*28 homozygosity is associated with a significant higher CYP3A4 activity in those who are CYP3A5 nonexpressers |
| Relling et al128CPIC166 | TPMT | Azathioprine | Reduce initial dose in TPMT heterozygous with 1 of alleles *2, *3A, *3B, *3C, and *4 |
| Relling et al128CPIC166 | NUDT15 | Azathioprine | Reduce initial dose for NUDT15 intermediate metabolizer. Consider an alternative agent for NUDT15 poor metabolizer |
| CPIC166 | HPRT1 | Mycophenolic acid | Consider using alternative agent in HGPRT deficiency |
| Crews et al136CPIC166 | CYP2D6 | Codeine Oxycodone | Use alternative analgesics in CYP2D6 poor metabolizers or ultra-rapid metabolizers |
| Moriyama et al131Scott et al134CPIC166 | CYP2C19 | Voriconazole Clopidogrel | Use an alternative agent other than voriconazolein CYP2C19 ultra-rapid or rapid or poor metabolizersUse an alternative agent other than Clopidogrel in patients with at least 1 decreased function allele |
| Johnson et al135CPIC166 | VKORC1 | Warfarin | Consider an alternative oral anticoagulant/calculate warfarin dosing according to CPIC guideline pharmacogenetic algorithma |
| Johnson et al135CPIC166 | CYP2C19 | Warfarin | Consider an alternative oral anticoagulant/calculate warfarin dosing according to CPIC guideline pharmacogenetic algorithm |
| Johnson et al135CPIC166 | CYP4F2 | Warfarin | Consider an alternative oral anticoagulant/calculate warfarin dosing according to CPIC guideline pharmacogenetic algorithm |
| SEARCH Collaborative Group138CPIC166 | SLCO1B1 | Simvastatin | Use an alternative agent or a reduced dose of simvastatin in patients with at least 1 reduced function allele |
| Hershfield et al140CPIC166 | HLA-B*58:01 | Allopurinol | Avoid allopurinol in patients with at least 1 HLA-B*58:01 allele |
aCPIC guideline pharmacogenetic algorithm https://cpicpgx.org/content/guideline/publication/warfarin/2017/28198005.pdf.
CPIC, Clinical Pharmacogenetics Implementation Consortium; CYP, Cytochrome P450; HGPRT, hypoxanthine-guanine phosphoribosyl-transferase; NUDT15, nucleoside diphosphate linked moiety X-type motif 15; SLCO1B1, solute carrier organic anion transporter family member 1B1; TPMT, thiopurine methyltransferase; VKORC1, vitamin K epoxide reductase complex subunit 1.