Table 1.

Drug-Gene Pair Alerts implemented in the Mayo Clinic EHR by year of implementation^a.

Drug	Gene(s)	Year implemented
Abacavir	HLA-B*57:01	2013
Azathiopurine	TPMT and NUDT15b	2013
Carbamazepine	HLA-B*15:02 and HLA-A*31:01c	2013
Codeine	CYP2D6	2013
Mercaptopurine	TPMT and NUDT15b	2013
Tamoxifen	CYP2D6	2013
Thioguanine	TPMT and NUDT15b	2013
Tramadol	CYP2D6	2013
Allopurinol	HLA-B*58:01	2014
Clopidogrel	CYP2C19	2014
Simvastatin	SLCO1B1	2014
Warfarin	CYP2C9 and VKORC1	2014
Citalopram	CYP2C19	2015
Escitalopram		2015
Fluvoxamine	CYP2D6	2015
Fluoxetine	CYP2D6	2015
Paroxetine	CYP2D6	2015
Venlafaxine	CYP2D6	2015
Tacrolimus	CYP3A5	2016
Capecitabine	DPYD	2017
Fluorouracil	DPYD	2017

^aA subset of these alerts were designed to fire in a “reactive fashion”, i.e. recommending PGx testing in response to all initial prescriptions: TPMT and NUDT15 for thiopurines (mercaptopurine, azathioprine and thioguanine), HLA-B*57:01 for abacavir, HLA-B*15:02 and HLA-A*31:01 for carbamazepine in patients of Asian descent, HLA-B*58:01 for allopurinol in patients of Asian or African decent and CYP2D6 for tamoxifen. This was done to avoid physician “alert fatigue” that might have occurred if all of the alerts had been reactive. All other alerts currently fire only for patients who already have PGx information in the EHR. Between March 2015 and December 2018 these alerts fired a total of 6620 times. No comparable data are available after December 2018 because of Mayo Clinic’s implementation of a new EHR.

^bNUDT15 added in 2018 and assayed by genotyping.

^cHLA-A*31:01 added in 2018.