Table 1. Potential safety implications for incorrect medication list.

Discrepancy classification	Potential consequence for PGx	Potential implication for patient safety
Missing/wrong dose	Some PGx guidelines/package labeling contain specific dosing recommendations	Dosing outside of prescribed dosage could result in either under or overdosing, each of which could affect safety/efficacy
Wrong frequency	–	Altered frequency dosage could result in either under or overdosing, each of which could affect safety/efficacy
Wrong medication	PGx recommendations may be missed, or incorrect recommendations may be made, implications if wrong medication is a strong inhibitor	Taking alternative medications unbeknownst to the treatment team could result in significant drug-drug interactions or could trigger an adverse event thought to be a new symptom thus triggering the prescribing cascade
Discontinued medication	Incorrect recommendations may be made; implications if discontinued medication is a strong inhibitor	Not taking medications that the healthcare team believes are being taken can result in less effective alternative medications being used
Duplicate medications	–	Can result in prescriber and healthcare team confusion with cluttered medication lists
Omissions	PGx recommendations may be missed, implications if added medication is a strong inhibitor	Taking alternative medications unbeknownst to the treatment team could result in significant drug-drug interactions or could trigger an adverse event thought to be a new symptom thus triggering the prescribing cascade
Added PRN indication	–	Joint Commission requirement; clarifies patient taking medication for correct reason

PGx, pharmacogenomic; PRN, pro re nata.