Example report. Made from Leslie Knope's DNA data so you can see what yours will look like. Get your own report

Full Report

Prepared for Leslie Knope

Version 4.5

Example made Oct 27, 2026

How these genes may affect your response to medications.

Data source: 23andMe
Genome build: GRCh37
Genes analyzed: 30
Medications: 120

How to read this report

Step 1
Two copies of each gene
You inherit one copy from each parent. The report names the pair, such as *1/*2.
Step 2
The pair gives a gene result
Such as Poor metabolizer. The color shows it: typical, reduced, poor.
Step 3
The result sets each medication's label
Consider alternative Use with caution Use as directed Unable to determine
Step 4
Then talk to your prescriber
Don't change or stop a medication on your own. Unable to determine doesn't mean normal.

Read the full guide: How to read your Gene2Rx report

How to read this report

Step 1
Two copies of each gene
You inherit one copy from each parent. The report names the pair, such as *1/*2.
Step 2
The pair gives a gene result
Such as Poor metabolizer. The color shows it: typical, reduced, poor.
Step 3
The result sets each medication's label
Consider alternative Use with caution Use as directed Unable to determine
Step 4
Then talk to your prescriber
Don't change or stop a medication on your own. Unable to determine doesn't mean normal.

Read the full guide: How to read your Gene2Rx report

What are you looking for?

Find a medication by generic or brand name, or look up a drug class or a gene, among the 120 medications in this report.

Or browse:Antidepressants Pain relievers Statins Blood thinners Acid reducers

What stands out in your genes

CYP2D6

*4/*4

Poor metabolizer

Neither copy works. CYP2D6 turns on or clears about 1 in 4 prescription drugs. These include many drugs for depression, pain and ADHD.

Changes the guidance for 45 of your medications

CYP2C19

*1/*2

Intermediate metabolizer

One copy works and one doesn't. CYP2C19 handles several SSRIs, acid reducers such as omeprazole, and the blood thinner clopidogrel.

Changes the guidance for 17 of your medications

CYP2C9

*1/*2

Intermediate metabolizer

One copy works and one works less well. CYP2C9 clears warfarin, phenytoin, celecoxib and some other pain relievers.

Changes the guidance for 8 of your medications

Also not typical:SLCO1B1 decreased function GIPR decreased function AKT1 decreased function CHRNA5 increased risk COMT intermediate function CYP1A2 rapid CYP3A5 intermediate CYP4F2 intermediate NAT2 poor VKORC1 decreased expression UGT1A1 intermediate See all 30 genes

Your genes at a glance

All 30 results. Find more details in the Genes section, or select a gene below for its full explanation.

Each dot is a copy

works normally
works less well
doesn't work
works faster than usual
couldn't be checked
Letters: your DNA letters, where copy function isn’t defined

Color is the result

Normal / typical / favorable
Intermediate / decreased
Poor / increased risk
Rapid / increased
Not determined

Gene results, part 1
Gene	Result
CYP2D6	Poor metabolizer4/4
CYP2C19	Intermediate metabolizer1/2
CYP2C9	Intermediate metabolizer1/2
SLCO1B1	Decreased function15/1A
GIPR	Decreased functionrs1800437C/rs1800437G
AKT1	CT Decreased functionrs2494732C/rs2494732T
CHRNA5	AA Increased riskrs16969968A/rs16969968A
COMT	Intermediate functionrs4680A/rs4680G
CYP1A2	Rapid metabolizer1/30
CYP3A5	Intermediate metabolizer1/3
CYP4F2	Intermediate metabolizer1/3
NAT2	Poor metabolizer16/5
VKORC1	AG Decreased expression-1639A/-1639G
UGT1A1	Intermediate metabolizer1/28+60+80
ABCG2	Normal functionrs2231142G/rs2231142G

Gene results, part 2
Gene	Result
ADH1B	Normal functionrs1229984C/rs1229984C
ALDH2	Normal functionrs671G/rs671G
BCHE	Normal metabolizerReference/Reference
CYP2A6	Normal metabolizer1/1
CYP2B6	Normal metabolizer1/1
CYP3A4	Normal metabolizer1/1
DPYD	Normal metabolizerReference/Reference
FAAH	Normal functionrs324420C/rs324420C
GLP1R	CC Typical responsers10305420C/rs10305420C
IFNL3	CC Favorable response genotypers12979860C/rs12979860C
NUDT15	Normal metabolizer1/1
SULT1A1	Normal function1/1
TPMT	Normal metabolizer1/1
CACNA1S	Not checked
RYR1	Not checked

Worth discussing with your prescriber

For these 14 medications, guidelines suggest considering another option. Share this list before you start something new.

Antidepressants: Amitriptyline Clomipramine Desipramine Doxepin Imipramine Nortriptyline Trimipramine Venlafaxine
Pain management: Codeine Tramadol
Antipsychotics: Thioridazine
Cardiovascular: Clopidogrel
Cholesterol medications: Lovastatin
Oncology: Tamoxifen

Anesthesia genes couldn't be checked. RYR1 and CACNA1S can't be read reliably from array data, so 7 anesthesia medications show "Unable to determine." This is not a negative result. If you or a relative ever reacted badly to anesthesia, tell your anesthesia team.

Don't change a dose on your own. Bring this report to your prescriber or pharmacist. They can weigh it with everything else they know about you.

All medications

120 medications in 26 groups. Open any medication to see the guideline behind its label.

Browse drug classes

Consider alternative
Use with caution
Use as directed
Unable to determine

Filter this list by name, brand or gene

Showing 120 of 120

Antidepressants14 medications

Compare antidepressants All drug classes

SNRIs

VenlafaxineEffexor XR Consider alternative Your body breaks down this drug much more slowly, which has been linked to more side effects. A different antidepressant may be a better choice.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body breaks down this drug much more slowly, which has been linked to more side effects. A different antidepressant may be a better choice.
What it means: Decreased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine and greatly decreased O-desmethylvenlafaxine:venlafaxine ratio compared with normal and intermediate metabolizers. Although the clinical impact is unclear, poor metabolizer status has been associated with adverse effects.
What the guideline suggests: Consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down venlafaxine much more slowly than normal, causing the drug to build up in your system. A lower dose may be needed to avoid side effects.
What it means: Alters systemic parent drug and metabolite concentrations. Consider dosage reductions.
What the label suggests: Consider dosage reductions.

See full details for venlafaxine

SSRIs

CitalopramCelexa Use with caution Your body may break down the drug more slowly, increasing side effects. Your doctor may use a lower dose or adjust it more slowly.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

CPIC guideline

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body may break down the drug more slowly, increasing side effects. Your doctor may use a lower dose or adjust it more slowly.
What it means: Reduced metabolism when compared with CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
What the guideline suggests: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.

FDA drug label

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down citalopram slightly slower than normal. The standard dose should work as expected.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for citalopram

EscitalopramLexapro Use with caution Your body may break down the drug more slowly, increasing side effects. Your doctor may use a lower dose or adjust it more slowly.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body may break down the drug more slowly, increasing side effects. Your doctor may use a lower dose or adjust it more slowly.
What it means: Reduced metabolism when compared with CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
What the guideline suggests: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.

See full details for escitalopram

FluvoxamineLuvox Use with caution Your body breaks down this drug much more slowly. A lower starting dose, a slower increase, or a different drug may be safer.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body breaks down this drug much more slowly. A lower starting dose, a slower increase, or a different drug may be safer.
What it means: Greatly reduced metabolism of fluvoxamine to less active compounds compared with normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
What the guideline suggests: Consider a 25 to 50% lower starting dose and slower titration schedule as compared with normal metabolizers or consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.

See full details for fluvoxamine

ParoxetinePaxil, Seroxat Use with caution Your body processes this drug very slowly, so you may need half the usual dose to avoid side effects.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body processes this drug very slowly, so you may need half the usual dose to avoid side effects.
What it means: Greatly reduced metabolism compared with CYP2D6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
What the guideline suggests: Consider a 50% reduction in recommended starting dose, slower titration schedule, and a 50% lower maintenance dose as compared with normal metabolizers.

See full details for paroxetine

SertralineZoloft Use with caution Your body processes this drug a bit more slowly. You can start at the usual dose, but your doctor may raise it slowly, and a lower ongoing dose may be enough.CYP2C19Intermediate metabolizerCYP2B6Normal metabolizer

CYP2C19Intermediate metabolizerCYP2B6Normal metabolizer

CPIC guideline, both genes together

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body processes this drug a bit more slowly. You can start at the usual dose, but your doctor may raise it slowly, and a lower ongoing dose may be enough.
What it means: CYP2C19: Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. CYP2B6: Normal metabolism of sertraline to less active compounds.
What the guideline suggests: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose.

From the combined CYP2C19 and CYP2B6 table in CPIC's guideline for serotonin reuptake inhibitor antidepressants.

CPIC reads your CYP2C19 and CYP2B6 results together for sertraline, so this label reflects both genes.

See full details for sertraline

VortioxetineTrintellix, Brintellix Use with caution Your body clears this drug much more slowly. Half the usual starting dose is advised, or a different antidepressant.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body clears this drug much more slowly. Half the usual starting dose is advised, or a different antidepressant.
What it means: Greatly reduced metabolism of vortioxetine to inactive compounds compared with normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
What the guideline suggests: Initiate 50% of starting dose (e.g., 5 mg) and titrate to the maximum recommended dose of 10 mg or consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down vortioxetine much more slowly than normal, causing the drug to build up to higher levels. A lower maximum dose is recommended to reduce the risk of side effects.
What it means: Results in higher systemic concentrations. The maximum recommended dose is 10 mg.
What the label suggests: The maximum recommended dose is 10 mg.

See full details for vortioxetine

Tricyclics

AmitriptylineElavil Consider alternative Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.CYP2D6Poor metabolizerCYP2C19Intermediate metabolizer

CYP2D6Poor metabolizer (activity score 0.0)CYP2C19Intermediate metabolizer

CPIC guideline, both genes together

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.
What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid amitriptyline use. If a amitripyline is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for amitriptyline, so this label reflects both genes.

Also inamitriptyline / chlordiazepoxide and amitriptyline / perphenazine

See full details for amitriptyline

ClomipramineAnafranil Consider alternative Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.CYP2D6Poor metabolizerCYP2C19Intermediate metabolizer

CYP2D6Poor metabolizer (activity score 0.0)CYP2C19Intermediate metabolizer

CPIC guideline, both genes together

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.
What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid clomipramine use. If a clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for clomipramine, so this label reflects both genes.

See full details for clomipramine

DesipramineNorpramin Consider alternative Your body breaks down this drug much more slowly, so it can build up and cause side effects. A different medicine is usually suggested.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body breaks down this drug much more slowly, so it can build up and cause side effects. A different medicine is usually suggested.
What it means: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects.
What the guideline suggests: Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.

See full details for desipramine

DoxepinSinequan, Quitaxon, Aponal Consider alternative Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.CYP2D6Poor metabolizerCYP2C19Intermediate metabolizer

CYP2D6Poor metabolizer (activity score 0.0)CYP2C19Intermediate metabolizer

CPIC guideline, both genes together

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.
What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid doxepin use. If a doxepin is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for doxepin, so this label reflects both genes.

See full details for doxepin

ImipramineTofranil Consider alternative Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.CYP2D6Poor metabolizerCYP2C19Intermediate metabolizer

CYP2D6Poor metabolizer (activity score 0.0)CYP2C19Intermediate metabolizer

CPIC guideline, both genes together

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.
What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid imipramine use. If imipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for imipramine, so this label reflects both genes.

See full details for imipramine

NortriptylinePamelor Consider alternative Your body breaks down this drug very slowly, so it builds up and side effects are more likely. A different drug is usually suggested.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body breaks down this drug very slowly, so it builds up and side effects are more likely. A different drug is usually suggested.
What it means: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects.
What the guideline suggests: Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.

See full details for nortriptyline

TrimipramineSurmontil Consider alternative Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.CYP2D6Poor metabolizerCYP2C19Intermediate metabolizer

CYP2D6Poor metabolizer (activity score 0.0)CYP2C19Intermediate metabolizer

CPIC guideline, both genes together

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.
What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid trimipramine use. If a trimipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for trimipramine, so this label reflects both genes.

See full details for trimipramine

Antipsychotics12 medications

Compare antipsychotics All drug classes

AripiprazoleAbilify Use with caution Your body clears aripiprazole slowly, so more of it builds up and side effects are more likely. A lower maximum dose is advised.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

DPWG guideline

Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

In plain words: Your body clears aripiprazole slowly, so more of it builds up and side effects are more likely. A lower maximum dose is advised.
What it means: Decreased CYP2D6 activity raises the combined blood level of aripiprazole and its active metabolite, increasing the risk of side effects.
What the guideline suggests: Administer no more than 10 mg/day, 300 mg/month or 720 mg/2 month (68-75% of the standard maximum dose of aripiprazole).

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down aripiprazole much more slowly than normal, causing the drug to build up and increasing the risk of side effects. A lower dose is recommended.
What it means: Results in higher systemic concentrations and higher adverse reaction risk. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Adjust the dosage as the FDA label directs for CYP2D6 poor metabolizers.

See full details for aripiprazole

Aripiprazole LauroxilAristada Use with caution Your body breaks down aripiprazole lauroxil more slowly than normal, causing higher levels of the drug in your system. A lower dose is recommended to reduce the risk of side effects.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down aripiprazole lauroxil more slowly than normal, causing higher levels of the drug in your system. A lower dose is recommended to reduce the risk of side effects.
What it means: Results in higher systemic concentrations. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Adjust the dosage as the FDA label directs for CYP2D6 poor metabolizers.

See full details for aripiprazole lauroxil

BrexpiprazoleRexulti Use with caution Your body clears brexpiprazole slowly, so more of it builds up. Half the usual dose is advised.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

DPWG guideline

Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

In plain words: Your body clears brexpiprazole slowly, so more of it builds up. Half the usual dose is advised.
What it means: Decreased CYP2D6 activity reduces the metabolism of brexpiprazole, so the risk of side effects is theoretically increased.
What the guideline suggests: Use half of the normal dose.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down brexpiprazole much more slowly than normal, causing the drug to build up in your system. A lower dose is recommended to reduce the risk of side effects.
What it means: Results in higher systemic concentrations. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Adjust the dosage as the FDA label directs for CYP2D6 poor metabolizers.

See full details for brexpiprazole

ClozapineClozaril Use with caution Your body breaks down clozapine much more slowly than normal, causing the drug to build up to higher levels in your system. A lower dose may be needed to reduce the risk of side effects.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

DPWG guideline

Use as directed Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

In plain words: Your CYP2D6 result does not change how clozapine should be dosed.
What it means: CYP2D6 variation can change clozapine blood levels, but this has no clinical consequences.
What the guideline suggests: No action is required. Use standard clozapine dosing.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down clozapine much more slowly than normal, causing the drug to build up to higher levels in your system. A lower dose may be needed to reduce the risk of side effects.
What it means: Results in higher systemic concentrations. Dosage reductions may be necessary.
What the label suggests: Dosage reductions may be necessary.

See full details for clozapine

HaloperidolHaldol Use with caution Your body clears haloperidol slowly, which raises the concentration in your blood and increases side effect risk. A lower dose is typically recommended.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

DPWG guideline

Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

In plain words: Your body clears haloperidol slowly, which raises the concentration in your blood and increases side effect risk. A lower dose is typically recommended.
What it means: Decreased CYP2D6 activity reduces conversion of haloperidol, increasing plasma concentration approximately 1.7-fold. This is associated with an increased risk of side effects.
What the guideline suggests: Use 60% of the normal dose.

See full details for haloperidol

IloperidoneFanapt Use with caution Your body breaks down iloperidone much more slowly than normal, causing the drug to build up and increasing the risk of heart rhythm problems. The dose should be cut in half.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down iloperidone much more slowly than normal, causing the drug to build up and increasing the risk of heart rhythm problems. The dose should be cut in half.
What it means: Results in higher systemic concentrations and higher adverse reaction risk (QT prolongation). Reduce dosage by 50%.
What the label suggests: Reduce the dosage by 50%.

See full details for iloperidone

PerphenazineTrilafon Use with caution Your body breaks down perphenazine much more slowly than normal, causing the drug to build up in your system. This increases your risk of side effects.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down perphenazine much more slowly than normal, causing the drug to build up in your system. This increases your risk of side effects.
What it means: Results in higher systemic concentrations and higher adverse reaction risk.
What the label suggests: No specific dosing change in the FDA table. Refer to FDA labeling.

Also inamitriptyline / perphenazine

See full details for perphenazine

PimozideOrap Use with caution Your body clears pimozide slowly, which could raise the risk of heart rhythm side effects. Half the usual maximum dose is advised.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

DPWG guideline

Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

In plain words: Your body clears pimozide slowly, which could raise the risk of heart rhythm side effects. Half the usual maximum dose is advised.
What it means: Decreased CYP2D6 activity raises the plasma concentration of pimozide, which theoretically increases the risk of QT prolongation and torsade de pointes. Following the dose limit offsets this.
What the guideline suggests: Use no more than the following doses (50% of the normal maximum dose): 12 years and older, 10 mg/day; younger than 12 years, 0.05 mg/kg per day to a maximum of 2 mg/day.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down pimozide more slowly than normal, causing higher levels of the drug in your system. A lower dose is recommended to reduce the risk of side effects.
What it means: Results in higher systemic concentrations. Dosages should not exceed 0.05 mg/kg in children or 4 mg/day in adults who are poor metabolizers and dosages should not be increased earlier than 14 days.
What the label suggests: Do not exceed 0.05 mg/kg a day in children or 4 mg a day in adults, and do not increase the dose earlier than 14 days.

See full details for pimozide

QuetiapineSeroquel Use as directed Your CYP3A4 gene works normally, so the standard dose of this drug is used.CYP3A4Normal metabolizer

CYP3A4Normal metabolizer

DPWG guideline

Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

In plain words: Your CYP3A4 gene works normally, so the standard dose of this drug is used.
What it means: No clinically significant effect on quetiapine metabolism.
What the guideline suggests: Use standard quetiapine dosing.

See full details for quetiapine

RisperidoneRisperdal Use with caution Your body clears risperidone slowly, so more of it builds up and side effects are more likely. About two-thirds of the usual dose is advised, and less if side effects still occur.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

DPWG guideline

Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

In plain words: Your body clears risperidone slowly, so more of it builds up and side effects are more likely. About two-thirds of the usual dose is advised, and less if side effects still occur.
What it means: Decreased CYP2D6 activity raises the combined blood level of risperidone and its active metabolite, and a larger share of it is risperidone, which enters the brain more easily. The share of patients with therapy failure rises from 16% to 26%.
What the guideline suggests: Use 67% of the normal dose. If problematic side effects originating in the central nervous system occur despite this reduced dose, then reduce the dose further to 50% of the normal dose.

See full details for risperidone

ThioridazineMellaril Consider alternative Your body breaks down thioridazine much too slowly, causing dangerous levels to build up. This significantly increases your risk of serious heart rhythm problems. This medication should not be used.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

Evidence: strongSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down thioridazine much too slowly, causing dangerous levels to build up. This significantly increases your risk of serious heart rhythm problems. This medication should not be used.
What it means: Results in higher systemic concentrations and higher adverse reaction risk (QT prolongation). Predicted effect based on experience with CYP2D6 inhibitors. Contraindicated in poor metabolizers.
What the label suggests: Do not use thioridazine. It is contraindicated for poor metabolizers due to dangerous heart rhythm risks.

See full details for thioridazine

ZuclopenthixolClopixol Use with caution Your body clears this drug slowly, so it builds up in your blood. Half the usual dose is advised.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

DPWG guideline

Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

In plain words: Your body clears this drug slowly, so it builds up in your blood. Half the usual dose is advised.
What it means: Markedly decreased CYP2D6 activity reduces conversion of zuclopenthixol, raising plasma concentration approximately 1.6-fold and elevating side effect risk.
What the guideline suggests: Use 50% of the normal dose.

See full details for zuclopenthixol

Psychostimulants2 medications

Compare psychostimulants All drug classes

AmphetamineAdzenys ER Use with caution Your body breaks down amphetamine much more slowly than normal, which may cause the drug to build up and increase your risk of side effects. A lower dose or a different medication may be needed.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down amphetamine much more slowly than normal, which may cause the drug to build up and increase your risk of side effects. A lower dose or a different medication may be needed.
What it means: May affect systemic concentrations and adverse reaction risk. Consider lower starting dosage or use alternative agent.
What the label suggests: Consider a lower starting dosage or an alternative agent.

Also inAdderall

See full details for amphetamine

AtomoxetineStrattera Use with caution Your body processes this drug very slowly, so it builds up. It may work well but cause more side effects, so your doctor may start low and go slowly.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer (activity score 0.0)

CPIC guideline

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body processes this drug very slowly, so it builds up. It may work well but cause more side effects, so your doctor may start low and go slowly.
What it means: Significantly decreased metabolism of atomoxetine may result in higher concentrations as compared to non- poor metabolizers. This may increase the occurrence of treatment-emergent side effects, but also a greater improvement of ADHD symptoms as compared with non- poor metabolizers in those who tolerate treatment. Poor metabolizer status is associated with lower final dose requirements as compared to non- poor metabolizers.
What the guideline suggests: Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down atomoxetine more slowly than normal, causing it to build up in your system. A lower dose or slower dose increases may be needed to reduce the risk of side effects.
What it means: Results in higher systemic concentrations and higher adverse reaction risk. Adjust titration interval and increase dosage if tolerated. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Adjust the titration interval and increase the dosage only if tolerated, as the FDA label directs.

See full details for atomoxetine

Movement disorders3 medications

Compare movement disorders All drug classes

Involuntary Movement Reducers

DeutetrabenazineAustedo Use with caution Your body breaks down deutetrabenazine much more slowly than normal, causing the drug to build up and raising the risk of heart rhythm problems. A lower maximum dose is recommended.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down deutetrabenazine much more slowly than normal, causing the drug to build up and raising the risk of heart rhythm problems. A lower maximum dose is recommended.
What it means: Results in higher systemic concentrations and adverse reaction risk (QT prolongation). The maximum recommended dosage should not exceed 36 mg (maximum single dose of 18 mg).
What the label suggests: Do not exceed 36 mg a day (maximum single dose of 18 mg).

See full details for deutetrabenazine

TetrabenazineXenazine Use with caution Your body breaks down tetrabenazine much more slowly than normal, causing the drug to reach higher levels in your system. A lower maximum dose is required to avoid side effects.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down tetrabenazine much more slowly than normal, causing the drug to reach higher levels in your system. A lower maximum dose is required to avoid side effects.
What it means: Results in higher systemic concentrations. The maximum recommended single dose is 25 mg and should not exceed 50 mg/day.
What the label suggests: The maximum single dose is 25 mg; do not exceed 50 mg a day.

See full details for tetrabenazine

ValbenazineIngrezza Use with caution Your body breaks down valbenazine much more slowly than normal, causing the drug to build up. This raises your risk of heart rhythm problems, so a lower dose may be needed.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down valbenazine much more slowly than normal, causing the drug to build up. This raises your risk of heart rhythm problems, so a lower dose may be needed.
What it means: Results in higher systemic active metabolite concentrations and may result in higher adverse reaction risk (QT prolongation). The recommended dosage for poor metabolizers is 40 mg once daily.
What the label suggests: The recommended dosage for poor metabolizers is 40 mg once daily.

See full details for valbenazine

Anticonvulsants4 medications

Compare anticonvulsants All drug classes

BrivaracetamBriviact Use with caution Your body breaks down this drug more slowly, so more of it builds up. This can raise the risk of side effects.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down this drug more slowly, so more of it builds up. This can raise the risk of side effects.
What it means: Results in higher systemic concentrations and higher adverse reaction risk.
What the label suggests: No specific dosing change for intermediate metabolizers. Refer to FDA labeling.

See full details for brivaracetam

ClobazamOnfi, Frisium Use with caution Your body breaks down clobazam more slowly than normal, causing higher levels of the drug's active form to build up. A lower dose may be needed to reduce the risk of side effects.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down clobazam more slowly than normal, causing higher levels of the drug's active form to build up. A lower dose may be needed to reduce the risk of side effects.
What it means: Results in higher systemic active metabolite concentrations. Poor metabolism results in higher adverse reaction risk. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Dosage adjustment is recommended; the FDA label gives specific dosing for poor metabolizers.

See full details for clobazam

FosphenytoinCerebyx Use with caution Your body clears this drug more slowly, so it can build up and cause nervous system side effects. A lower starting dose and blood level checks are suggested.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer (activity score 1.5)

CPIC guideline

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug slightly, but no dose changes are usually needed.
What it means: Slightly reduced fosphenytoin metabolism; however, this does not appear to translate into increased side effects.
What the guideline suggests: No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN, and patients should be carefully monitored according to standard practice.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body clears this drug more slowly, so it can build up and cause nervous system side effects. A lower starting dose and blood level checks are suggested.
What it means: May result in higher systemic concentrations and higher adverse reaction risk (central nervous system toxicity). Consider starting at the lower end of the dosage range and monitor serum concentrations. Refer to FDA labeling for specific dosing recommendations. Carriers of CYP2C9*3 alleles may be at increased risk of severe cutaneous adverse reactions. Consider avoiding fosphenytoin as an alternative to carbamazepine in patients who are CYP2C9*3 carriers. Genotyping is not a substitute for clinical vigilance and patient management.
What the label suggests: Consider starting at the lower end of the dosage range and monitor serum concentrations. CYP2C9*3 carriers may be at higher risk of severe skin reactions; consider avoiding fosphenytoin as an alternative to carbamazepine in them.

See full details for fosphenytoin

PhenytoinDilantin Use with caution Your body breaks down this drug more slowly, so it can build up. That raises the risk of side effects on the brain and nerves.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer (activity score 1.5)

CPIC guideline

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug slightly, but no dose changes are usually needed.
What it means: Slightly reduced phenytoin metabolism; however, this does not appear to translate into increased side effects.
What the guideline suggests: No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN, and patients should be carefully monitored according to standard practice.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down this drug more slowly, so it can build up. That raises the risk of side effects on the brain and nerves.
What it means: May result in higher systemic concentrations and higher adverse reaction risk (central nervous system toxicity). Refer to FDA labeling for specific dosing recommendations. Carriers of CYP2C9*3 alleles may be at increased risk of severe cutaneous adverse reactions. Consider avoiding phenytoin as an alternative to carbamazepine in patients who are CYP2C9*3 carriers. Genotyping is not a substitute for clinical vigilance and patient management.
What the label suggests: Refer to FDA labeling for dosing. CYP2C9*3 carriers may be at higher risk of severe skin reactions; consider avoiding phenytoin as an alternative to carbamazepine in them.

See full details for phenytoin

Pain management13 medications

Compare pain management All drug classes

CarisoprodolSoma Use as directed Your body breaks down carisoprodol slightly slower than normal. The standard dose should work as expected.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

FDA drug label

Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down carisoprodol slightly slower than normal. The standard dose should work as expected.
What it means: No FDA guidance for this phenotype
What the label suggests: Initiate therapy with recommended starting dose.

Also inaspirin / carisoprodol and aspirin / carisoprodol / codeine

See full details for carisoprodol

CelecoxibCelebrex Use as directed Your body slows the drug down slightly, but usually the normal starting dose is fine.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer (activity score 1.5)

CPIC guideline

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug down slightly, but usually the normal starting dose is fine.
What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

FDA drug label

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your CYP2C9 result means somewhat lower CYP2C9 activity than usual, but the FDA gives no genetic dosing change for celecoxib at this result.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Also inConsensi and Seglentis

See full details for celecoxib

CodeineTylenol 3 Consider alternative Your body turns very little codeine into its active form, so it likely won't ease your pain. A different pain reliever is usually suggested.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

Consider alternative Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body turns very little codeine into its active form, so it likely won't ease your pain. A different pain reliever is usually suggested.
What it means: Greatly reduced morphine formation leading to diminished analgesia.
What the guideline suggests: Avoid codeine use because of possibility of diminished analgesia. If opioid use is warranted, consider a non-tramadol opioid.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body turns very little codeine into its active form, so it may not relieve your pain as well.
What it means: Results in lower systemic active metabolite concentrations and may result in reduced efficacy.
What the label suggests: No specific dosing change; codeine may be less effective. Refer to FDA labeling.

Also inTylenol #3, Fioricet with Codeine, Ascomp and 15 more

See full details for codeine

FlurbiprofenAnsaid, Ocufen, Strefen Use as directed Your body slows the drug down slightly, but usually the normal starting dose is fine.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer (activity score 1.5)

CPIC guideline

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug down slightly, but usually the normal starting dose is fine.
What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

FDA drug label

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body may break down this drug a little slower than average. The FDA label gives no dose change for your result.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for flurbiprofen

HydrocodoneHysingla ER Use with caution Your body makes less of hydrocodone's stronger active form. It's not clear this changes pain relief, so the usual dose is recommended, with a different pain medicine to consider if it doesn't work.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body makes less of hydrocodone's stronger active form. It's not clear this changes pain relief, so the usual dose is recommended, with a different pain medicine to consider if it doesn't work.
What it means: Decreased metabolism of hydrocodone to active metabolite, hydromorphone, but there is insufficient evidence to determine if these effects on pharmacokinetics translate into decreased analgesia or side effects.
What the guideline suggests: Use hydrocodone label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine and non-tramadol opioid.

Also inVicodin, chlorpheniramine / hydrocodone, Obredon and 2 more

See full details for hydrocodone

IbuprofenAdvil Use as directed Your body slows the drug down slightly, but usually the normal starting dose is fine.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer (activity score 1.5)

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug down slightly, but usually the normal starting dose is fine.
What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

Also inAdvil Dual Action, Advil Allergy and Congestion Relief, Advil Allergy Sinus and 5 more

See full details for ibuprofen

LornoxicamXefo Use as directed Your body slows the drug down slightly, but usually the normal starting dose is fine.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer (activity score 1.5)

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug down slightly, but usually the normal starting dose is fine.
What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

See full details for lornoxicam

MeloxicamMobic Use with caution Your body breaks down meloxicam slightly slower than normal. While there is no specific FDA guidance, your doctor may want to monitor you for side effects.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer (activity score 1.5)

CPIC guideline

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug slightly, but usually the normal starting dose is fine.
What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the meloxicam prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down meloxicam slightly slower than normal. While there is no specific FDA guidance, your doctor may want to monitor you for side effects.
What it means: No FDA guidance for this phenotype
What the label suggests: Initiate therapy with recommended starting dose.

Also inZynrelef and Symbravo

See full details for meloxicam

OliceridineOlinvyk Use with caution Your body clears this drug much more slowly, raising the risk of slowed breathing and deep drowsiness. You may need doses less often.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body clears this drug much more slowly, raising the risk of slowed breathing and deep drowsiness. You may need doses less often.
What it means: Results in higher systemic concentrations and higher adverse reaction risk (respiratory depression and sedation). May require less frequent dosing.
What the label suggests: May require less frequent dosing.

See full details for oliceridine

PiroxicamFeldene Use with caution Your body breaks down piroxicam more slowly than normal, which can cause higher drug levels. Your doctor may need to adjust your dosing.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer (activity score 1.5)

CPIC guideline

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug slightly, but the usual starting dose is still fine.
What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down piroxicam more slowly than normal, which can cause higher drug levels. Your doctor may need to adjust your dosing.
What it means: Results in higher systemic concentrations.
What the label suggests: No specific dosing change for intermediate metabolizers. Refer to FDA labeling.

See full details for piroxicam

PitolisantWakix Use with caution Your body breaks down pitolisant much more slowly than normal, causing the drug to reach higher levels in your system. The lowest starting dose is recommended to reduce the risk of side effects.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down pitolisant much more slowly than normal, causing the drug to reach higher levels in your system. The lowest starting dose is recommended to reduce the risk of side effects.
What it means: Results in higher systemic concentrations. Use lowest recommended starting dosage. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Use the lowest recommended starting dosage. Refer to FDA labeling.

See full details for pitolisant

TenoxicamMobiflex Use as directed Your body slows the drug slightly, but the usual starting dose is still fine.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer (activity score 1.5)

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug slightly, but the usual starting dose is still fine.
What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

See full details for tenoxicam

TramadolUltram, ConZip Consider alternative Your body can't turn this drug into its active form well, so it may not relieve your pain. A different pain medicine is advised.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

Consider alternative Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body can't turn this drug into its active form well, so it may not relieve your pain. A different pain medicine is advised.
What it means: Greatly reduced O-desmethyltramadol (active metabolite) formation leading to diminished analgesia.
What the guideline suggests: Avoid tramadol use because of possibility of diminished analgesia. If opioid use is warranted, consider a non-codeine opioid.

FDA drug label

Use with caution Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body turns this drug into its active form slowly, so it may not relieve pain as well. Your doctor may check how well it works.
What it means: Results in lower systemic active metabolite concentrations and may result in reduced efficacy.
What the label suggests: The FDA notes reduced efficacy but gives no dosing change. Monitor for adequate pain relief.

Also inUltracet and Seglentis

See full details for tramadol

Cardiovascular7 medications

Compare cardiovascular All drug classes

Antiarrhythmics

PropafenoneRythmol SR Use with caution Your body breaks down this drug much more slowly, so an irregular heartbeat is more likely. Some other drugs raise this risk even more.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down this drug much more slowly, so an irregular heartbeat is more likely. Some other drugs raise this risk even more.
What it means: Results in higher systemic concentrations and higher adverse reaction risk (arrhythmia). Avoid use in poor metabolizers taking a CYP3A4 inhibitor.
What the label suggests: Avoid use in poor metabolizers taking a CYP3A4 inhibitor.

See full details for propafenone

Antihypertensives

HydralazineApresoline Use with caution Your body breaks down hydralazine slowly, which means you need a lower starting dose. Higher doses may increase side effects, including a rare immune reaction.NAT2Poor metabolizer

NAT2Poor metabolizer

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body breaks down hydralazine slowly, which means you need a lower starting dose. Higher doses may increase side effects, including a rare immune reaction.
What it means: Predicted to have increased hydralazine plasma concentrations compared to NAT2 rapid and intermediate metabolizers, which may lead to both increased efficacy and adverse effects, including drug-induced systemic lupus erythematosus.
What the guideline suggests: Initiate therapy at a total daily dose of 40 to 75 mg. Carefully titrate dose upward to clinical effect or guideline-recommended dose; use caution with total daily hydralazine doses of 200 mg or more.

Also inBidil

See full details for hydralazine

Beta Blockers

CarvedilolCoreg, Coreg CR Use with caution Your body breaks down carvedilol much more slowly than normal, causing the drug to build up in your system. This increases your risk of dizziness and other side effects.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down carvedilol much more slowly than normal, causing the drug to build up in your system. This increases your risk of dizziness and other side effects.
What it means: Results in higher systemic concentrations and higher adverse reaction risk (dizziness).
What the label suggests: No specific dosing change in the FDA table. Refer to FDA labeling.

See full details for carvedilol

MetoprololLopressor, Toprol XL Use with caution Your body clears this drug very slowly, so it can build up. Your doctor may start with the lowest dose and watch your heart rate.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer (activity score 0.0)

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body clears this drug very slowly, so it can build up. Your doctor may start with the lowest dose and watch your heart rate.
What it means: Decreased metabolism of metoprolol leading to markedly increased drug concentrations; this leads to greater heart rate and blood pressure reductions. The effect on clinical outcomes is unclear.
What the guideline suggests: Initiate therapy with the lowest recommended starting dose. Carefully titrate dose upward to clinical effect or guideline-recommended dose; monitor more closely for bradycardia. Alternatively, consider selecting another beta-blocker.

Also inLopressor HCT

See full details for metoprolol

Blood Thinners

ClopidogrelPlavix Consider alternative Your body turns this drug into its active form more slowly, so it may not protect you as well. A different blood thinner is usually suggested.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

CPIC guideline

Consider alternative Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body turns this drug into its active form more slowly, so it may not protect you as well. A different blood thinner is usually suggested.
What it means: Reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events
What the guideline suggests: Avoid standard dose (75 mg) clopidogrel if possible. Use prasugrel or ticagrelor at standard dose if no contraindication

FDA drug label

Consider alternative Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: This drug may not work as well for you, which can raise the risk of heart problems. Your doctor may use a different drug to prevent clots.
What it means: Results in lower systemic active metabolite concentrations, lower antiplatelet response, and may result in higher cardiovascular risk. Consider use of another platelet P2Y12 inhibitor.
What the label suggests: Results in lower systemic active metabolite concentrations, lower antiplatelet response, and may result in higher cardiovascular risk. Consider use of another platelet P2Y12 inhibitor.

See full details for clopidogrel

WarfarinCoumadin Use with caution Your genes suggest a lower dose may be safer. Your doctor can decide.CYP2C9Intermediate metabolizerVKORC1Decreased expressionCYP4F2Intermediate metabolizer

CYP2C9Intermediate metabolizerVKORC1Decreased expressionCYP4F2Intermediate metabolizer

CPIC guideline, all three genes together

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

Estimated dose: 3.2-4.4 mg/day (lower than typical starting dose).

In plain words: Your genes suggest a lower dose may be safer. Your doctor can decide.

Based on your CYP2C9 (*2/*1) and VKORC1 (-1639A/-1639G) genotypes, your predicted stable warfarin dose is 3.2-4.4 mg/day (increased ~5-10% for CYP4F2 *3). This estimate is genotype-based only and does not account for age, weight, or interacting drugs. A clinician should confirm the starting dose using a validated pharmacogenetic dosing algorithm.

Base genotype dose (CYP2C9 *1/*2, VKORC1 GA): 3-4 mg/day. Because you carry CYP4F2*3 (rs2108622 T), your estimated dose is increased by about 5-10%.

CPIC reads your CYP2C9, VKORC1 and CYP4F2 results together for warfarin, so this label reflects all of them.

See full details for warfarin

Cardiomyopathy

MavacamtenCamzyos Use with caution Your body breaks down mavacamten slightly slower than normal, which may lead to higher drug levels. Your doctor will monitor you closely and adjust the dose based on your response.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

FDA drug label

Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down mavacamten slightly slower than normal, which may lead to higher drug levels. Your doctor will monitor you closely and adjust the dose based on your response.
What it means: Results in higher systemic concentrations and may have higher adverse reaction risk (heart failure). Dosage is based on individual response. The dose titration and monitoring schedule accounts for differences due to CYP2C19 genetic variation, so adjustments based on CYP2C19 genotype are not necessary. Refer to FDA labeling for specific dosing recommendations and monitoring.
What the label suggests: Follow the label's dose titration and monitoring schedule; no genotype-based adjustment is needed.

See full details for mavacamten

Cholesterol medications7 medications

Compare cholesterol medications All drug classes

AtorvastatinLipitor Use with caution More of this statin stays in your blood, which can raise the chance of muscle side effects. Your doctor may limit the dose.SLCO1B1Decreased function

SLCO1B1Decreased function

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: More of this statin stays in your blood, which can raise the chance of muscle side effects. Your doctor may limit the dose.
What it means: Increased atorvastatin exposure as compared with normal function, which may translate to increased myopathy risk.
What the guideline suggests: Prescribe ≤40 mg as a starting dose and adjust doses of atorvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for the 40-mg dose. If dose >40 mg is needed for desired efficacy, consider combination therapy (i.e., atorvastatin plus nonstatin guideline-directed medical therapy).

Also inCaduet

See full details for atorvastatin

FluvastatinLescol Use with caution Your genes make this statin build up in your blood, which can raise the risk of muscle problems. A lower starting dose or a dose limit is suggested.CYP2C9Intermediate metabolizerSLCO1B1Decreased function

CYP2C9Intermediate metabolizer (activity score 1.5)SLCO1B1Decreased function

CPIC guideline, both genes together

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your genes make this statin build up in your blood, which can raise the risk of muscle problems. A lower starting dose or a dose limit is suggested.
What it means: CYP2C9: Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk. SLCO1B1: Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg.
What the guideline suggests: Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).

From the combined CYP2C9 and SLCO1B1 table in CPIC's statin guideline. CYP2C9 is matched on its activity score.

CPIC reads your CYP2C9 and SLCO1B1 results together for fluvastatin, so this label reflects both genes.

See full details for fluvastatin

LovastatinMevacor Consider alternative Your genes make this statin build up in your blood, which may raise your risk of muscle problems. A different statin, or a low dose of this one, is often suggested.SLCO1B1Decreased function

SLCO1B1Decreased function

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your genes make this statin build up in your blood, which may raise your risk of muscle problems. A different statin, or a low dose of this one, is often suggested.
What it means: Increased lovastatin acid exposure as compared with normal function, which may translate to increased myopathy risk
What the guideline suggests: Consider prescribing a lower-risk alternative such as atorvastatin (10 to 20 mg), pravastatin (40 mg), or rosuvastatin (5 to 10 mg). If lovastatin is warranted, limit the dose to ≤20 mg/day to reduce the risk of muscle-related side effects.

See full details for lovastatin

PitavastatinLivalo Use with caution More of this statin stays in your blood, so muscle side effects are more likely. Your doctor may keep the dose low or suggest another statin.SLCO1B1Decreased function

SLCO1B1Decreased function

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: More of this statin stays in your blood, so muscle side effects are more likely. Your doctor may keep the dose low or suggest another statin.
What it means: Increased pitavastatin exposure as compared with normal function, which may translate to increased myopathy risk
What the guideline suggests: Prescribe ≤2 mg as a starting dose and adjust doses of pitavastatin based on disease-specific guidelines. Be aware of possible increased risk for muscle-related side effects, especially for doses >1 mg. If dose >2 mg is needed for desired efficacy, consider switching to a lower-risk alternative such as atorvastatin (10 to 20 mg), pravastatin (40 mg), or rosuvastatin (5 to 10 mg), or using combination therapy (e.g., pitavastatin plus nonstatin guideline-directed medical therapy).

See full details for pitavastatin

PravastatinPravachol Use with caution Your body may process this drug more slowly, so higher doses might carry added risks.SLCO1B1Decreased function

SLCO1B1Decreased function

CPIC guideline

Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body may process this drug more slowly, so higher doses might carry added risks.
What it means: Increased pravastatin exposure compared with normal function; typical myopathy risk with doses ≤40 mg
What the guideline suggests: Prescribe desired starting dose and adjust doses of pravastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially with doses >40 mg per day.

See full details for pravastatin

RosuvastatinCrestor Use as directed Your genes support the usual starting dose of this statin.ABCG2Normal functionSLCO1B1Decreased function

ABCG2Normal functionSLCO1B1Decreased function

CPIC guideline, both genes together

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your genes support the usual starting dose of this statin.
What it means: ABCG2: Typical myopathy risk and rosuvastatin exposure SLCO1B1: Increased rosuvastatin exposure as compared to normal function; Typical myopathy risk with doses ≤20 mg.
What the guideline suggests: Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >20mg.

From the combined ABCG2 and SLCO1B1 table in CPIC's statin guideline.

CPIC reads your ABCG2 and SLCO1B1 results together for rosuvastatin, so this label reflects both genes.

Also inRoszet

See full details for rosuvastatin

SimvastatinZocor Use with caution More of this statin stays in your blood, so muscle side effects are more likely. Your doctor may use a different statin or a lower dose.SLCO1B1Decreased function

SLCO1B1Decreased function

CPIC guideline

Use with caution Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: More of this statin stays in your blood, so muscle side effects are more likely. Your doctor may use a different statin or a lower dose.
What it means: Increased simvastatin acid exposure compared with normal function; increased risk of muscle side effects (myopathy)
What the guideline suggests: Prescribe an alternative statin depending on desired potency. Low-risk options: atorvastatin 10 to 20 mg, pitavastatin 1 mg, pravastatin 40 mg, rosuvastatin 5 to 10 mg. Moderate-risk options: fluvastatin 80 mg, pitavastatin 2 mg, pravastatin 80 mg. High-risk options (use with caution): lovastatin 40 to 80 mg, pitavastatin 4 mg, simvastatin 20 to 40 mg. If simvastatin is used, limit dose to <20 mg/day.

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body clears simvastatin more slowly than normal, causing it to build up in your system. This raises your risk of muscle pain or damage, especially at higher doses.
What it means: Results in higher systemic concentrations and higher adverse reaction risk (myopathy). The risk of adverse reaction (myopathy) is higher for patients on 80 mg than for those on lower doses.
What the label suggests: No specific dosing change in the FDA table. The risk of myopathy is higher at 80 mg than at lower doses.

Also inVytorin

See full details for simvastatin

Antiemetics4 medications

Compare antiemetics All drug classes

DronabinolSyndros Use with caution Your body breaks down dronabinol more slowly than normal, which may cause the drug to build up and increase the risk of side effects. Extra monitoring is recommended.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down dronabinol more slowly than normal, which may cause the drug to build up and increase the risk of side effects. Extra monitoring is recommended.
What it means: May result in higher systemic concentrations and higher adverse reaction risk. Monitor for adverse reactions.
What the label suggests: Monitor for adverse reactions.

See full details for dronabinol

MetoclopramideReglan Use with caution Your body breaks down metoclopramide much more slowly than normal, causing the drug to build up and increasing the risk of side effects. A lower dose is recommended.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down metoclopramide much more slowly than normal, causing the drug to build up and increasing the risk of side effects. A lower dose is recommended.
What it means: Results in higher systemic concentrations and higher adverse reaction risk. The recommended dosage is lower. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Use the lower dosage the FDA label recommends.

See full details for metoclopramide

OndansetronZofran Use as directed There is not enough evidence to know how your CYP2D6 result affects your response to ondansetron. CPIC makes no prescribing recommendation based on this result.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

No recommendationRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: There is not enough evidence to know how your CYP2D6 result affects your response to ondansetron. CPIC makes no prescribing recommendation based on this result.
What it means: Insufficient evidence demonstrating clinical impact
What the guideline suggests: No recommendation based on insufficient evidence

See full details for ondansetron

TropisetronNavoban Use as directed There is not enough evidence to know how your CYP2D6 result affects your response to tropisetron. CPIC makes no prescribing recommendation based on this result.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

No recommendationRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: There is not enough evidence to know how your CYP2D6 result affects your response to tropisetron. CPIC makes no prescribing recommendation based on this result.
What it means: Insufficient evidence demonstrating clinical impact
What the guideline suggests: No recommendation based on insufficient evidence

See full details for tropisetron

Proton pump inhibitors4 medications

Compare proton pump inhibitors All drug classes

DexlansoprazoleDexilant Use with caution Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

CPIC guideline

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.
What it means: Increased plasma concentration of PPI compared with CYP2C19 normal metabolizers; increased chance of efficacy and potentially toxicity
What the guideline suggests: Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.

See full details for dexlansoprazole

LansoprazolePrevacid Use with caution Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

CPIC guideline

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.
What it means: Increased plasma concentration of PPI compared with CYP2C19 normal metabolizers; increased chance of efficacy and potentially toxicity
What the guideline suggests: Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.

Also inamoxicillin / clarithromycin / lansoprazole

See full details for lansoprazole

OmeprazolePrilosec, Losec Use with caution Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

CPIC guideline

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.
What it means: Increased plasma concentration of PPI compared with CYP2C19 normal metabolizers; increased chance of efficacy and potentially toxicity
What the guideline suggests: Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.

Also inTalicia, Yosprala and Konvomep

See full details for omeprazole

PantoprazoleProtonix Use with caution Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

CPIC guideline

Use with caution Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.
What it means: Increased plasma concentration of PPI compared with CYP2C19 normal metabolizers; increased chance of efficacy and potentially toxicity
What the guideline suggests: Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.

FDA drug label

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body processes this drug a bit slower than average. The FDA gives no dose change for your result, so the usual dose is used.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for pantoprazole

Oncology13 medications

Compare oncology All drug classes

Chemotherapies

BelinostatBeleodaq Use as directed Your body may process this drug a little more slowly. The FDA has no special advice for this, so the usual dose is used.UGT1A1Intermediate metabolizer

UGT1A1Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body may process this drug a little more slowly. The FDA has no special advice for this, so the usual dose is used.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for belinostat

BelzutifanWelireg Use as directed Your CYP2C19 result means somewhat lower CYP2C19 activity than usual, but the FDA gives no genetic dosing change for belzutifan at this result.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your CYP2C19 result means somewhat lower CYP2C19 activity than usual, but the FDA gives no genetic dosing change for belzutifan at this result.
What it means: No FDA guidance for this phenotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for belzutifan

CapecitabineXeloda, Xitabin, Kapetral Use as directed Your body processes capecitabine normally. You have a typical risk of side effects, and the standard dose is expected to be appropriate.DPYDNormal metabolizer

DPYDNormal metabolizer (activity score 2.0)

CPIC guideline

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body processes capecitabine normally. You have a typical risk of side effects, and the standard dose is expected to be appropriate.
What it means: Normal DPD activity and “normal” risk for fluoropyrimidine toxicity
What the guideline suggests: Based on genotype, there is no indication to change dose or therapy. Use label-recommended dosage and administration

FDA drug label

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down capecitabine at a normal rate. The standard dose should work as expected.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for capecitabine

ErdafitinibBalversa Use as directed Your CYP2C9 result means somewhat lower CYP2C9 activity than usual, but the FDA gives no genetic dosing change for erdafitinib at this result.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your CYP2C9 result means somewhat lower CYP2C9 activity than usual, but the FDA gives no genetic dosing change for erdafitinib at this result.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for erdafitinib

FluorouracilAdrucil, Carac Use as directed Your body breaks down this drug normally. Your risk of side effects is typical, and the usual dose is used.DPYDNormal metabolizer

DPYDNormal metabolizer (activity score 2.0)

CPIC guideline

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body breaks down this drug normally. Your risk of side effects is typical, and the usual dose is used.
What it means: Normal DPD activity and “normal” risk for fluoropyrimidine toxicity
What the guideline suggests: Based on genotype, there is no indication to change dose or therapy. Use label-recommended dosage and administration

FDA drug label

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body processes fluorouracil at a normal rate. The standard dose should work as expected.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for fluorouracil

GefitinibIressa Use with caution Your body breaks down gefitinib more slowly than normal, causing higher levels of the drug in your system. This increases the risk of side effects and closer monitoring may be needed.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down gefitinib more slowly than normal, causing higher levels of the drug in your system. This increases the risk of side effects and closer monitoring may be needed.
What it means: Results in higher systemic concentrations and higher adverse reaction risk. Monitor for adverse reactions.
What the label suggests: Monitor for adverse reactions.

See full details for gefitinib

IrinotecanCamptosar, Onivyde Use as directed Your body breaks down irinotecan slightly slower than normal. The standard dose should work as expected.UGT1A1Intermediate metabolizer

UGT1A1Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down irinotecan slightly slower than normal. The standard dose should work as expected.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for irinotecan

MercaptopurinePurinethol Use as directed Both genes that affect this drug look normal, so a standard starting dose is expected.TPMTNormal metabolizerNUDT15Normal metabolizer

TPMTNormal metabolizerNUDT15Normal metabolizer

CPIC guideline, both genes together

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Both genes that affect this drug look normal, so a standard starting dose is expected.
What it means: Both TPMT and NUDT15 predict normal thiopurine metabolism and a normal risk of myelosuppression.
What the guideline suggests: Initiate therapy with standard starting dose of mecaptopurine (e.g., 75 mg/m2/day for malignancy or 1.5 mg/kg/day for nonmalignancy). During therapy, adjust the doses of myelosuppressive agents, as per standard clinical practice. It usually takes at least 2 weeks of stable dosing to reach steady state after each dose adjustment.

From the combined TPMT and NUDT15 table in CPIC's thiopurine guideline.

CPIC reads your TPMT and NUDT15 results together for mercaptopurine, so this label reflects both genes.

See full details for mercaptopurine

NilotinibTasigna Use as directed Your UGT1A1 result means somewhat lower UGT1A1 activity than usual, but the FDA gives no genetic dosing change for nilotinib at this result.UGT1A1Intermediate metabolizer

UGT1A1Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your UGT1A1 result means somewhat lower UGT1A1 activity than usual, but the FDA gives no genetic dosing change for nilotinib at this result.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for nilotinib

PazopanibVotrient Use as directed Your UGT1A1 gene works a bit less than average. The FDA gives no dose change for your result, so the usual dose is used.UGT1A1Intermediate metabolizer

UGT1A1Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your UGT1A1 gene works a bit less than average. The FDA gives no dose change for your result, so the usual dose is used.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for pazopanib

Sacituzumab Govitecan-HziyTrodelvy Use as directed Your body processes this drug a bit slower than average. The FDA gives no dose change for your result, so the usual dose is used.UGT1A1Intermediate metabolizer

UGT1A1Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body processes this drug a bit slower than average. The FDA gives no dose change for your result, so the usual dose is used.
What it means: No FDA guidance for this phenotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for sacituzumab govitecan-hziy

ThioguanineLanvis, Tabloid Use as directed Both genes that affect this drug look normal, so a standard starting dose is expected.TPMTNormal metabolizerNUDT15Normal metabolizer

TPMTNormal metabolizerNUDT15Normal metabolizer

CPIC guideline, both genes together

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Both genes that affect this drug look normal, so a standard starting dose is expected.
What it means: Both TPMT and NUDT15 predict normal thiopurine metabolism and a normal risk of myelosuppression.
What the guideline suggests: Initiate therapy with standard starting dose of thioguanine (e.g., 40 mg/m2/day for malignancy). During therapy, adjust the doses of myelosuppressive agents, as per standard clinical practice. It usually takes at least 2 weeks of stable dosing to reach steady state after each dose adjustment.

From the combined TPMT and NUDT15 table in CPIC's thiopurine guideline.

CPIC reads your TPMT and NUDT15 results together for thioguanine, so this label reflects both genes.

See full details for thioguanine

Estrogen Modulators

TamoxifenNolvadex, Soltamox Consider alternative Your body makes very little of this drug's active form, so it may not work well to stop breast cancer from coming back. Another hormone therapy is advised.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

CPIC guideline

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body makes very little of this drug's active form, so it may not work well to stop breast cancer from coming back. Another hormone therapy is advised.
What it means: Lower endoxifen concentrations compared to normal metabolizers; higher risk of breast cancer recurrence, event-free and recurrence-free survival compared to normal metabolizers.
What the guideline suggests: Recommend alternative hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women given that these approaches are superior to tamoxifen regardless of CYP2D6 genotype and based on knowledge that CYP2D6 poor metabolizers switched from tamoxifen to anastrozole do not have an increased risk of recurrence. Note, higher dose tamoxifen (40 mg/day) increases but does not normalize endoxifen concentrations and can be considered if there are contraindications to aromatase inhibitor therapy.

See full details for tamoxifen

Immunosuppressants4 medications

Compare immunosuppressants All drug classes

AbrocitinibCibinqo Use as directed Your body may process this drug a little more slowly. The drug label has no special advice for this, so the usual dose is used.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

FDA drug label

Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body may process this drug a little more slowly. The drug label has no special advice for this, so the usual dose is used.
What it means: No FDA guidance for this phenotype
What the label suggests: Abrocitinib - label recommended dosage and administration

See full details for abrocitinib

AzathioprineImuran Use as directed Both genes that affect this drug look normal, so a standard starting dose is expected.TPMTNormal metabolizerNUDT15Normal metabolizer

TPMTNormal metabolizerNUDT15Normal metabolizer

CPIC guideline, both genes together

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Both genes that affect this drug look normal, so a standard starting dose is expected.
What it means: Both TPMT and NUDT15 predict normal thiopurine metabolism and a normal risk of myelosuppression.
What the guideline suggests: Initiate therapy with standard starting dose (e.g., 2 mg/kg/day for autoimmune diseases). During therapy, adjust doses of azathioprine based on disease-specific guidelines. It usually takes at least 2 weeks to reach steady state after each dose adjustment.

From the combined TPMT and NUDT15 table in CPIC's thiopurine guideline.

CPIC reads your TPMT and NUDT15 results together for azathioprine, so this label reflects both genes.

See full details for azathioprine

SiponimodMayzent Use with caution Your body breaks down siponimod slower than normal, causing the drug to reach higher levels in your system. Your doctor will need to adjust your dose based on your specific genetic profile.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down siponimod slower than normal, causing the drug to reach higher levels in your system. Your doctor will need to adjust your dose based on your specific genetic profile.
What it means: Results in higher systemic concentrations. Adjust dosage based on genotype. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Adjust the dosage based on genotype as the FDA label directs.

See full details for siponimod

TacrolimusPrograf Use with caution Your body breaks down this drug faster than many people do, so the usual dose may fall short. A higher starting dose and blood tests are advised.CYP3A5Intermediate metabolizer

CYP3A5Intermediate metabolizer

CPIC guideline

Use with caution Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body breaks down this drug faster than many people do, so the usual dose may fall short. A higher starting dose and blood tests are advised.
What it means: Lower dose-adjusted trough concentrations of tacrolimus and decreased chance of achieving target tacrolimus concentrations
What the guideline suggests: Increase starting dose 1.5 to 2 times recommended starting dose. Total starting dose should not exceed 0.3mg/kg/day. Use therapeutic drug monitoring to guide dose adjustments

FDA drug label

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body processes tacrolimus at a moderate rate. Your dose may need to be adjusted based on blood level monitoring to make sure you get the right amount.
What it means: Results in lower systemic concentrations, lower probability of achieving target concentrations and may result in higher rejection risk. Measure drug concentrations and adjust dosage based on trough whole blood tacrolimus concentrations.
What the label suggests: Measure drug concentrations and adjust the dosage based on trough whole blood tacrolimus concentrations.

See full details for tacrolimus

Antivirals5 medications

Compare antivirals All drug classes

Antiretrovirals

AtazanavirReyataz, Evotaz, Others Use as directed Your body processes atazanavir a bit more slowly than normal, but you still have a low chance of developing jaundice (yellowing of skin or eyes). The standard dose is expected to be appropriate.UGT1A1Intermediate metabolizer

UGT1A1Intermediate metabolizer

CPIC guideline

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body processes atazanavir a bit more slowly than normal, but you still have a low chance of developing jaundice (yellowing of skin or eyes). The standard dose is expected to be appropriate.
What it means: Somewhat decreased UGT1A1 activity; low likelihood of bilirubin-related discontinuation of atazanavir.
What the guideline suggests: There is no need to avoid prescribing of atazanavir based on UGT1A1 genetic test result. Inform the patient that some patients stop atazanavir because of jaundice (yellow eyes and skin), but that this patient’s genotype makes this unlikely

Also inEvotaz

See full details for atazanavir

EfavirenzSustiva Use as directed Your body processes efavirenz normally. The standard dose is expected to be appropriate for you.CYP2B6Normal metabolizer

CYP2B6Normal metabolizer

CPIC guideline

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body processes efavirenz normally. The standard dose is expected to be appropriate for you.
What it means: Normal efavirenz metabolism
What the guideline suggests: Initiate efavirenz with standard dosing (600 mg/day)

FDA drug label

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body processes efavirenz at a normal rate. The standard dose should work as expected.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Also inAtripla and Symfi

See full details for efavirenz

Antivirals

Peginterferon Alfa-2APegasys Use as directed Your genes make this hepatitis C drug more likely to work. You may be able to take it for a shorter time.IFNL3Favorable response genotype

IFNL3Favorable response genotype

CPIC guideline

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your genes make this hepatitis C drug more likely to work. You may be able to take it for a shorter time.
What it means: Approximately 70% chance for sustained virologic response (SVR) after 48 weeks of treatment. Consider implications before initiating PEG-IFN alpha and RBV containing regimens.
What the guideline suggests: Approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients are eligible for shortened therapy (24-28 weeks vs. 48 weeks). Weighs in favor of using PEG-IFN alpha and RBV containing regimens.

See full details for peginterferon alfa-2a

Peginterferon Alfa-2BPegIntron Use as directed Your genes make this hepatitis C drug more likely to work. You may be able to take it for a shorter time.IFNL3Favorable response genotype

IFNL3Favorable response genotype

CPIC guideline

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your genes make this hepatitis C drug more likely to work. You may be able to take it for a shorter time.
What it means: Approximately 70% chance for sustained virologic response (SVR) after 48 weeks of treatment. Consider implications before initiating PEG-IFN alpha and RBV containing regimens.
What the guideline suggests: Approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients are eligible for shortened therapy (24-28 weeks vs. 48 weeks). Weighs in favor of using PEG-IFN alpha and RBV containing regimens.

See full details for peginterferon alfa-2b

RibavirinCopegus, Rebetol, Virazole Use as directed Your genes make this hepatitis C treatment more likely to work. You may be able to take it for a shorter time.IFNL3Favorable response genotype

IFNL3Favorable response genotype

CPIC guideline

Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your genes make this hepatitis C treatment more likely to work. You may be able to take it for a shorter time.
What it means: Approximately 70% chance for sustained virologic response (SVR) after 48 weeks of treatment. Consider implications before initiating PEG-IFN alpha and RBV containing regimens.
What the guideline suggests: Approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients are eligible for shortened therapy (24-28 weeks vs. 48 weeks). Weighs in favor of using PEG-IFN alpha and RBV containing regimens.

See full details for ribavirin

Antifungals1 medication

All drug classes

VoriconazoleVfend Use with caution Your body breaks down this drug more slowly, so levels can rise and side effects are more likely.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

CPIC guideline

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body breaks down this drug a bit more slowly, so levels may run a little higher. The usual dose is still advised.
What it means: Higher dose-adjusted trough concentrations of voriconazole compared to normal metabolizers.
What the guideline suggests: Initiate therapy with recommended standard of care dosing.

FDA drug label

Use with caution Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down this drug more slowly, so levels can rise and side effects are more likely.
What it means: Results in higher systemic concentrations and may result in higher adverse reaction risk.
What the label suggests: No specific dosing change in the FDA table. Refer to FDA labeling.

See full details for voriconazole

Anesthetics8 medications

Compare anesthetics All drug classes

Desflurane Unable to determine We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.RYR1No resultCACNA1SNo result

RYR1No resultCACNA1SNo result

CPIC guideline, both genes together

Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.
What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for desflurane, so this label reflects both genes.

See full details for desflurane

Enflurane Unable to determine We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.RYR1No resultCACNA1SNo result

RYR1No resultCACNA1SNo result

CPIC guideline, both genes together

Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.
What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for enflurane, so this label reflects both genes.

See full details for enflurane

Halothane Unable to determine We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.RYR1No resultCACNA1SNo result

RYR1No resultCACNA1SNo result

CPIC guideline, both genes together

Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.
What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for halothane, so this label reflects both genes.

See full details for halothane

Isoflurane Unable to determine We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.RYR1No resultCACNA1SNo result

RYR1No resultCACNA1SNo result

CPIC guideline, both genes together

Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.
What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for isoflurane, so this label reflects both genes.

See full details for isoflurane

Methoxyflurane Unable to determine We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.RYR1No resultCACNA1SNo result

RYR1No resultCACNA1SNo result

CPIC guideline, both genes together

Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.
What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for methoxyflurane, so this label reflects both genes.

See full details for methoxyflurane

MivacuriumMivacron Use as directed Your body breaks down this drug normally. Your doctor can use the usual dose.BCHENormal metabolizer

BCHENormal metabolizer

FDA drug label

Evidence: strongSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down this drug normally. Your doctor can use the usual dose.
What it means: Normal BCHE activity and expected metabolism of mivacurium.
What the label suggests: Initiate therapy with recommended starting dose and adjust per standard clinical practice.

See full details for mivacurium

Sevoflurane Unable to determine We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.RYR1No resultCACNA1SNo result

RYR1No resultCACNA1SNo result

CPIC guideline, both genes together

Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.
What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for sevoflurane, so this label reflects both genes.

See full details for sevoflurane

SuccinylcholineQuelicin, Anectine Unable to determine We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.RYR1No resultCACNA1SNo resultBCHENormal metabolizer

RYR1No resultCACNA1SNo result

CPIC guideline, both genes together

Unable to determine Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.
What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

BCHENormal metabolizer

FDA drug label

Use as directed Evidence: strongSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down this drug normally. Your doctor can use the usual dose.
What it means: Normal BCHE activity and expected metabolism of succinylcholine.
What the label suggests: Initiate therapy with recommended starting dose and adjust per standard clinical practice.

CPIC reads your RYR1 and CACNA1S results together for succinylcholine, so this label reflects both genes.

See full details for succinylcholine

Weight management3 medications

Compare weight management All drug classes

Retatrutide Use with caution Your GIPR gene raises your chance of nausea or vomiting on retatrutide: roughly 4.4% of people with your genotype vomit, compared with about 2.5% at the lowest risk. Semaglutide is not affected by this gene.GLP1RTypical responseGIPRDecreased function

GLP1RTypical responseGIPRDecreased function

Gene2Rx research summary, both genes together

Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your GIPR gene raises your chance of nausea or vomiting on retatrutide: roughly 4.4% of people with your genotype vomit, compared with about 2.5% at the lowest risk. Semaglutide is not affected by this gene.
What it means: GLP1R: the more common Pro7/Pro7 form of the signal peptide (rs10305420 C/C). GIPR: one copy of the Gln354 partial loss-of-function allele (rs1800437 G/C). No pharmacogenetic study of retatrutide exists; by extrapolation from the tirzepatide data this pair is expected to carry roughly 1.8-fold the odds of moderate-to-severe vomiting seen with the lowest-risk genotype pair. Expected weight-loss efficacy from the GLP1R arm of retatrutide. The GIPR component of this risk is specific to dual GIP/GLP-1 agonists and does not apply to semaglutide.
What the research suggests: Use standard dosing but consider a slower dose-escalation schedule, and counsel on the elevated chance of nausea and vomiting. If GI symptoms are intolerable, a GLP1R-only agonist such as semaglutide is unaffected by the GIPR variant and may be better tolerated.

Gene2Rx guideline extrapolated from the tirzepatide results in Su et al., Nature (2026). Retatrutide, an investigational GIP, GLP-1 and glucagon receptor agonist, has no genetic study of its own, so this assumes the GLP1R and GIPR variants act as they do with tirzepatide, which also acts on both receptors.

Gene2Rx reads your GLP1R and GIPR results together for retatrutide, so this label reflects both genes.

See full details for retatrutide

SemaglutideOzempic, Wegovy Use as directed Your genes point to a typical response to this drug, with average weight loss and side effects.GLP1RTypical response

GLP1RTypical response

Gene2Rx research summary

Evidence: moderateSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your genes point to a typical response to this drug, with average weight loss and side effects.
What it means: The Pro7/Pro7 form of the GLP1R signal peptide (rs10305420 C/C). The Leu7 (T) allele is the less common one in every ancestry group studied. Expected weight-loss efficacy and typical nausea/vomiting risk.
What the research suggests: Standard dosing and titration are expected to produce an average response.

See full details for semaglutide

TirzepatideMounjaro, Zepbound Use with caution Your GIPR gene raises your chance of nausea or vomiting on tirzepatide: roughly 4.4% of people with your genotype vomit, compared with about 2.5% at the lowest risk. Semaglutide is not affected by this gene.GLP1RTypical responseGIPRDecreased function

GLP1RTypical responseGIPRDecreased function

Gene2Rx research summary, both genes together

Evidence: moderateSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your GIPR gene raises your chance of nausea or vomiting on tirzepatide: roughly 4.4% of people with your genotype vomit, compared with about 2.5% at the lowest risk. Semaglutide is not affected by this gene.
What it means: GLP1R: the more common Pro7/Pro7 form of the signal peptide (rs10305420 C/C). GIPR: one copy of the Gln354 partial loss-of-function allele (rs1800437 G/C). Estimated risk of moderate-to-severe vomiting on tirzepatide is about 4.4% versus 2.5% for the lowest-risk genotype pair (odds ratio 1.8), and nausea about 17% versus 14%. Expected weight-loss efficacy from the GLP1R arm of tirzepatide. The GIPR component of this risk is specific to dual GIP/GLP-1 agonists and does not apply to semaglutide.
What the research suggests: Use standard dosing but consider a slower dose-escalation schedule, and counsel on the elevated chance of nausea and vomiting. If GI symptoms are intolerable, semaglutide is unaffected by the GIPR variant and may be better tolerated.

Gene2Rx guideline based on Su et al., Nature (2026), which linked GLP1R rs10305420 and GIPR rs1800437 to nausea and vomiting on tirzepatide. The GIPR effect was specific to tirzepatide and was not seen with semaglutide.

Gene2Rx reads your GLP1R and GIPR results together for tirzepatide, so this label reflects both genes.

See full details for tirzepatide

Antidiabetics1 medication

All drug classes

NateglinideStarlix Use as directed Your body breaks down nateglinide slightly slower than normal. The standard dose should work as expected.CYP2C9Intermediate metabolizer

CYP2C9Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down nateglinide slightly slower than normal. The standard dose should work as expected.
What it means: No FDA guidance for this phenotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for nateglinide

Antihistamines1 medication

All drug classes

MeclizineAntivert Use with caution Your body breaks down meclizine much more slowly than normal, which may cause the drug to build up to higher levels and increase the risk of side effects. Close monitoring is recommended.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down meclizine much more slowly than normal, which may cause the drug to build up to higher levels and increase the risk of side effects. Close monitoring is recommended.
What it means: May affect systemic concentrations. Monitor for adverse reactions and clinical effect.
What the label suggests: Monitor for adverse reactions and clinical effect.

See full details for meclizine

Drugs used in addictive disorders1 medication

All drug classes

LofexidineLucemyra Use with caution Your body breaks down lofexidine more slowly than normal, causing it to build up in your system. This increases the risk of side effects like low blood pressure and a slow heart rate.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down lofexidine more slowly than normal, causing it to build up in your system. This increases the risk of side effects like low blood pressure and a slow heart rate.
What it means: Results in higher systemic concentrations and higher adverse reaction risk. Monitor for orthostatic hypotension and bradycardia.
What the label suggests: Monitor for orthostatic hypotension and bradycardia.

See full details for lofexidine

Female sexual health1 medication

All drug classes

FlibanserinAddyi Use as directed Your CYP2C19 result means somewhat lower CYP2C19 activity than usual, but the FDA gives no genetic dosing change for flibanserin at this result.CYP2C19Intermediate metabolizer

CYP2C19Intermediate metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your CYP2C19 result means somewhat lower CYP2C19 activity than usual, but the FDA gives no genetic dosing change for flibanserin at this result.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

See full details for flibanserin

Gaucher's disease treatments1 medication

All drug classes

EliglustatCerdelga Use with caution Your body breaks down this drug much more slowly, which can raise the risk of heart rhythm problems. Your doctor will set your dose, and some other medicines can't be taken with it.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down this drug much more slowly, which can raise the risk of heart rhythm problems. Your doctor will set your dose, and some other medicines can't be taken with it.
What it means: Alters systemic concentrations, effectiveness, and adverse reaction risk (QT prolongation). Coadministration with strong CYP3A inhibitors is contraindicated in intermediate and poor CYP2D6 metabolizers. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Use the dosage the FDA label gives for CYP2D6 poor metabolizers. Coadministration with strong CYP3A inhibitors is contraindicated.

See full details for eliglustat

Gout1 medication

All drug classes

AllopurinolZyloprim Use as directed Your ABCG2 genotype does not change how you respond to allopurinol; standard dosing applies.ABCG2Normal function

ABCG2Normal function

DPWG guideline

Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

In plain words: Your ABCG2 genotype does not change how you respond to allopurinol; standard dosing applies.
What it means: Normal ABCG2 transporter function. Renal and intestinal uric acid excretion is not impaired by ABCG2 variation at p.Gln141Lys.
What the guideline suggests: Use standard allopurinol dosing.

Also inallopurinol / lesinurad

See full details for allopurinol

Hair loss1 medication

All drug classes

Topical minoxidilRogaine Use as directed Your SULT1A1 result suggests normal enzyme function. This enzyme helps activate topical minoxidil, but hair growth results can vary. Use topical minoxidil as directed and assess hair growth over time with your clinician.SULT1A1Normal function

SULT1A1Normal function

Gene2Rx research summary

Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your SULT1A1 result suggests normal enzyme function. This enzyme helps activate topical minoxidil, but hair growth results can vary. Use topical minoxidil as directed and assess hair growth over time with your clinician.
What it means: Your SULT1A1 result suggests normal enzyme function. This enzyme helps activate topical minoxidil, but hair growth results can vary.
What the research suggests: Use topical minoxidil as directed and assess hair growth over time with your clinician.

See full details for topical minoxidil

Saliva production stimulators1 medication

All drug classes

CevimelineEvoxac Use with caution Your body breaks down cevimeline much more slowly than normal, which may increase the risk of side effects. Careful monitoring by your doctor is recommended.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down cevimeline much more slowly than normal, which may increase the risk of side effects. Careful monitoring by your doctor is recommended.
What it means: May result in higher adverse reaction risk. Use with caution.
What the label suggests: Use with caution.

See full details for cevimeline

Urologicals1 medication

All drug classes

TolterodineDetrol Use with caution Your body breaks down tolterodine more slowly than normal, causing it to build up in your system. This increases the risk of side effects, including heart rhythm problems.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

FDA drug label

See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down tolterodine more slowly than normal, causing it to build up in your system. This increases the risk of side effects, including heart rhythm problems.
What it means: Results in higher systemic concentrations and higher adverse reaction risk (QT prolongation).
What the label suggests: No specific dosing change in the FDA table. Refer to FDA labeling.

See full details for tolterodine

Other substances7 medications

Compare other substances All drug classes

Alcohol Use as directed Your genes have little effect on how your body handles alcohol.ADH1BNormal functionALDH2Normal function

ADH1BNormal function

Gene2Rx research summary

Use as directed See the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your genes have little effect on how your body handles alcohol.
What it means: Two Arg48 alleles (rs1229984). Usual rate of ethanol oxidation. Compared with His48 carriers, associated with higher risk of alcohol dependence and, among heavy drinkers in East Asian studies, higher risk of esophageal and head and neck cancer. Only rs1229984 is assessed: ADH1B*3 (rs2066702), common in people of African ancestry, is not read, so its carriers are reported here.
What the research suggests: Follow standard guidelines for alcohol consumption.

ALDH2Normal function

Gene2Rx research summary

Use as directed See the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your genes have little effect on how you clear the toxic by-product of alcohol.
What it means: Two Glu504 alleles (rs671 G/G, ALDH2*1/*1). Normal acetaldehyde clearance; typical risk of flushing, hangover and alcohol dependence for this gene.
What the research suggests: Standard advice on drinking limits.

See full details for alcohol

CaffeineCoffee, Tea Use with caution Caffeine may wear off slightly sooner for you than average. The usual advice on caffeine limits applies.CYP1A2Rapid metabolizer

CYP1A2Rapid metabolizer

Gene2Rx research summary

Evidence: moderateSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Caffeine may wear off slightly sooner for you than average. The usual advice on caffeine limits applies.
What it means: One rs762551 A allele (*1/*30). Modestly higher CYP1A2 activity, mainly in smokers. Note: in the coffee and cardiovascular literature, A/C carriers are classed as 'slow' metabolizers.
What the research suggests: Caffeine may be cleared somewhat faster than average. Standard advice on moderate intake applies.

Also inExcedrin, Fioricet, Fiorinal and 5 more

See full details for caffeine

KetamineKetalar Use as directed Your body processes ketamine at the usual rate.CYP2B6Normal metabolizer

CYP2B6Normal metabolizer

Gene2Rx research summary

Evidence: strongSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your body processes ketamine at the usual rate.
What it means: Usual CYP2B6 activity and expected N-demethylation of ketamine to norketamine. CYP3A4 contributes to the same step, and the relative roles of the two enzymes are still debated.
What the research suggests: Initiate with standard ketamine doses per clinical practice and titrate to effect.

See full details for ketamine

LSDAcid Use with caution You clear this drug slowly, so its effects may be stronger and last longer. Starting with a lower dose may help avoid a bad experience.CYP2D6Poor metabolizer

CYP2D6Poor metabolizer

Gene2Rx research summary

Evidence: strongSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: You clear this drug slowly, so its effects may be stronger and last longer. Starting with a lower dose may help avoid a bad experience.
What it means: No functional CYP2D6. In the pooled analysis of 81 participants, poor metabolizers had longer LSD half-lives and about 75% higher area under the curve for LSD and for 2-oxo-3-hydroxy-LSD than carriers of functional CYP2D6, and reported greater alterations of mind and longer-lasting effects. In a separate analysis of 213 participants, acute anxiety was inversely correlated with genetically determined CYP2D6 function, although dose and pre-drug mood were much stronger predictors of the experience.
What the research suggests: Expect higher exposure and a longer duration of effect. In a research setting, consider a lower starting dose with gradual increases and a longer monitoring period.

See full details for LSD

MDMAEcstasy Use with caution You have little or no activity of the main enzyme that clears MDMA. Studies have not shown that this makes MDMA poisoning more likely, and no genotype makes MDMA safe.COMTIntermediate functionCYP2D6Poor metabolizer

COMTIntermediate function

Gene2Rx research summary

Use as directed Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: This is the middle result for this gene. It is not linked to a stronger or weaker reaction to MDMA.
What it means: One rs4680 G and one A allele (Val158/Met158). Intermediate COMT activity; no distinct cardiovascular or subjective pattern was reported for this genotype.
What the research suggests: No genotype-based adjustment. Watch for unexpected cognitive or cardiovascular effects.

CYP2D6Poor metabolizer

Gene2Rx research summary

Use with caution Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: You have little or no activity of the main enzyme that clears MDMA. Studies have not shown that this makes MDMA poisoning more likely, and no genotype makes MDMA safe.
What it means: No functional CYP2D6. MDMA clearance depends on CYP2D6 for no more than about 30% of its metabolism in people, and a single typical dose inactivates most CYP2D6 regardless of genotype, so the difference from other phenotypes is smaller than once assumed. No clear link between inherited CYP2D6 deficiency and acute MDMA toxicity has been demonstrated.
What the research suggests: Exposure may be higher than in normal metabolizers, but the size of the effect is not established. If exposure occurs, intensive monitoring of vital signs, temperature and fluid intake is advised.

See full details for MDMA

NicotineCigarettes, Zyn Use with caution This variant is linked to heavier smoking and finding it harder to quit. Stop-smoking medicines appear to help people with this result as much as or more than others.CHRNA5Increased riskCOMTIntermediate functionCYP2A6Normal metabolizer

CHRNA5Increased risk

Gene2Rx research summary

Use with caution Evidence: strongSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: This variant is linked to heavier smoking and finding it harder to quit. Stop-smoking medicines appear to help people with this result as much as or more than others.
What it means: One or two rs16969968 A alleles (Asn398). The Asn398 receptor shows reduced response to nicotinic agonists in vitro. Associated with more cigarettes per day, higher risk of nicotine dependence, later smoking cessation and earlier lung cancer diagnosis in smokers. In a cessation trial, carriers of the high-risk haplotype benefited more from cessation pharmacotherapy than non-carriers.
What the research suggests: Higher risk of heavy, persistent use. For patients who want to quit, offer cessation pharmacotherapy with counseling rather than an unassisted attempt.

COMTIntermediate function

Gene2Rx research summary

Use with caution Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: This result has been studied in relation to smoking, but the findings are mixed, so it tells you little about how you respond to nicotine.
What it means: rs4680 Val/Met. Moderately lower COMT activity. Associations with nicotine reward, withdrawal and smoking behavior are inconsistent across studies.
What the research suggests: No genotype-based change to cessation treatment; monitor craving as usual.

CYP2A6Normal metabolizer

Gene2Rx research summary

Use as directed Evidence: strongSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your body is expected to clear nicotine at a typical rate.
What it means: No reduced-function allele detected among those assessed. Typical nicotine clearance. The CYP2A6*4 deletion, *12 hybrid and duplications are not assessed, so reduced activity cannot be ruled out.
What the research suggests: Typical response to nicotine. In smokers with normal nicotine metabolism, varenicline was more effective than the nicotine patch in a randomized trial.

See full details for nicotine

THCCannabis, Marijuana Use with caution You may be more likely to feel anxious or paranoid on THC. Starting with a lower dose can help.AKT1Decreased functionCOMTIntermediate functionCYP2C9Intermediate metabolizerFAAHNormal function

AKT1Decreased function

Gene2Rx research summary

Use with caution Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: You may be more likely to feel anxious or paranoid on THC. Starting with a lower dose can help.
What it means: One rs2494732 C allele. In a case-control study of first-episode psychosis the variant was not associated with psychosis, cannabis use or frequency of use on its own, but modified the association between cannabis use and psychotic disorder, and acute psychotomimetic symptoms rose with C-allele count in cannabis users. A later study of 720 people found no such association.
What the research suggests: Some research suggests that carriers of this variant may have a moderately higher risk of psychotic-like effects from THC. However these findings are not conclusive. Consider starting at a lower dose and monitoring for psychotic-like effects or avoiding THC altogether.

COMTIntermediate function

Gene2Rx research summary

Use as directed Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your genes point to a typical response to THC, with an average chance of side effects.
What it means: One rs4680 G and one A allele (Val158/Met158). Intermediate COMT activity and average dopamine clearance.
What the research suggests: No COMT-based adjustment. A typical response to THC is expected.

CYP2C9Intermediate metabolizer (activity score 1.5)

Gene2Rx research summary

Use as directed Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your body may break down THC slightly more slowly than average, so effects could feel a little stronger or last a little longer.
What it means: Activity score 1.5 (one decreased-function allele, usually *2). Slightly reduced hydroxylation of THC. In the only published pharmacokinetic study of oral THC by CYP2C9 genotype, *2 status alone did not change THC exposure, so any increase at this activity score is expected to be small.
What the research suggests: Initiate at standard doses. Monitor for increased sedation or psychotropic intensity.

FAAHNormal function

Gene2Rx research summary

Use as directed Evidence: moderateSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: This gene works normally, so THC should affect you in the usual way.
What it means: Two rs324420 C alleles (Pro129). Usual hydrolysis of anandamide and related endocannabinoids, so baseline cannabinoid receptor tone is typical. FAAH does not metabolize THC.
What the research suggests: No FAAH-based adjustment. Response to THC is expected to match population norms.

See full details for THC

Your genes

30 genes from the 23andMe file. Results that differ from the most common one come first, then typical results, then genes we couldn't check.

Two dots per gene, one for each copy you inherited:

works normally
works less well
doesn't work
works faster than usual
couldn't be checked

Color shows the overall gene result. Dot fill shows each copy’s function; lettered dots show your DNA letters where copy function isn’t defined.

Normal / typical / favorable
Intermediate / decreased
Poor / increased risk
Rapid / increased
Not determined

Not typical

14 genesYour result differs from the most common one. Not every difference changes the guidance for your medications.

CYP2D6
Turns on or clears about 1 in 4 prescription drugs. These include many drugs for depression, pain and ADHD.
Poor metabolizer*4/*4 · Neither copy works.
0.0 activity scoreTypical: 1.25 to 2.25
47 medicationsChanges the guidance for 45

CYP2D6 poor metabolizer: estimated in 0.3% to 6.5% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean
2.3%
American
2.0%
Central/South Asian
2.4%
East Asian
0.8%
European
6.5%
Latino
3.1%
Near Eastern
2.2%
Oceanian
0.3%
Sub-Saharan African
2.0%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC CYP2D6 frequency table and methods. Data retrieved 2026-10-17.
CYP2C19
Handles several SSRIs, acid reducers such as omeprazole, and the blood thinner clopidogrel.
Intermediate metabolizer*1/*2 · One copy works and one doesn't.
21 medicationsChanges the guidance for 17

CYP2C19 intermediate metabolizer: estimated in 19.0% to 45.9% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean
31.4%
American
21.4%
Central/South Asian
40.8%
East Asian
45.9%
European
26.1%
Latino
19.0%
Near Eastern
23.5%
Oceanian
36.9%
Sub-Saharan African
29.9%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC CYP2C19 frequency table and methods. Data retrieved 2026-10-17.
CYP2C9
Clears warfarin, phenytoin, celecoxib and some other pain relievers.
Intermediate metabolizer*1/*2 · One copy works and one works less well.
1.5 activity scoreTypical: 2
16 medicationsChanges the guidance for 8

CYP2C9 intermediate metabolizer: estimated in 8.7% to 36.2% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean
23.6%
American
16.4%
Central/South Asian
36.2%
East Asian
15.2%
European
34.5%
Latino
24.6%
Near Eastern
35.9%
Oceanian
8.7%
Sub-Saharan African
26.3%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC CYP2C9 frequency table and methods. Data retrieved 2026-10-17.
SLCO1B1
Moves statins into the liver.
Decreased function*15/*1A · One copy works and one works less well.
7 medicationsChanges the guidance for 6

SLCO1B1 decreased function: estimated in 0% to 36.5% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean
2.0%
American
36.5%
Central/South Asian
13.0%
East Asian
21.8%
European
28.3%
Near Eastern
32.0%
Oceanian
0%
Sub-Saharan African
5.4%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC SLCO1B1 frequency table and methods. Data retrieved 2026-10-17.
GIPR
A gut-hormone receptor that tirzepatide and retatrutide act on.
Decreased functionrs1800437C/rs1800437G · One copy works and one works less well.
2 medicationsChanges the guidance for 2

GIPR rs1800437 C allele: 11.5% to 29.5% of DNA copies across ancestry groups

Your result has 1 copy of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the C allele / total DNA copies measured.

African / African American
11.5%4,770 / 41,492
Admixed American
13.2%2,018 / 15,286
Amish
11.6%106 / 910
Ashkenazi Jewish
29.5%1,022 / 3,470
East Asian
19.9%1,021 / 5,142
Finnish
22.8%2,405 / 10,570
Middle Eastern
16.0%47 / 294
European (non-Finnish)
20.6%14,004 / 67,974
South Asian
15.1%726 / 4,818
Remaining ancestry group
19.8%417 / 2,110

Reference: gnomAD v4.1 genomes, GRCh38 19-45678134-G-C. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.
AKT1
A signaling gene linked to the risk of psychosis with heavy cannabis use.
CTDecreased functionrs2494732C/rs2494732T
1 medicationChanges the guidance for 1

AKT1 rs2494732 C allele: 33.2% to 72.2% of DNA copies across ancestry groups

Your result has 1 copy of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the C allele / total DNA copies measured.

African / African American
49.2%20,373 / 41,440
Admixed American
55.2%8,437 / 15,284
Amish
33.2%303 / 912
Ashkenazi Jewish
42.2%1,464 / 3,466
East Asian
72.2%3,713 / 5,144
Finnish
43.7%4,616 / 10,572
Middle Eastern
44.2%130 / 294
European (non-Finnish)
43.3%29,377 / 67,904
South Asian
59.8%2,887 / 4,824
Remaining ancestry group
47.3%998 / 2,110

Reference: gnomAD v4.1 genomes, GRCh38 14-104772855-T-C. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.
CHRNA5
A nicotine receptor in the brain linked to heavy smoking.
AAIncreased riskrs16969968A/rs16969968A
1 medicationChanges the guidance for 1

CHRNA5 rs16969968 A allele: 3.2% to 40.7% of DNA copies across ancestry groups

Your result has 2 copies of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the A allele / total DNA copies measured.

African / African American
5.9%2,458 / 41,526
Admixed American
22.6%3,458 / 15,290
Amish
40.7%368 / 904
Ashkenazi Jewish
37.5%1,302 / 3,470
East Asian
3.2%166 / 5,186
Finnish
32.7%3,455 / 10,568
Middle Eastern
40.1%118 / 294
European (non-Finnish)
34.7%23,587 / 67,982
South Asian
22.2%1,069 / 4,826
Remaining ancestry group
27.5%581 / 2,112

Reference: gnomAD v4.1 genomes, GRCh38 15-78590583-G-A. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.
COMT
Breaks down dopamine and other brain chemicals.
Intermediate functionrs4680A/rs4680G · One copy works and one works less well.
3 medicationsChanges the guidance for 1

COMT rs4680 A allele: 27.4% to 66.4% of DNA copies across ancestry groups

Your result has 1 copy of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the A allele / total DNA copies measured.

African / African American
31.0%12,853 / 41,484
Admixed American
40.4%6,184 / 15,292
Amish
66.4%604 / 910
Ashkenazi Jewish
45.3%1,571 / 3,466
East Asian
27.4%1,414 / 5,152
Finnish
55.3%5,854 / 10,592
Middle Eastern
46.9%138 / 294
European (non-Finnish)
51.8%35,191 / 67,942
South Asian
44.5%2,147 / 4,822
Remaining ancestry group
41.8%883 / 2,110

Reference: gnomAD v4.1 genomes, GRCh38 22-19963748-G-A. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.
CYP1A2
Breaks down caffeine and some medicines, such as clozapine.
Rapid metabolizer*1/*30 · One copy works normally and one works faster than usual.
1 medicationChanges the guidance for 1
CYP3A5
Breaks down tacrolimus, a drug used after organ transplants.
Intermediate metabolizer*1/*3 · One copy works and one doesn't.
1 medicationChanges the guidance for 1

CYP3A5 intermediate metabolizer: estimated in 13.7% to 49.9% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean
49.6%
Central/South Asian
44.0%
East Asian
37.9%
European
13.7%
Latino
28.6%
Near Eastern
21.4%
Sub-Saharan African
49.9%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC CYP3A5 frequency table and methods. Data retrieved 2026-10-17.
CYP4F2
Clears extra vitamin K from the body, which changes how much warfarin you need.
Intermediate metabolizer*1/*3 · One copy works and one works less well.
1 medicationChanges the guidance for 1
NAT2
Breaks down hydralazine, isoniazid and some other drugs.
Poor metabolizer*16/*5 · Both copies work less well.
1 medicationChanges the guidance for 1
VKORC1
Recycles vitamin K and is the protein warfarin blocks.
AGDecreased expression-1639A/-1639G
1 medicationChanges the guidance for 1

VKORC1 rs9923231 -1639A allele: 10.0% to 89.2% of DNA copies across ancestry groups

Your result has 1 copy of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the -1639A allele / total DNA copies measured.

African / African American
10.0%4,141 / 41,504
Admixed American
39.1%5,974 / 15,262
Amish
44.2%400 / 906
Ashkenazi Jewish
49.9%1,734 / 3,472
East Asian
89.2%4,612 / 5,172
Finnish
39.1%4,127 / 10,558
Middle Eastern
53.4%156 / 292
European (non-Finnish)
37.8%25,693 / 67,986
South Asian
17.8%859 / 4,824
Remaining ancestry group
38.9%824 / 2,116

Reference: gnomAD v4.1 genomes, GRCh38 16-31096368-C-T. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.
UGT1A1
Clears bilirubin and some drugs, such as the cancer drug irinotecan.
Intermediate metabolizer*1/*28+*60+*80 · One copy works and one works less well.
6 medicationsGuidance unchanged

Typical

14 genesThe most common result. The medications that depend only on these genes should work as expected.

ABCG2
A pump that clears uric acid and some drugs, such as rosuvastatin, from the body.
Normal functionrs2231142G/rs2231142G · Both copies work normally.
2 medicationsGuidance unchanged

ABCG2 normal function: estimated in 48.0% to 98.8% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean
93.1%
American
64.0%
Central/South Asian
82.2%
East Asian
48.0%
European
80.4%
Latino
60.2%
Near Eastern
87.4%
Oceanian
63.2%
Sub-Saharan African
98.8%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC ABCG2 frequency table and methods. Data retrieved 2026-10-17.
ADH1B
Turns alcohol into acetaldehyde, a toxic by-product.
Normal functionrs1229984C/rs1229984C · Both copies work normally.
1 medicationGuidance unchanged

ADH1B rs1229984 C allele: 29.6% to 99.7% of DNA copies across ancestry groups

Your result has 2 copies of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the C allele / total DNA copies measured.

African / African American
98.8%41,031 / 41,534
Admixed American
93.2%14,240 / 15,282
Amish
89.9%820 / 912
Ashkenazi Jewish
73.1%2,539 / 3,472
East Asian
29.6%1,530 / 5,168
Finnish
99.7%10,586 / 10,618
Middle Eastern
78.6%231 / 294
European (non-Finnish)
96.4%65,617 / 68,036
South Asian
95.9%4,626 / 4,822
Remaining ancestry group
88.4%1,861 / 2,106

Reference: gnomAD v4.1 genomes, GRCh38 4-99318162-T-C. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.
ALDH2
Clears acetaldehyde, the toxic by-product of alcohol.
Normal functionrs671G/rs671G · Both copies work normally.
1 medicationGuidance unchanged

ALDH2 rs671 A allele: 0% to 22.5% of DNA copies across ancestry groups

Your result has 0 copies of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the A allele / total DNA copies measured.

African / African American
<0.1%8 / 41,546
Admixed American
<0.1%14 / 15,274
Amish
0%0 / 912
Ashkenazi Jewish
0%0 / 3,470
East Asian
22.5%1,154 / 5,132
Finnish
<0.1%1 / 10,598
Middle Eastern
0%0 / 294
European (non-Finnish)
<0.1%2 / 68,020
South Asian
<0.1%4 / 4,820
Remaining ancestry group
0.5%10 / 2,108

Reference: gnomAD v4.1 genomes, GRCh38 12-111803962-G-A. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.
BCHE
Breaks down two muscle relaxers used in surgery. These are succinylcholine and mivacurium.
Normal metabolizerReference/Reference · Both copies work normally.
2 medicationsGuidance unchanged
CYP2A6
Breaks down nicotine.
Normal metabolizer*1/*1 · Both copies work normally.
1 medicationGuidance unchanged
CYP2B6
Breaks down efavirenz, ketamine, methadone and some drugs for depression.
Normal metabolizer*1/*1 · Both copies work normally.
3 medicationsGuidance unchanged

CYP2B6 normal metabolizer: estimated in 13.0% to 48.6% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean
33.4%
Central/South Asian
42.2%
East Asian
48.6%
European
43.0%
Latino
33.6%
Near Eastern
29.1%
Oceanian
13.0%
Sub-Saharan African
14.3%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC CYP2B6 frequency table and methods. Data retrieved 2026-10-17.
CYP3A4
Breaks down more prescription drugs than any other enzyme.
Normal metabolizer*1/*1 · Both copies work normally.
1 medicationGuidance unchanged
DPYD
Breaks down the cancer drugs fluorouracil and capecitabine.
Normal metabolizerReference/Reference · Both copies work normally.
2.0 activity scoreTypical: 2
2 medicationsGuidance unchanged
FAAH
Breaks down chemicals your body makes that act like cannabis.
Normal functionrs324420C/rs324420C · Both copies work normally.
1 medicationGuidance unchanged

FAAH rs324420 A allele: 14.5% to 35.9% of DNA copies across ancestry groups

Your result has 0 copies of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the A allele / total DNA copies measured.

African / African American
35.9%14,873 / 41,480
Admixed American
30.4%4,643 / 15,292
Amish
14.5%132 / 910
Ashkenazi Jewish
14.7%509 / 3,470
East Asian
17.6%910 / 5,176
Finnish
27.8%2,946 / 10,584
Middle Eastern
15.1%44 / 292
European (non-Finnish)
20.7%14,044 / 67,986
South Asian
19.6%946 / 4,826
Remaining ancestry group
23.9%506 / 2,116

Reference: gnomAD v4.1 genomes, GRCh38 1-46405089-C-A. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.
GLP1R
The receptor that semaglutide and other GLP-1 drugs act on.
CCTypical responsers10305420C/rs10305420C
3 medicationsGuidance unchanged

GLP1R rs10305420 T allele: 7.7% to 39.8% of DNA copies across ancestry groups

Your result has 0 copies of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the T allele / total DNA copies measured.

African / African American
7.7%3,208 / 41,572
Admixed American
29.9%4,573 / 15,294
Amish
26.2%239 / 912
Ashkenazi Jewish
36.9%1,279 / 3,470
East Asian
14.4%740 / 5,154
Finnish
39.8%4,217 / 10,590
Middle Eastern
36.3%106 / 292
European (non-Finnish)
38.2%25,971 / 67,946
South Asian
19.2%926 / 4,830
Remaining ancestry group
28.4%601 / 2,114

Reference: gnomAD v4.1 genomes, GRCh38 6-39048860-C-T. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.
IFNL3
An immune gene that affects how well hepatitis C treatment works.
CCFavorable response genotypers12979860C/rs12979860C
3 medicationsGuidance unchanged

IFNL3 rs12979860 T allele: 7.1% to 60.3% of DNA copies across ancestry groups

Your result has 0 copies of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the T allele / total DNA copies measured.

African / African American
60.3%25,033 / 41,510
Admixed American
37.4%5,725 / 15,292
Amish
36.9%332 / 900
Ashkenazi Jewish
39.4%1,369 / 3,472
East Asian
7.1%369 / 5,176
Finnish
24.1%2,553 / 10,600
Middle Eastern
38.1%112 / 294
European (non-Finnish)
31.5%21,409 / 67,956
South Asian
22.7%1,094 / 4,828
Remaining ancestry group
36.3%767 / 2,114

Reference: gnomAD v4.1 genomes, GRCh38 19-39248147-C-T. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.
NUDT15
Breaks down the active form of thiopurines such as azathioprine.
Normal metabolizer*1/*1 · Both copies work normally.
3 medicationsGuidance unchanged

NUDT15 normal metabolizer: estimated in 79.2% to 98.6% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

Central/South Asian
86.6%
East Asian
79.2%
European
98.6%
Latino
87.7%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC NUDT15 frequency table and methods. Data retrieved 2026-10-17.
SULT1A1
Turns topical minoxidil into its active form in the scalp.
Normal function*1/*1 · Both copies work normally.
1 medicationGuidance unchanged
TPMT
Breaks down thiopurines such as azathioprine and mercaptopurine.
Normal metabolizer*1/*1 · Both copies work normally.
3 medicationsGuidance unchanged

TPMT normal metabolizer: estimated in 86.5% to 96.3% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean
86.5%
Central/South Asian
96.3%
East Asian
96.0%
European
90.9%
Latino
89.2%
Near Eastern
93.2%
Sub-Saharan African
89.3%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC TPMT frequency table and methods. Data retrieved 2026-10-17.

Couldn't be checked

2 genesYour data can't show these genes reliably. A missing result is not a normal one.

CACNA1S
A muscle channel. Rare changes in it can cause a dangerous reaction to some anesthetics.
Not checkedWe couldn't check this gene from your data. This does not mean that a normal response is expected.
7 medicationsShown as "Unable to determine"
RYR1
A muscle channel. Rare changes in it can cause a dangerous reaction to some anesthetics.
Not checkedWe couldn't check this gene from your data. This does not mean that a normal response is expected.
7 medicationsShown as "Unable to determine"

About this report

What it covers, where the guidance comes from, and what the data can and can't show.

What's in it

120 medications, 26 groups, 30 genes

Full Report, version 4.5. Made Oct 27, 2026 from a 23andMe file.

This report includes information about how your pharmacogenetics may influence your response to the medications assessed in this report. Coverage depends on your data and report tier. A medication missing from this report may still have guidance from a clinical guideline or product label.

What's new in version 4.5 Download the PDF Open the original layout

What the data can show

28 of 30 genes read from the 23andMe data, with missing positions filled in from a reference panel.
113 medications have a result.
CACNA1S and RYR1 couldn't be read from the data, so 7 medications show "Unable to determine."
CYP2D6 copy number isn't measured. Extra or missing copies can change CYP2D6 results.
Rare variants can be missed. Arrays test selected positions; imputation helps fill the gaps but can still miss rare variants.

Where the guidance comes from

Every medication names its source, and some have more than one. Gene2Rx is not affiliated with or endorsed by CPIC, the FDA or DPWG.

CPICClinical Pharmacogenetics Implementation Consortium. Peer-reviewed prescribing guidelines.64 medications
DPWGDutch Pharmacogenetics Working Group. Prescribing guidelines used across Europe.9 medications
FDAU.S. Food and Drug Administration. Pharmacogenetic information in drug labels.61 medications
Gene2RxGene2Rx research summaries. Published studies we summarize where no guideline exists yet.11 medications

How we read your DNA

Step 1
We fill in positions your array didn't test by comparing your data with a large reference panel.
Step 2
We name the two copies of each gene you inherited, such as *1/*2.
Step 3
We look up what that pair means in published tables, then match it to each medication's guidance.

Questions

What do I do now?

If you may have an unusual response to a medication you take or are thinking about taking, talk with your healthcare provider or a genetic counselor before making any changes. The sources linked beside each finding explain its evidence and limits. Not every finding supports a treatment change.

Should I change medications or my dose based on this report?

No. Don't change a dose or stop a medication without talking to your healthcare provider first. Consumer DNA data is not clinical grade, so use this report to start a conversation with your provider, who may order a clinical lab test. Read more about consumer tests and the research behind this advice.

Are these expert annotations?

Each finding names its source. This report includes CPIC, FDA, DPWG and Gene2Rx interpretations, with different levels of evidence. Those organizations don't endorse Gene2Rx's own interpretations, which explain the research behind a finding and its limits.

Why would my results change?

Your genes don't change, but research does. Guidelines and drug labels are updated when new research meets strict standards and experts agree. Your report keeps the guidance used when it was made; an updated report can use newer guidance.

I don't see my medication. Why not?

Not every medication is affected by genetics, and some need more research before guidance exists. A medication can also be missing because of your report tier, your data or what this report covers. A missing medication may still have guidance from a clinical guideline or a drug label.

Does Gene2Rx check CYP2D6 copy number?

No. Gene2Rx doesn't measure CYP2D6 copy number (deletions and duplications of the gene), which can change how you respond to drugs CYP2D6 handles.

More questions? Email contact@gene2rx.com.

This is not a clinical test. Results are predictions from consumer DNA data and published research. They may be wrong. Don't change or stop a medication without talking to your prescriber, and confirm any result that matters with a clinical-grade test.

gene2rx.com · Pharmacogenetics

Example report · Complete report for your doctor or pharmacist

Full Report

Prepared for Leslie Knope

Report version: 4.5
Created: Oct 27, 2026
Data source: 23andMe
Genome build: GRCh37

120 medications · 30 genes · 26 drug classes

This complete edition includes every gene result and every medication in this report tier, including results labeled “Use as directed,” all source guidance, evidence levels and limitations.

This is not a clinical test. Results are predictions from consumer DNA data and published research. The quality of submitted data is not independently verified and errors can affect the report. Do not change a dose or stop a medication without talking to your prescriber. Confirm any result that matters with a clinical-grade test.

Coverage depends on your data and report tier. A medication missing from this report may still have guidance from a clinical guideline or product label.

Reading the guidance

Consider alternative 14

Use with caution 63

Use as directed 36

Unable to determine 7

Use as directed: no change suggested by the assessed genetic findings. Use with caution: a dose change, slower titration or monitoring may be suggested. Consider alternative: discuss another medication or the source’s dose advice. Unable to determine: the available data could not establish a result. These labels do not guarantee effectiveness or freedom from side effects.

Report contents

Gene results at a glance · Complete medication guidance · Gene details and frequencies · About this report

Antidepressants14 medications

Antipsychotics12 medications

Psychostimulants2 medications

Movement disorders3 medications

Anticonvulsants4 medications

Pain management13 medications

Cardiovascular7 medications

Cholesterol medications7 medications

Antiemetics4 medications

Proton pump inhibitors4 medications

Oncology13 medications

Immunosuppressants4 medications

Antivirals5 medications

Antifungals1 medication

Anesthetics8 medications

Weight management3 medications

Antidiabetics1 medication

Antihistamines1 medication

Drugs used in addictive disorders1 medication

Female sexual health1 medication

Gaucher's disease treatments1 medication

Gout1 medication

Hair loss1 medication

Saliva production stimulators1 medication

Urologicals1 medication

Other substances7 medications

Your genes at a glance

All 30 results. Evidence and actionability differ by gene and medication. An activity score adds the activity values of your gene copies; higher scores indicate more enzyme activity. The detailed gene section explains each result.

Gene	Your two copies	Genotype	Phenotype	Activity score
ABCG2		rs2231142G/rs2231142G	Normal Function	-
ADH1B		rs1229984C/rs1229984C	Normal Function	-
AKT1	CT	rs2494732C/rs2494732T	Decreased Function	-
ALDH2		rs671G/rs671G	Normal Function	-
BCHE		Reference/Reference	Normal Metabolizer	-
CACNA1S		Not determined	Not checked	-
CHRNA5	AA	rs16969968A/rs16969968A	Increased Risk	-
COMT		rs4680A/rs4680G	Intermediate Function	-
CYP1A2		1/30	Rapid Metabolizer	-
CYP2A6		1/1	Normal Metabolizer	-
CYP2B6		1/1	Normal Metabolizer	-
CYP2C19		1/2	Intermediate Metabolizer	-
CYP2C9		1/2	Intermediate Metabolizer	1.5
CYP2D6		4/4	Poor Metabolizer	0.0
CYP3A4		1/1	Normal Metabolizer	-
CYP3A5		1/3	Intermediate Metabolizer	-
CYP4F2		1/3	Intermediate Metabolizer	-
DPYD		Reference/Reference	Normal Metabolizer	2.0
FAAH		rs324420C/rs324420C	Normal Function	-
GIPR		rs1800437C/rs1800437G	Decreased Function	-
GLP1R	CC	rs10305420C/rs10305420C	Typical Response	-
IFNL3	CC	rs12979860C/rs12979860C	Favorable Response Genotype	-
NAT2		16/5	Poor Metabolizer	-
NUDT15		1/1	Normal Metabolizer	-
RYR1		Not determined	Not checked	-
SLCO1B1		15/1A	Decreased Function	-
SULT1A1		1/1	Normal Function	-
TPMT		1/1	Normal Metabolizer	-
UGT1A1		1/28+60+80	Intermediate Metabolizer	-
VKORC1	AG	-1639A/-1639G	Decreased Expression	-

Color shows the overall gene result. Dot fill shows each copy’s function; lettered dots show your DNA letters where copy function isn’t defined.

Normal / typical / favorable
Intermediate / decreased
Poor / increased risk
Rapid / increased
Not determined

Filled dots: works normally. Half-filled: works less well. Empty: does not work. Ringed: more active than usual. Dotted gray: not determined. Letters show DNA bases without assigning copy function. A non-normal allele does not necessarily change medication guidance.

Complete medication guidance

All 120 medications, grouped by drug class. Each source’s wording and evidence level are retained; sources may offer different recommendations.

Antidepressants 14 medications

8 Consider alternative6 Use with caution

SNRIs

Venlafaxine Consider alternative Effexor XR Your body breaks down this drug much more slowly, which has been linked to more side effects. A different antidepressant may be a better choice. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer CPIC guideline, CYP2D6 Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Decreased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine and greatly decreased O-desmethylvenlafaxine:venlafaxine ratio compared with normal and intermediate metabolizers. Although the clinical impact is unclear, poor metabolizer status has been associated with adverse effects. What the guideline suggests Consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) In plain words Your body breaks down venlafaxine much more slowly than normal, causing the drug to build up in your system. A lower dose may be needed to avoid side effects. What it means Alters systemic parent drug and metabolite concentrations. Consider dosage reductions. What the label suggests Consider dosage reductions.

Venlafaxine

Consider alternative

Effexor XR

Your body breaks down this drug much more slowly, which has been linked to more side effects. A different antidepressant may be a better choice.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Decreased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine and greatly decreased O-desmethylvenlafaxine:venlafaxine ratio compared with normal and intermediate metabolizers. Although the clinical impact is unclear, poor metabolizer status has been associated with adverse effects.
What the guideline suggests: Consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down venlafaxine much more slowly than normal, causing the drug to build up in your system. A lower dose may be needed to avoid side effects.
What it means: Alters systemic parent drug and metabolite concentrations. Consider dosage reductions.
What the label suggests: Consider dosage reductions.

SSRIs

Citalopram Use with caution Celexa Your body may break down the drug more slowly, increasing side effects. Your doctor may use a lower dose or adjust it more slowly. CYP2C19 Intermediate metabolizer
CYP2C19: Intermediate metabolizer CPIC guideline, CYP2C19 Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Reduced metabolism when compared with CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects. What the guideline suggests Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.
CYP2C19: Intermediate metabolizer FDA drug label, CYP2C19 Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab) In plain words Your body breaks down citalopram slightly slower than normal. The standard dose should work as expected. What it means No FDA guidance for your genotype What the label suggests Initiate therapy with recommended starting dose.

Citalopram

Use with caution

Celexa

Your body may break down the drug more slowly, increasing side effects. Your doctor may use a lower dose or adjust it more slowly.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

CPIC guideline, CYP2C19

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Reduced metabolism when compared with CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
What the guideline suggests: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down citalopram slightly slower than normal. The standard dose should work as expected.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Escitalopram Use with caution Lexapro Your body may break down the drug more slowly, increasing side effects. Your doctor may use a lower dose or adjust it more slowly. CYP2C19 Intermediate metabolizer
CYP2C19: Intermediate metabolizer CPIC guideline, CYP2C19 Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Reduced metabolism when compared with CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects. What the guideline suggests Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.

Escitalopram

Use with caution

Lexapro

Your body may break down the drug more slowly, increasing side effects. Your doctor may use a lower dose or adjust it more slowly.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

CPIC guideline, CYP2C19

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Reduced metabolism when compared with CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
What the guideline suggests: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.

Fluvoxamine Use with caution Luvox Your body breaks down this drug much more slowly. A lower starting dose, a slower increase, or a different drug may be safer. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer CPIC guideline, CYP2D6 Use with caution Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Greatly reduced metabolism of fluvoxamine to less active compounds compared with normal metabolizers. Higher plasma concentrations may increase the probability of side effects. What the guideline suggests Consider a 25 to 50% lower starting dose and slower titration schedule as compared with normal metabolizers or consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.

Fluvoxamine

Use with caution

Luvox

Your body breaks down this drug much more slowly. A lower starting dose, a slower increase, or a different drug may be safer.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Use with caution Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Greatly reduced metabolism of fluvoxamine to less active compounds compared with normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
What the guideline suggests: Consider a 25 to 50% lower starting dose and slower titration schedule as compared with normal metabolizers or consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.

Paroxetine Use with caution Paxil, Seroxat Your body processes this drug very slowly, so you may need half the usual dose to avoid side effects. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer CPIC guideline, CYP2D6 Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Greatly reduced metabolism compared with CYP2D6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects. What the guideline suggests Consider a 50% reduction in recommended starting dose, slower titration schedule, and a 50% lower maintenance dose as compared with normal metabolizers.

Paroxetine

Use with caution

Paxil, Seroxat

Your body processes this drug very slowly, so you may need half the usual dose to avoid side effects.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Greatly reduced metabolism compared with CYP2D6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
What the guideline suggests: Consider a 50% reduction in recommended starting dose, slower titration schedule, and a 50% lower maintenance dose as compared with normal metabolizers.

Sertraline Use with caution Zoloft Your body processes this drug a bit more slowly. You can start at the usual dose, but your doctor may raise it slowly, and a lower ongoing dose may be enough. CYP2C19 Intermediate metabolizerCYP2B6 Normal metabolizer
CYP2C19: Intermediate metabolizer; CYP2B6: Normal metabolizer CPIC guideline, both genes together Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means CYP2C19: Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. CYP2B6: Normal metabolism of sertraline to less active compounds. What the guideline suggests Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. From the combined CYP2C19 and CYP2B6 table in CPIC's guideline for serotonin reuptake inhibitor antidepressants.
CPIC reads your CYP2C19 and CYP2B6 results together for sertraline, so this label reflects both genes.

Sertraline

Use with caution

Zoloft

Your body processes this drug a bit more slowly. You can start at the usual dose, but your doctor may raise it slowly, and a lower ongoing dose may be enough.

CYP2C19 Intermediate metabolizerCYP2B6 Normal metabolizer

CYP2C19: Intermediate metabolizer; CYP2B6: Normal metabolizer

CPIC guideline, both genes together

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: CYP2C19: Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. CYP2B6: Normal metabolism of sertraline to less active compounds.
What the guideline suggests: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose.

From the combined CYP2C19 and CYP2B6 table in CPIC's guideline for serotonin reuptake inhibitor antidepressants.

CPIC reads your CYP2C19 and CYP2B6 results together for sertraline, so this label reflects both genes.

Vortioxetine Use with caution Trintellix, Brintellix Your body clears this drug much more slowly. Half the usual starting dose is advised, or a different antidepressant. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer CPIC guideline, CYP2D6 Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Greatly reduced metabolism of vortioxetine to inactive compounds compared with normal metabolizers. Higher plasma concentrations may increase the probability of side effects. What the guideline suggests Initiate 50% of starting dose (e.g., 5 mg) and titrate to the maximum recommended dose of 10 mg or consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) In plain words Your body breaks down vortioxetine much more slowly than normal, causing the drug to build up to higher levels. A lower maximum dose is recommended to reduce the risk of side effects. What it means Results in higher systemic concentrations. The maximum recommended dose is 10 mg. What the label suggests The maximum recommended dose is 10 mg.

Vortioxetine

Use with caution

Trintellix, Brintellix

Your body clears this drug much more slowly. Half the usual starting dose is advised, or a different antidepressant.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Greatly reduced metabolism of vortioxetine to inactive compounds compared with normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
What the guideline suggests: Initiate 50% of starting dose (e.g., 5 mg) and titrate to the maximum recommended dose of 10 mg or consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down vortioxetine much more slowly than normal, causing the drug to build up to higher levels. A lower maximum dose is recommended to reduce the risk of side effects.
What it means: Results in higher systemic concentrations. The maximum recommended dose is 10 mg.
What the label suggests: The maximum recommended dose is 10 mg.

Tricyclics

Amitriptyline Consider alternative Elavil Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested. CYP2D6 Poor metabolizerCYP2C19 Intermediate metabolizer
CYP2D6: Poor metabolizer (activity score 0.0); CYP2C19: Intermediate metabolizer CPIC guideline, both genes together Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers What the guideline suggests Avoid amitriptyline use. If a amitripyline is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended. From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.
CPIC reads your CYP2D6 and CYP2C19 results together for amitriptyline, so this label reflects both genes.

Amitriptyline

Consider alternative

Elavil

Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.

CYP2D6 Poor metabolizerCYP2C19 Intermediate metabolizer

CYP2D6: Poor metabolizer (activity score 0.0); CYP2C19: Intermediate metabolizer

CPIC guideline, both genes together

Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid amitriptyline use. If a amitripyline is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for amitriptyline, so this label reflects both genes.

Clomipramine Consider alternative Anafranil Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested. CYP2D6 Poor metabolizerCYP2C19 Intermediate metabolizer
CYP2D6: Poor metabolizer (activity score 0.0); CYP2C19: Intermediate metabolizer CPIC guideline, both genes together Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers What the guideline suggests Avoid clomipramine use. If a clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended. From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.
CPIC reads your CYP2D6 and CYP2C19 results together for clomipramine, so this label reflects both genes.

Clomipramine

Consider alternative

Anafranil

Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.

CYP2D6 Poor metabolizerCYP2C19 Intermediate metabolizer

CYP2D6: Poor metabolizer (activity score 0.0); CYP2C19: Intermediate metabolizer

CPIC guideline, both genes together

Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid clomipramine use. If a clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for clomipramine, so this label reflects both genes.

Desipramine Consider alternative Norpramin Your body breaks down this drug much more slowly, so it can build up and cause side effects. A different medicine is usually suggested. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer CPIC guideline, CYP2D6 Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects. What the guideline suggests Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.

Desipramine

Consider alternative

Norpramin

Your body breaks down this drug much more slowly, so it can build up and cause side effects. A different medicine is usually suggested.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects.
What the guideline suggests: Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.

Doxepin Consider alternative Sinequan, Quitaxon, Aponal Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested. CYP2D6 Poor metabolizerCYP2C19 Intermediate metabolizer
CYP2D6: Poor metabolizer (activity score 0.0); CYP2C19: Intermediate metabolizer CPIC guideline, both genes together Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers What the guideline suggests Avoid doxepin use. If a doxepin is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended. From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.
CPIC reads your CYP2D6 and CYP2C19 results together for doxepin, so this label reflects both genes.

Doxepin

Consider alternative

Sinequan, Quitaxon, Aponal

Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.

CYP2D6 Poor metabolizerCYP2C19 Intermediate metabolizer

CYP2D6: Poor metabolizer (activity score 0.0); CYP2C19: Intermediate metabolizer

CPIC guideline, both genes together

Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid doxepin use. If a doxepin is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for doxepin, so this label reflects both genes.

Imipramine Consider alternative Tofranil Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested. CYP2D6 Poor metabolizerCYP2C19 Intermediate metabolizer
CYP2D6: Poor metabolizer (activity score 0.0); CYP2C19: Intermediate metabolizer CPIC guideline, both genes together Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers What the guideline suggests Avoid imipramine use. If imipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended. From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.
CPIC reads your CYP2D6 and CYP2C19 results together for imipramine, so this label reflects both genes.

Imipramine

Consider alternative

Tofranil

Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.

CYP2D6 Poor metabolizerCYP2C19 Intermediate metabolizer

CYP2D6: Poor metabolizer (activity score 0.0); CYP2C19: Intermediate metabolizer

CPIC guideline, both genes together

Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid imipramine use. If imipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for imipramine, so this label reflects both genes.

Nortriptyline Consider alternative Pamelor Your body breaks down this drug very slowly, so it builds up and side effects are more likely. A different drug is usually suggested. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer CPIC guideline, CYP2D6 Consider alternative Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects. What the guideline suggests Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.

Nortriptyline

Consider alternative

Pamelor

Your body breaks down this drug very slowly, so it builds up and side effects are more likely. A different drug is usually suggested.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Consider alternative Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects.
What the guideline suggests: Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.

Trimipramine Consider alternative Surmontil Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested. CYP2D6 Poor metabolizerCYP2C19 Intermediate metabolizer
CYP2D6: Poor metabolizer (activity score 0.0); CYP2C19: Intermediate metabolizer CPIC guideline, both genes together Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers What the guideline suggests Avoid trimipramine use. If a trimipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended. From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.
CPIC reads your CYP2D6 and CYP2C19 results together for trimipramine, so this label reflects both genes.

Trimipramine

Consider alternative

Surmontil

Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.

CYP2D6 Poor metabolizerCYP2C19 Intermediate metabolizer

CYP2D6: Poor metabolizer (activity score 0.0); CYP2C19: Intermediate metabolizer

CPIC guideline, both genes together

Consider alternative Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid trimipramine use. If a trimipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for trimipramine, so this label reflects both genes.

Antipsychotics 12 medications

1 Consider alternative10 Use with caution1 Use as directed

Aripiprazole Use with caution Abilify Your body clears aripiprazole slowly, so more of it builds up and side effects are more likely. A lower maximum dose is advised. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer DPWG guideline, CYP2D6 Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab) What it means Decreased CYP2D6 activity raises the combined blood level of aripiprazole and its active metabolite, increasing the risk of side effects. What the guideline suggests Administer no more than 10 mg/day, 300 mg/month or 720 mg/2 month (68-75% of the standard maximum dose of aripiprazole).
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) In plain words Your body breaks down aripiprazole much more slowly than normal, causing the drug to build up and increasing the risk of side effects. A lower dose is recommended. What it means Results in higher systemic concentrations and higher adverse reaction risk. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations. What the label suggests Adjust the dosage as the FDA label directs for CYP2D6 poor metabolizers.

Aripiprazole

Use with caution

Abilify

Your body clears aripiprazole slowly, so more of it builds up and side effects are more likely. A lower maximum dose is advised.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

DPWG guideline, CYP2D6

Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

What it means: Decreased CYP2D6 activity raises the combined blood level of aripiprazole and its active metabolite, increasing the risk of side effects.
What the guideline suggests: Administer no more than 10 mg/day, 300 mg/month or 720 mg/2 month (68-75% of the standard maximum dose of aripiprazole).

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down aripiprazole much more slowly than normal, causing the drug to build up and increasing the risk of side effects. A lower dose is recommended.
What it means: Results in higher systemic concentrations and higher adverse reaction risk. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Adjust the dosage as the FDA label directs for CYP2D6 poor metabolizers.

Aripiprazole Lauroxil Use with caution Aristada Your body breaks down aripiprazole lauroxil more slowly than normal, causing higher levels of the drug in your system. A lower dose is recommended to reduce the risk of side effects. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations. What the label suggests Adjust the dosage as the FDA label directs for CYP2D6 poor metabolizers.

Aripiprazole Lauroxil

Use with caution

Aristada

Your body breaks down aripiprazole lauroxil more slowly than normal, causing higher levels of the drug in your system. A lower dose is recommended to reduce the risk of side effects.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Adjust the dosage as the FDA label directs for CYP2D6 poor metabolizers.

Brexpiprazole Use with caution Rexulti Your body clears brexpiprazole slowly, so more of it builds up. Half the usual dose is advised. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer DPWG guideline, CYP2D6 Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab) What it means Decreased CYP2D6 activity reduces the metabolism of brexpiprazole, so the risk of side effects is theoretically increased. What the guideline suggests Use half of the normal dose.
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) In plain words Your body breaks down brexpiprazole much more slowly than normal, causing the drug to build up in your system. A lower dose is recommended to reduce the risk of side effects. What it means Results in higher systemic concentrations. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations. What the label suggests Adjust the dosage as the FDA label directs for CYP2D6 poor metabolizers.

Brexpiprazole

Use with caution

Rexulti

Your body clears brexpiprazole slowly, so more of it builds up. Half the usual dose is advised.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

DPWG guideline, CYP2D6

Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

What it means: Decreased CYP2D6 activity reduces the metabolism of brexpiprazole, so the risk of side effects is theoretically increased.
What the guideline suggests: Use half of the normal dose.

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down brexpiprazole much more slowly than normal, causing the drug to build up in your system. A lower dose is recommended to reduce the risk of side effects.
What it means: Results in higher systemic concentrations. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Adjust the dosage as the FDA label directs for CYP2D6 poor metabolizers.

Clozapine Use with caution Clozaril Your body breaks down clozapine much more slowly than normal, causing the drug to build up to higher levels in your system. A lower dose may be needed to reduce the risk of side effects. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer DPWG guideline, CYP2D6 Use as directed Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab) In plain words Your CYP2D6 result does not change how clozapine should be dosed. What it means CYP2D6 variation can change clozapine blood levels, but this has no clinical consequences. What the guideline suggests No action is required. Use standard clozapine dosing.
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations. Dosage reductions may be necessary. What the label suggests Dosage reductions may be necessary.

Clozapine

Use with caution

Clozaril

Your body breaks down clozapine much more slowly than normal, causing the drug to build up to higher levels in your system. A lower dose may be needed to reduce the risk of side effects.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

DPWG guideline, CYP2D6

Use as directed Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

In plain words: Your CYP2D6 result does not change how clozapine should be dosed.
What it means: CYP2D6 variation can change clozapine blood levels, but this has no clinical consequences.
What the guideline suggests: No action is required. Use standard clozapine dosing.

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations. Dosage reductions may be necessary.
What the label suggests: Dosage reductions may be necessary.

Haloperidol Use with caution Haldol Your body clears haloperidol slowly, which raises the concentration in your blood and increases side effect risk. A lower dose is typically recommended. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer DPWG guideline, CYP2D6 Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab) What it means Decreased CYP2D6 activity reduces conversion of haloperidol, increasing plasma concentration approximately 1.7-fold. This is associated with an increased risk of side effects. What the guideline suggests Use 60% of the normal dose.

Haloperidol

Use with caution

Haldol

Your body clears haloperidol slowly, which raises the concentration in your blood and increases side effect risk. A lower dose is typically recommended.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

DPWG guideline, CYP2D6

Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

What it means: Decreased CYP2D6 activity reduces conversion of haloperidol, increasing plasma concentration approximately 1.7-fold. This is associated with an increased risk of side effects.
What the guideline suggests: Use 60% of the normal dose.

Iloperidone Use with caution Fanapt Your body breaks down iloperidone much more slowly than normal, causing the drug to build up and increasing the risk of heart rhythm problems. The dose should be cut in half. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations and higher adverse reaction risk (QT prolongation). Reduce dosage by 50%. What the label suggests Reduce the dosage by 50%.

Iloperidone

Use with caution

Fanapt

Your body breaks down iloperidone much more slowly than normal, causing the drug to build up and increasing the risk of heart rhythm problems. The dose should be cut in half.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk (QT prolongation). Reduce dosage by 50%.
What the label suggests: Reduce the dosage by 50%.

Perphenazine Use with caution Trilafon Your body breaks down perphenazine much more slowly than normal, causing the drug to build up in your system. This increases your risk of side effects. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations and higher adverse reaction risk. What the label suggests No specific dosing change in the FDA table. Refer to FDA labeling.

Perphenazine

Use with caution

Trilafon

Your body breaks down perphenazine much more slowly than normal, causing the drug to build up in your system. This increases your risk of side effects.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk.
What the label suggests: No specific dosing change in the FDA table. Refer to FDA labeling.

Pimozide Use with caution Orap Your body clears pimozide slowly, which could raise the risk of heart rhythm side effects. Half the usual maximum dose is advised. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer DPWG guideline, CYP2D6 Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab) What it means Decreased CYP2D6 activity raises the plasma concentration of pimozide, which theoretically increases the risk of QT prolongation and torsade de pointes. Following the dose limit offsets this. What the guideline suggests Use no more than the following doses (50% of the normal maximum dose): 12 years and older, 10 mg/day; younger than 12 years, 0.05 mg/kg per day to a maximum of 2 mg/day.
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) In plain words Your body breaks down pimozide more slowly than normal, causing higher levels of the drug in your system. A lower dose is recommended to reduce the risk of side effects. What it means Results in higher systemic concentrations. Dosages should not exceed 0.05 mg/kg in children or 4 mg/day in adults who are poor metabolizers and dosages should not be increased earlier than 14 days. What the label suggests Do not exceed 0.05 mg/kg a day in children or 4 mg a day in adults, and do not increase the dose earlier than 14 days.

Pimozide

Use with caution

Orap

Your body clears pimozide slowly, which could raise the risk of heart rhythm side effects. Half the usual maximum dose is advised.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

DPWG guideline, CYP2D6

Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

What it means: Decreased CYP2D6 activity raises the plasma concentration of pimozide, which theoretically increases the risk of QT prolongation and torsade de pointes. Following the dose limit offsets this.
What the guideline suggests: Use no more than the following doses (50% of the normal maximum dose): 12 years and older, 10 mg/day; younger than 12 years, 0.05 mg/kg per day to a maximum of 2 mg/day.

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down pimozide more slowly than normal, causing higher levels of the drug in your system. A lower dose is recommended to reduce the risk of side effects.
What it means: Results in higher systemic concentrations. Dosages should not exceed 0.05 mg/kg in children or 4 mg/day in adults who are poor metabolizers and dosages should not be increased earlier than 14 days.
What the label suggests: Do not exceed 0.05 mg/kg a day in children or 4 mg a day in adults, and do not increase the dose earlier than 14 days.

Quetiapine Use as directed Seroquel Your CYP3A4 gene works normally, so the standard dose of this drug is used. CYP3A4 Normal metabolizer
CYP3A4: Normal metabolizer DPWG guideline, CYP3A4 Use as directed Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab) What it means No clinically significant effect on quetiapine metabolism. What the guideline suggests Use standard quetiapine dosing.

Quetiapine

Use as directed

Seroquel

Your CYP3A4 gene works normally, so the standard dose of this drug is used.

CYP3A4 Normal metabolizer

CYP3A4: Normal metabolizer

DPWG guideline, CYP3A4

Use as directed Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

What it means: No clinically significant effect on quetiapine metabolism.
What the guideline suggests: Use standard quetiapine dosing.

Risperidone Use with caution Risperdal Your body clears risperidone slowly, so more of it builds up and side effects are more likely. About two-thirds of the usual dose is advised, and less if side effects still occur. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer DPWG guideline, CYP2D6 Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab) What it means Decreased CYP2D6 activity raises the combined blood level of risperidone and its active metabolite, and a larger share of it is risperidone, which enters the brain more easily. The share of patients with therapy failure rises from 16% to 26%. What the guideline suggests Use 67% of the normal dose. If problematic side effects originating in the central nervous system occur despite this reduced dose, then reduce the dose further to 50% of the normal dose.

Risperidone

Use with caution

Risperdal

Your body clears risperidone slowly, so more of it builds up and side effects are more likely. About two-thirds of the usual dose is advised, and less if side effects still occur.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

DPWG guideline, CYP2D6

Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

What it means: Decreased CYP2D6 activity raises the combined blood level of risperidone and its active metabolite, and a larger share of it is risperidone, which enters the brain more easily. The share of patients with therapy failure rises from 16% to 26%.
What the guideline suggests: Use 67% of the normal dose. If problematic side effects originating in the central nervous system occur despite this reduced dose, then reduce the dose further to 50% of the normal dose.

Thioridazine Consider alternative Mellaril Your body breaks down thioridazine much too slowly, causing dangerous levels to build up. This significantly increases your risk of serious heart rhythm problems. This medication should not be used. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Consider alternative Evidence: strongSee the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations and higher adverse reaction risk (QT prolongation). Predicted effect based on experience with CYP2D6 inhibitors. Contraindicated in poor metabolizers. What the label suggests Do not use thioridazine. It is contraindicated for poor metabolizers due to dangerous heart rhythm risks.

Thioridazine

Consider alternative

Mellaril

Your body breaks down thioridazine much too slowly, causing dangerous levels to build up. This significantly increases your risk of serious heart rhythm problems. This medication should not be used.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Consider alternative Evidence: strongSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk (QT prolongation). Predicted effect based on experience with CYP2D6 inhibitors. Contraindicated in poor metabolizers.
What the label suggests: Do not use thioridazine. It is contraindicated for poor metabolizers due to dangerous heart rhythm risks.

Zuclopenthixol Use with caution Clopixol Your body clears this drug slowly, so it builds up in your blood. Half the usual dose is advised. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer DPWG guideline, CYP2D6 Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab) What it means Markedly decreased CYP2D6 activity reduces conversion of zuclopenthixol, raising plasma concentration approximately 1.6-fold and elevating side effect risk. What the guideline suggests Use 50% of the normal dose.

Zuclopenthixol

Use with caution

Clopixol

Your body clears this drug slowly, so it builds up in your blood. Half the usual dose is advised.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

DPWG guideline, CYP2D6

Use with caution Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

What it means: Markedly decreased CYP2D6 activity reduces conversion of zuclopenthixol, raising plasma concentration approximately 1.6-fold and elevating side effect risk.
What the guideline suggests: Use 50% of the normal dose.

Psychostimulants 2 medications

2 Use with caution

Amphetamine Use with caution Adzenys ER Your body breaks down amphetamine much more slowly than normal, which may cause the drug to build up and increase your risk of side effects. A lower dose or a different medication may be needed. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means May affect systemic concentrations and adverse reaction risk. Consider lower starting dosage or use alternative agent. What the label suggests Consider a lower starting dosage or an alternative agent.

Amphetamine

Use with caution

Adzenys ER

Your body breaks down amphetamine much more slowly than normal, which may cause the drug to build up and increase your risk of side effects. A lower dose or a different medication may be needed.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: May affect systemic concentrations and adverse reaction risk. Consider lower starting dosage or use alternative agent.
What the label suggests: Consider a lower starting dosage or an alternative agent.

Atomoxetine Use with caution Strattera Your body processes this drug very slowly, so it builds up. It may work well but cause more side effects, so your doctor may start low and go slowly. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer (activity score 0.0) CPIC guideline, CYP2D6 Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Significantly decreased metabolism of atomoxetine may result in higher concentrations as compared to non- poor metabolizers. This may increase the occurrence of treatment-emergent side effects, but also a greater improvement of ADHD symptoms as compared with non- poor metabolizers in those who tolerate treatment. Poor metabolizer status is associated with lower final dose requirements as compared to non- poor metabolizers. What the guideline suggests Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose.
CYP2D6: Poor metabolizer (activity score 0.0) FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) In plain words Your body breaks down atomoxetine more slowly than normal, causing it to build up in your system. A lower dose or slower dose increases may be needed to reduce the risk of side effects. What it means Results in higher systemic concentrations and higher adverse reaction risk. Adjust titration interval and increase dosage if tolerated. Refer to FDA labeling for specific dosing recommendations. What the label suggests Adjust the titration interval and increase the dosage only if tolerated, as the FDA label directs.

Atomoxetine

Use with caution

Strattera

Your body processes this drug very slowly, so it builds up. It may work well but cause more side effects, so your doctor may start low and go slowly.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer (activity score 0.0)

CPIC guideline, CYP2D6

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Significantly decreased metabolism of atomoxetine may result in higher concentrations as compared to non- poor metabolizers. This may increase the occurrence of treatment-emergent side effects, but also a greater improvement of ADHD symptoms as compared with non- poor metabolizers in those who tolerate treatment. Poor metabolizer status is associated with lower final dose requirements as compared to non- poor metabolizers.
What the guideline suggests: Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/ml, consider a proportional dose increase to achieve a concentration to approach 400 ng/ml. If unacceptable side effects are present at any time, consider a reduction in dose.

CYP2D6: Poor metabolizer (activity score 0.0)

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down atomoxetine more slowly than normal, causing it to build up in your system. A lower dose or slower dose increases may be needed to reduce the risk of side effects.
What it means: Results in higher systemic concentrations and higher adverse reaction risk. Adjust titration interval and increase dosage if tolerated. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Adjust the titration interval and increase the dosage only if tolerated, as the FDA label directs.

Movement disorders 3 medications

3 Use with caution

Involuntary Movement Reducers

Deutetrabenazine Use with caution Austedo Your body breaks down deutetrabenazine much more slowly than normal, causing the drug to build up and raising the risk of heart rhythm problems. A lower maximum dose is recommended. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations and adverse reaction risk (QT prolongation). The maximum recommended dosage should not exceed 36 mg (maximum single dose of 18 mg). What the label suggests Do not exceed 36 mg a day (maximum single dose of 18 mg).

Deutetrabenazine

Use with caution

Austedo

Your body breaks down deutetrabenazine much more slowly than normal, causing the drug to build up and raising the risk of heart rhythm problems. A lower maximum dose is recommended.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and adverse reaction risk (QT prolongation). The maximum recommended dosage should not exceed 36 mg (maximum single dose of 18 mg).
What the label suggests: Do not exceed 36 mg a day (maximum single dose of 18 mg).

Tetrabenazine Use with caution Xenazine Your body breaks down tetrabenazine much more slowly than normal, causing the drug to reach higher levels in your system. A lower maximum dose is required to avoid side effects. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations. The maximum recommended single dose is 25 mg and should not exceed 50 mg/day. What the label suggests The maximum single dose is 25 mg; do not exceed 50 mg a day.

Tetrabenazine

Use with caution

Xenazine

Your body breaks down tetrabenazine much more slowly than normal, causing the drug to reach higher levels in your system. A lower maximum dose is required to avoid side effects.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations. The maximum recommended single dose is 25 mg and should not exceed 50 mg/day.
What the label suggests: The maximum single dose is 25 mg; do not exceed 50 mg a day.

Valbenazine Use with caution Ingrezza Your body breaks down valbenazine much more slowly than normal, causing the drug to build up. This raises your risk of heart rhythm problems, so a lower dose may be needed. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic active metabolite concentrations and may result in higher adverse reaction risk (QT prolongation). The recommended dosage for poor metabolizers is 40 mg once daily. What the label suggests The recommended dosage for poor metabolizers is 40 mg once daily.

Valbenazine

Use with caution

Ingrezza

Your body breaks down valbenazine much more slowly than normal, causing the drug to build up. This raises your risk of heart rhythm problems, so a lower dose may be needed.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic active metabolite concentrations and may result in higher adverse reaction risk (QT prolongation). The recommended dosage for poor metabolizers is 40 mg once daily.
What the label suggests: The recommended dosage for poor metabolizers is 40 mg once daily.

Anticonvulsants 4 medications

4 Use with caution

Brivaracetam Use with caution Briviact Your body breaks down this drug more slowly, so more of it builds up. This can raise the risk of side effects. CYP2C19 Intermediate metabolizer
CYP2C19: Intermediate metabolizer FDA drug label, CYP2C19 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations and higher adverse reaction risk. What the label suggests No specific dosing change for intermediate metabolizers. Refer to FDA labeling.

Brivaracetam

Use with caution

Briviact

Your body breaks down this drug more slowly, so more of it builds up. This can raise the risk of side effects.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk.
What the label suggests: No specific dosing change for intermediate metabolizers. Refer to FDA labeling.

Clobazam Use with caution Onfi, Frisium Your body breaks down clobazam more slowly than normal, causing higher levels of the drug's active form to build up. A lower dose may be needed to reduce the risk of side effects. CYP2C19 Intermediate metabolizer
CYP2C19: Intermediate metabolizer FDA drug label, CYP2C19 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic active metabolite concentrations. Poor metabolism results in higher adverse reaction risk. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations. What the label suggests Dosage adjustment is recommended; the FDA label gives specific dosing for poor metabolizers.

Clobazam

Use with caution

Onfi, Frisium

Your body breaks down clobazam more slowly than normal, causing higher levels of the drug's active form to build up. A lower dose may be needed to reduce the risk of side effects.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic active metabolite concentrations. Poor metabolism results in higher adverse reaction risk. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Dosage adjustment is recommended; the FDA label gives specific dosing for poor metabolizers.

Fosphenytoin Use with caution Cerebyx Your body clears this drug more slowly, so it can build up and cause nervous system side effects. A lower starting dose and blood level checks are suggested. CYP2C9 Intermediate metabolizer
CYP2C9: Intermediate metabolizer (activity score 1.5) CPIC guideline, CYP2C9 Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) In plain words Your body slows the drug slightly, but no dose changes are usually needed. What it means Slightly reduced fosphenytoin metabolism; however, this does not appear to translate into increased side effects. What the guideline suggests No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN, and patients should be carefully monitored according to standard practice.
CYP2C9: Intermediate metabolizer (activity score 1.5) FDA drug label, CYP2C9 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means May result in higher systemic concentrations and higher adverse reaction risk (central nervous system toxicity). Consider starting at the lower end of the dosage range and monitor serum concentrations. Refer to FDA labeling for specific dosing recommendations. Carriers of CYP2C93 alleles may be at increased risk of severe cutaneous adverse reactions. Consider avoiding fosphenytoin as an alternative to carbamazepine in patients who are CYP2C93 carriers. Genotyping is not a substitute for clinical vigilance and patient management. What the label suggests Consider starting at the lower end of the dosage range and monitor serum concentrations. CYP2C9*3 carriers may be at higher risk of severe skin reactions; consider avoiding fosphenytoin as an alternative to carbamazepine in them.

Fosphenytoin

Use with caution

Cerebyx

Your body clears this drug more slowly, so it can build up and cause nervous system side effects. A lower starting dose and blood level checks are suggested.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer (activity score 1.5)

CPIC guideline, CYP2C9

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug slightly, but no dose changes are usually needed.
What it means: Slightly reduced fosphenytoin metabolism; however, this does not appear to translate into increased side effects.
What the guideline suggests: No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN, and patients should be carefully monitored according to standard practice.

CYP2C9: Intermediate metabolizer (activity score 1.5)

FDA drug label, CYP2C9

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: May result in higher systemic concentrations and higher adverse reaction risk (central nervous system toxicity). Consider starting at the lower end of the dosage range and monitor serum concentrations. Refer to FDA labeling for specific dosing recommendations. Carriers of CYP2C9*3 alleles may be at increased risk of severe cutaneous adverse reactions. Consider avoiding fosphenytoin as an alternative to carbamazepine in patients who are CYP2C9*3 carriers. Genotyping is not a substitute for clinical vigilance and patient management.
What the label suggests: Consider starting at the lower end of the dosage range and monitor serum concentrations. CYP2C9*3 carriers may be at higher risk of severe skin reactions; consider avoiding fosphenytoin as an alternative to carbamazepine in them.

Phenytoin Use with caution Dilantin Your body breaks down this drug more slowly, so it can build up. That raises the risk of side effects on the brain and nerves. CYP2C9 Intermediate metabolizer
CYP2C9: Intermediate metabolizer (activity score 1.5) CPIC guideline, CYP2C9 Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) In plain words Your body slows the drug slightly, but no dose changes are usually needed. What it means Slightly reduced phenytoin metabolism; however, this does not appear to translate into increased side effects. What the guideline suggests No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN, and patients should be carefully monitored according to standard practice.
CYP2C9: Intermediate metabolizer (activity score 1.5) FDA drug label, CYP2C9 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means May result in higher systemic concentrations and higher adverse reaction risk (central nervous system toxicity). Refer to FDA labeling for specific dosing recommendations. Carriers of CYP2C93 alleles may be at increased risk of severe cutaneous adverse reactions. Consider avoiding phenytoin as an alternative to carbamazepine in patients who are CYP2C93 carriers. Genotyping is not a substitute for clinical vigilance and patient management. What the label suggests Refer to FDA labeling for dosing. CYP2C9*3 carriers may be at higher risk of severe skin reactions; consider avoiding phenytoin as an alternative to carbamazepine in them.

Phenytoin

Use with caution

Dilantin

Your body breaks down this drug more slowly, so it can build up. That raises the risk of side effects on the brain and nerves.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer (activity score 1.5)

CPIC guideline, CYP2C9

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug slightly, but no dose changes are usually needed.
What it means: Slightly reduced phenytoin metabolism; however, this does not appear to translate into increased side effects.
What the guideline suggests: No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN, and patients should be carefully monitored according to standard practice.

CYP2C9: Intermediate metabolizer (activity score 1.5)

FDA drug label, CYP2C9

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: May result in higher systemic concentrations and higher adverse reaction risk (central nervous system toxicity). Refer to FDA labeling for specific dosing recommendations. Carriers of CYP2C9*3 alleles may be at increased risk of severe cutaneous adverse reactions. Consider avoiding phenytoin as an alternative to carbamazepine in patients who are CYP2C9*3 carriers. Genotyping is not a substitute for clinical vigilance and patient management.
What the label suggests: Refer to FDA labeling for dosing. CYP2C9*3 carriers may be at higher risk of severe skin reactions; consider avoiding phenytoin as an alternative to carbamazepine in them.

Pain management 13 medications

2 Consider alternative5 Use with caution6 Use as directed

Carisoprodol Use as directed Soma Your body breaks down carisoprodol slightly slower than normal. The standard dose should work as expected. CYP2C19 Intermediate metabolizer
CYP2C19: Intermediate metabolizer FDA drug label, CYP2C19 Use as directed Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means No FDA guidance for this phenotype What the label suggests Initiate therapy with recommended starting dose.

Carisoprodol

Use as directed

Soma

Your body breaks down carisoprodol slightly slower than normal. The standard dose should work as expected.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Use as directed Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for this phenotype
What the label suggests: Initiate therapy with recommended starting dose.

Celecoxib Use as directed Celebrex Your body slows the drug down slightly, but usually the normal starting dose is fine. CYP2C9 Intermediate metabolizer
CYP2C9: Intermediate metabolizer (activity score 1.5) CPIC guideline, CYP2C9 Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Mildly reduced metabolism What the guideline suggests Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
CYP2C9: Intermediate metabolizer (activity score 1.5) FDA drug label, CYP2C9 Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab) In plain words Your CYP2C9 result means somewhat lower CYP2C9 activity than usual, but the FDA gives no genetic dosing change for celecoxib at this result. What it means No FDA guidance for your genotype What the label suggests Initiate therapy with recommended starting dose.

Celecoxib

Use as directed

Celebrex

Your body slows the drug down slightly, but usually the normal starting dose is fine.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer (activity score 1.5)

CPIC guideline, CYP2C9

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

CYP2C9: Intermediate metabolizer (activity score 1.5)

FDA drug label, CYP2C9

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your CYP2C9 result means somewhat lower CYP2C9 activity than usual, but the FDA gives no genetic dosing change for celecoxib at this result.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Codeine Consider alternative Tylenol 3 Your body turns very little codeine into its active form, so it likely won't ease your pain. A different pain reliever is usually suggested. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer CPIC guideline, CYP2D6 Consider alternative Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Greatly reduced morphine formation leading to diminished analgesia. What the guideline suggests Avoid codeine use because of possibility of diminished analgesia. If opioid use is warranted, consider a non-tramadol opioid.
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) In plain words Your body turns very little codeine into its active form, so it may not relieve your pain as well. What it means Results in lower systemic active metabolite concentrations and may result in reduced efficacy. What the label suggests No specific dosing change; codeine may be less effective. Refer to FDA labeling.

Codeine

Consider alternative

Tylenol 3

Your body turns very little codeine into its active form, so it likely won't ease your pain. A different pain reliever is usually suggested.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Consider alternative Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Greatly reduced morphine formation leading to diminished analgesia.
What the guideline suggests: Avoid codeine use because of possibility of diminished analgesia. If opioid use is warranted, consider a non-tramadol opioid.

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body turns very little codeine into its active form, so it may not relieve your pain as well.
What it means: Results in lower systemic active metabolite concentrations and may result in reduced efficacy.
What the label suggests: No specific dosing change; codeine may be less effective. Refer to FDA labeling.

Flurbiprofen Use as directed Ansaid, Ocufen, Strefen Your body slows the drug down slightly, but usually the normal starting dose is fine. CYP2C9 Intermediate metabolizer
CYP2C9: Intermediate metabolizer (activity score 1.5) CPIC guideline, CYP2C9 Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Mildly reduced metabolism What the guideline suggests Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
CYP2C9: Intermediate metabolizer (activity score 1.5) FDA drug label, CYP2C9 Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab) In plain words Your body may break down this drug a little slower than average. The FDA label gives no dose change for your result. What it means No FDA guidance for your genotype What the label suggests Initiate therapy with recommended starting dose.

Flurbiprofen

Use as directed

Ansaid, Ocufen, Strefen

Your body slows the drug down slightly, but usually the normal starting dose is fine.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer (activity score 1.5)

CPIC guideline, CYP2C9

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

CYP2C9: Intermediate metabolizer (activity score 1.5)

FDA drug label, CYP2C9

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body may break down this drug a little slower than average. The FDA label gives no dose change for your result.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Hydrocodone Use with caution Hysingla ER Your body makes less of hydrocodone's stronger active form. It's not clear this changes pain relief, so the usual dose is recommended, with a different pain medicine to consider if it doesn't work. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer CPIC guideline, CYP2D6 Use with caution Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Decreased metabolism of hydrocodone to active metabolite, hydromorphone, but there is insufficient evidence to determine if these effects on pharmacokinetics translate into decreased analgesia or side effects. What the guideline suggests Use hydrocodone label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine and non-tramadol opioid.

Hydrocodone

Use with caution

Hysingla ER

Your body makes less of hydrocodone's stronger active form. It's not clear this changes pain relief, so the usual dose is recommended, with a different pain medicine to consider if it doesn't work.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Use with caution Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Decreased metabolism of hydrocodone to active metabolite, hydromorphone, but there is insufficient evidence to determine if these effects on pharmacokinetics translate into decreased analgesia or side effects.
What the guideline suggests: Use hydrocodone label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine and non-tramadol opioid.

Ibuprofen Use as directed Advil Your body slows the drug down slightly, but usually the normal starting dose is fine. CYP2C9 Intermediate metabolizer
CYP2C9: Intermediate metabolizer (activity score 1.5) CPIC guideline, CYP2C9 Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Mildly reduced metabolism What the guideline suggests Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

Ibuprofen

Use as directed

Advil

Your body slows the drug down slightly, but usually the normal starting dose is fine.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer (activity score 1.5)

CPIC guideline, CYP2C9

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

Lornoxicam Use as directed Xefo Your body slows the drug down slightly, but usually the normal starting dose is fine. CYP2C9 Intermediate metabolizer
CYP2C9: Intermediate metabolizer (activity score 1.5) CPIC guideline, CYP2C9 Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Mildly reduced metabolism What the guideline suggests Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

Lornoxicam

Use as directed

Xefo

Your body slows the drug down slightly, but usually the normal starting dose is fine.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer (activity score 1.5)

CPIC guideline, CYP2C9

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

Meloxicam Use with caution Mobic Your body breaks down meloxicam slightly slower than normal. While there is no specific FDA guidance, your doctor may want to monitor you for side effects. CYP2C9 Intermediate metabolizer
CYP2C9: Intermediate metabolizer (activity score 1.5) CPIC guideline, CYP2C9 Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) In plain words Your body slows the drug slightly, but usually the normal starting dose is fine. What it means Mildly reduced metabolism What the guideline suggests Initiate therapy with recommended starting dose. In accordance with the meloxicam prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
CYP2C9: Intermediate metabolizer (activity score 1.5) FDA drug label, CYP2C9 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means No FDA guidance for this phenotype What the label suggests Initiate therapy with recommended starting dose.

Meloxicam

Use with caution

Mobic

Your body breaks down meloxicam slightly slower than normal. While there is no specific FDA guidance, your doctor may want to monitor you for side effects.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer (activity score 1.5)

CPIC guideline, CYP2C9

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug slightly, but usually the normal starting dose is fine.
What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the meloxicam prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

CYP2C9: Intermediate metabolizer (activity score 1.5)

FDA drug label, CYP2C9

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for this phenotype
What the label suggests: Initiate therapy with recommended starting dose.

Oliceridine Use with caution Olinvyk Your body clears this drug much more slowly, raising the risk of slowed breathing and deep drowsiness. You may need doses less often. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations and higher adverse reaction risk (respiratory depression and sedation). May require less frequent dosing. What the label suggests May require less frequent dosing.

Oliceridine

Use with caution

Olinvyk

Your body clears this drug much more slowly, raising the risk of slowed breathing and deep drowsiness. You may need doses less often.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk (respiratory depression and sedation). May require less frequent dosing.
What the label suggests: May require less frequent dosing.

Piroxicam Use with caution Feldene Your body breaks down piroxicam more slowly than normal, which can cause higher drug levels. Your doctor may need to adjust your dosing. CYP2C9 Intermediate metabolizer
CYP2C9: Intermediate metabolizer (activity score 1.5) CPIC guideline, CYP2C9 Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) In plain words Your body slows the drug slightly, but the usual starting dose is still fine. What it means Mildly reduced metabolism What the guideline suggests Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
CYP2C9: Intermediate metabolizer (activity score 1.5) FDA drug label, CYP2C9 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations. What the label suggests No specific dosing change for intermediate metabolizers. Refer to FDA labeling.

Piroxicam

Use with caution

Feldene

Your body breaks down piroxicam more slowly than normal, which can cause higher drug levels. Your doctor may need to adjust your dosing.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer (activity score 1.5)

CPIC guideline, CYP2C9

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body slows the drug slightly, but the usual starting dose is still fine.
What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

CYP2C9: Intermediate metabolizer (activity score 1.5)

FDA drug label, CYP2C9

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations.
What the label suggests: No specific dosing change for intermediate metabolizers. Refer to FDA labeling.

Pitolisant Use with caution Wakix Your body breaks down pitolisant much more slowly than normal, causing the drug to reach higher levels in your system. The lowest starting dose is recommended to reduce the risk of side effects. CYP2D6 Poor metabolizer
CYP2D6: Poor metabolizer FDA drug label, CYP2D6 Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab) What it means Results in higher systemic concentrations. Use lowest recommended starting dosage. Refer to FDA labeling for specific dosing recommendations. What the label suggests Use the lowest recommended starting dosage. Refer to FDA labeling.

Pitolisant

Use with caution

Wakix

Your body breaks down pitolisant much more slowly than normal, causing the drug to reach higher levels in your system. The lowest starting dose is recommended to reduce the risk of side effects.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations. Use lowest recommended starting dosage. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Use the lowest recommended starting dosage. Refer to FDA labeling.

Tenoxicam Use as directed Mobiflex Your body slows the drug slightly, but the usual starting dose is still fine. CYP2C9 Intermediate metabolizer
CYP2C9: Intermediate metabolizer (activity score 1.5) CPIC guideline, CYP2C9 Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab) What it means Mildly reduced metabolism What the guideline suggests Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

Tenoxicam

Use as directed

Mobiflex

Your body slows the drug slightly, but the usual starting dose is still fine.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer (activity score 1.5)

CPIC guideline, CYP2C9

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Mildly reduced metabolism
What the guideline suggests: Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.

Tramadol

Consider alternative

Ultram, ConZip

Your body can't turn this drug into its active form well, so it may not relieve your pain. A different pain medicine is advised.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Consider alternative Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Greatly reduced O-desmethyltramadol (active metabolite) formation leading to diminished analgesia.
What the guideline suggests: Avoid tramadol use because of possibility of diminished analgesia. If opioid use is warranted, consider a non-codeine opioid.

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body turns this drug into its active form slowly, so it may not relieve pain as well. Your doctor may check how well it works.
What it means: Results in lower systemic active metabolite concentrations and may result in reduced efficacy.
What the label suggests: The FDA notes reduced efficacy but gives no dosing change. Monitor for adequate pain relief.

Cardiovascular 7 medications

1 Consider alternative6 Use with caution

Antiarrhythmics

Propafenone

Use with caution

Rythmol SR

Your body breaks down this drug much more slowly, so an irregular heartbeat is more likely. Some other drugs raise this risk even more.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk (arrhythmia). Avoid use in poor metabolizers taking a CYP3A4 inhibitor.
What the label suggests: Avoid use in poor metabolizers taking a CYP3A4 inhibitor.

Antihypertensives

Hydralazine

Use with caution

Apresoline

Your body breaks down hydralazine slowly, which means you need a lower starting dose. Higher doses may increase side effects, including a rare immune reaction.

NAT2 Poor metabolizer

NAT2: Poor metabolizer

CPIC guideline, NAT2

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Predicted to have increased hydralazine plasma concentrations compared to NAT2 rapid and intermediate metabolizers, which may lead to both increased efficacy and adverse effects, including drug-induced systemic lupus erythematosus.
What the guideline suggests: Initiate therapy at a total daily dose of 40 to 75 mg. Carefully titrate dose upward to clinical effect or guideline-recommended dose; use caution with total daily hydralazine doses of 200 mg or more.

Beta Blockers

Carvedilol

Use with caution

Coreg, Coreg CR

Your body breaks down carvedilol much more slowly than normal, causing the drug to build up in your system. This increases your risk of dizziness and other side effects.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk (dizziness).
What the label suggests: No specific dosing change in the FDA table. Refer to FDA labeling.

Metoprolol

Use with caution

Lopressor, Toprol XL

Your body clears this drug very slowly, so it can build up. Your doctor may start with the lowest dose and watch your heart rate.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer (activity score 0.0)

CPIC guideline, CYP2D6

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Decreased metabolism of metoprolol leading to markedly increased drug concentrations; this leads to greater heart rate and blood pressure reductions. The effect on clinical outcomes is unclear.
What the guideline suggests: Initiate therapy with the lowest recommended starting dose. Carefully titrate dose upward to clinical effect or guideline-recommended dose; monitor more closely for bradycardia. Alternatively, consider selecting another beta-blocker.

Blood Thinners

Clopidogrel

Consider alternative

Plavix

Your body turns this drug into its active form more slowly, so it may not protect you as well. A different blood thinner is usually suggested.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

CPIC guideline, CYP2C19

Consider alternative Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events
What the guideline suggests: Avoid standard dose (75 mg) clopidogrel if possible. Use prasugrel or ticagrelor at standard dose if no contraindication

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Consider alternative Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: This drug may not work as well for you, which can raise the risk of heart problems. Your doctor may use a different drug to prevent clots.
What it means: Results in lower systemic active metabolite concentrations, lower antiplatelet response, and may result in higher cardiovascular risk. Consider use of another platelet P2Y12 inhibitor.
What the label suggests: Results in lower systemic active metabolite concentrations, lower antiplatelet response, and may result in higher cardiovascular risk. Consider use of another platelet P2Y12 inhibitor.

Warfarin

Use with caution

Coumadin

Your genes suggest a lower dose may be safer. Your doctor can decide.

CYP2C9 Intermediate metabolizerVKORC1 Decreased expressionCYP4F2 Intermediate metabolizer

CYP2C9: Intermediate metabolizer; VKORC1: Decreased expression; CYP4F2: Intermediate metabolizer

CPIC guideline, all three genes together

Use with caution Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

Estimated dose: 3.2-4.4 mg/day (lower than typical starting dose).

Base genotype dose (CYP2C9 *1/*2, VKORC1 GA): 3-4 mg/day. Because you carry CYP4F2*3 (rs2108622 T), your estimated dose is increased by about 5-10%.

CPIC reads your CYP2C9, VKORC1 and CYP4F2 results together for warfarin, so this label reflects all of them.

Cardiomyopathy

Mavacamten

Use with caution

Camzyos

Your body breaks down mavacamten slightly slower than normal, which may lead to higher drug levels. Your doctor will monitor you closely and adjust the dose based on your response.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Use with caution Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and may have higher adverse reaction risk (heart failure). Dosage is based on individual response. The dose titration and monitoring schedule accounts for differences due to CYP2C19 genetic variation, so adjustments based on CYP2C19 genotype are not necessary. Refer to FDA labeling for specific dosing recommendations and monitoring.
What the label suggests: Follow the label's dose titration and monitoring schedule; no genotype-based adjustment is needed.

Cholesterol medications 7 medications

1 Consider alternative5 Use with caution1 Use as directed

Atorvastatin

Use with caution

Lipitor

More of this statin stays in your blood, which can raise the chance of muscle side effects. Your doctor may limit the dose.

SLCO1B1 Decreased function

SLCO1B1: Decreased function

CPIC guideline, SLCO1B1

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Increased atorvastatin exposure as compared with normal function, which may translate to increased myopathy risk.
What the guideline suggests: Prescribe ≤40 mg as a starting dose and adjust doses of atorvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for the 40-mg dose. If dose >40 mg is needed for desired efficacy, consider combination therapy (i.e., atorvastatin plus nonstatin guideline-directed medical therapy).

Fluvastatin

Use with caution

Lescol

Your genes make this statin build up in your blood, which can raise the risk of muscle problems. A lower starting dose or a dose limit is suggested.

CYP2C9 Intermediate metabolizerSLCO1B1 Decreased function

CYP2C9: Intermediate metabolizer (activity score 1.5); SLCO1B1: Decreased function

CPIC guideline, both genes together

Use with caution Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: CYP2C9: Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk. SLCO1B1: Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg.
What the guideline suggests: Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).

From the combined CYP2C9 and SLCO1B1 table in CPIC's statin guideline. CYP2C9 is matched on its activity score.

CPIC reads your CYP2C9 and SLCO1B1 results together for fluvastatin, so this label reflects both genes.

Lovastatin

Consider alternative

Mevacor

Your genes make this statin build up in your blood, which may raise your risk of muscle problems. A different statin, or a low dose of this one, is often suggested.

SLCO1B1 Decreased function

SLCO1B1: Decreased function

CPIC guideline, SLCO1B1

Consider alternative Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Increased lovastatin acid exposure as compared with normal function, which may translate to increased myopathy risk
What the guideline suggests: Consider prescribing a lower-risk alternative such as atorvastatin (10 to 20 mg), pravastatin (40 mg), or rosuvastatin (5 to 10 mg). If lovastatin is warranted, limit the dose to ≤20 mg/day to reduce the risk of muscle-related side effects.

Pitavastatin

Use with caution

Livalo

More of this statin stays in your blood, so muscle side effects are more likely. Your doctor may keep the dose low or suggest another statin.

SLCO1B1 Decreased function

SLCO1B1: Decreased function

CPIC guideline, SLCO1B1

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Increased pitavastatin exposure as compared with normal function, which may translate to increased myopathy risk
What the guideline suggests: Prescribe ≤2 mg as a starting dose and adjust doses of pitavastatin based on disease-specific guidelines. Be aware of possible increased risk for muscle-related side effects, especially for doses >1 mg. If dose >2 mg is needed for desired efficacy, consider switching to a lower-risk alternative such as atorvastatin (10 to 20 mg), pravastatin (40 mg), or rosuvastatin (5 to 10 mg), or using combination therapy (e.g., pitavastatin plus nonstatin guideline-directed medical therapy).

Pravastatin

Use with caution

Pravachol

Your body may process this drug more slowly, so higher doses might carry added risks.

SLCO1B1 Decreased function

SLCO1B1: Decreased function

CPIC guideline, SLCO1B1

Use with caution Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Increased pravastatin exposure compared with normal function; typical myopathy risk with doses ≤40 mg
What the guideline suggests: Prescribe desired starting dose and adjust doses of pravastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially with doses >40 mg per day.

Rosuvastatin

Use as directed

Crestor

Your genes support the usual starting dose of this statin.

ABCG2 Normal functionSLCO1B1 Decreased function

ABCG2: Normal function; SLCO1B1: Decreased function

CPIC guideline, both genes together

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: ABCG2: Typical myopathy risk and rosuvastatin exposure SLCO1B1: Increased rosuvastatin exposure as compared to normal function; Typical myopathy risk with doses ≤20 mg.
What the guideline suggests: Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >20mg.

From the combined ABCG2 and SLCO1B1 table in CPIC's statin guideline.

CPIC reads your ABCG2 and SLCO1B1 results together for rosuvastatin, so this label reflects both genes.

Simvastatin

Use with caution

Zocor

More of this statin stays in your blood, so muscle side effects are more likely. Your doctor may use a different statin or a lower dose.

SLCO1B1 Decreased function

SLCO1B1: Decreased function

CPIC guideline, SLCO1B1

Use with caution Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Increased simvastatin acid exposure compared with normal function; increased risk of muscle side effects (myopathy)
What the guideline suggests: Prescribe an alternative statin depending on desired potency. Low-risk options: atorvastatin 10 to 20 mg, pitavastatin 1 mg, pravastatin 40 mg, rosuvastatin 5 to 10 mg. Moderate-risk options: fluvastatin 80 mg, pitavastatin 2 mg, pravastatin 80 mg. High-risk options (use with caution): lovastatin 40 to 80 mg, pitavastatin 4 mg, simvastatin 20 to 40 mg. If simvastatin is used, limit dose to <20 mg/day.

SLCO1B1: Decreased function

FDA drug label, SLCO1B1

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body clears simvastatin more slowly than normal, causing it to build up in your system. This raises your risk of muscle pain or damage, especially at higher doses.
What it means: Results in higher systemic concentrations and higher adverse reaction risk (myopathy). The risk of adverse reaction (myopathy) is higher for patients on 80 mg than for those on lower doses.
What the label suggests: No specific dosing change in the FDA table. The risk of myopathy is higher at 80 mg than at lower doses.

Antiemetics 4 medications

2 Use with caution2 Use as directed

Dronabinol

Use with caution

Syndros

Your body breaks down dronabinol more slowly than normal, which may cause the drug to build up and increase the risk of side effects. Extra monitoring is recommended.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer

FDA drug label, CYP2C9

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: May result in higher systemic concentrations and higher adverse reaction risk. Monitor for adverse reactions.
What the label suggests: Monitor for adverse reactions.

Metoclopramide

Use with caution

Reglan

Your body breaks down metoclopramide much more slowly than normal, causing the drug to build up and increasing the risk of side effects. A lower dose is recommended.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk. The recommended dosage is lower. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Use the lower dosage the FDA label recommends.

Ondansetron

Use as directed

Zofran

There is not enough evidence to know how your CYP2D6 result affects your response to ondansetron. CPIC makes no prescribing recommendation based on this result.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Use as directed No recommendationRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Insufficient evidence demonstrating clinical impact
What the guideline suggests: No recommendation based on insufficient evidence

Tropisetron

Use as directed

Navoban

There is not enough evidence to know how your CYP2D6 result affects your response to tropisetron. CPIC makes no prescribing recommendation based on this result.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Use as directed No recommendationRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Insufficient evidence demonstrating clinical impact
What the guideline suggests: No recommendation based on insufficient evidence

Proton pump inhibitors 4 medications

4 Use with caution

Dexlansoprazole

Use with caution

Dexilant

Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

CPIC guideline, CYP2C19

Use with caution Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Increased plasma concentration of PPI compared with CYP2C19 normal metabolizers; increased chance of efficacy and potentially toxicity
What the guideline suggests: Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.

Lansoprazole

Use with caution

Prevacid

Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

CPIC guideline, CYP2C19

Use with caution Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Increased plasma concentration of PPI compared with CYP2C19 normal metabolizers; increased chance of efficacy and potentially toxicity
What the guideline suggests: Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.

Omeprazole

Use with caution

Prilosec, Losec

Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

CPIC guideline, CYP2C19

Use with caution Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Increased plasma concentration of PPI compared with CYP2C19 normal metabolizers; increased chance of efficacy and potentially toxicity
What the guideline suggests: Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.

Pantoprazole

Use with caution

Protonix

Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

CPIC guideline, CYP2C19

Use with caution Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Increased plasma concentration of PPI compared with CYP2C19 normal metabolizers; increased chance of efficacy and potentially toxicity
What the guideline suggests: Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body processes this drug a bit slower than average. The FDA gives no dose change for your result, so the usual dose is used.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Oncology 13 medications

1 Consider alternative1 Use with caution11 Use as directed

Chemotherapies

Belinostat

Use as directed

Beleodaq

Your body may process this drug a little more slowly. The FDA has no special advice for this, so the usual dose is used.

UGT1A1 Intermediate metabolizer

UGT1A1: Intermediate metabolizer

FDA drug label, UGT1A1

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Belzutifan

Use as directed

Welireg

Your CYP2C19 result means somewhat lower CYP2C19 activity than usual, but the FDA gives no genetic dosing change for belzutifan at this result.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for this phenotype
What the label suggests: Initiate therapy with recommended starting dose.

Capecitabine

Use as directed

Xeloda, Xitabin, Kapetral

Your body processes capecitabine normally. You have a typical risk of side effects, and the standard dose is expected to be appropriate.

DPYD Normal metabolizer

DPYD: Normal metabolizer (activity score 2.0)

CPIC guideline, DPYD

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Normal DPD activity and “normal” risk for fluoropyrimidine toxicity
What the guideline suggests: Based on genotype, there is no indication to change dose or therapy. Use label-recommended dosage and administration

DPYD: Normal metabolizer (activity score 2.0)

FDA drug label, DPYD

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down capecitabine at a normal rate. The standard dose should work as expected.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Erdafitinib

Use as directed

Balversa

Your CYP2C9 result means somewhat lower CYP2C9 activity than usual, but the FDA gives no genetic dosing change for erdafitinib at this result.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer

FDA drug label, CYP2C9

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Fluorouracil

Use as directed

Adrucil, Carac

Your body breaks down this drug normally. Your risk of side effects is typical, and the usual dose is used.

DPYD Normal metabolizer

DPYD: Normal metabolizer (activity score 2.0)

CPIC guideline, DPYD

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Normal DPD activity and “normal” risk for fluoropyrimidine toxicity
What the guideline suggests: Based on genotype, there is no indication to change dose or therapy. Use label-recommended dosage and administration

DPYD: Normal metabolizer (activity score 2.0)

FDA drug label, DPYD

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body processes fluorouracil at a normal rate. The standard dose should work as expected.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Gefitinib

Use with caution

Iressa

Your body breaks down gefitinib more slowly than normal, causing higher levels of the drug in your system. This increases the risk of side effects and closer monitoring may be needed.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk. Monitor for adverse reactions.
What the label suggests: Monitor for adverse reactions.

Irinotecan

Use as directed

Camptosar, Onivyde

Your body breaks down irinotecan slightly slower than normal. The standard dose should work as expected.

UGT1A1 Intermediate metabolizer

UGT1A1: Intermediate metabolizer

FDA drug label, UGT1A1

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Mercaptopurine

Use as directed

Purinethol

Both genes that affect this drug look normal, so a standard starting dose is expected.

TPMT Normal metabolizerNUDT15 Normal metabolizer

TPMT: Normal metabolizer; NUDT15: Normal metabolizer

CPIC guideline, both genes together

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Both TPMT and NUDT15 predict normal thiopurine metabolism and a normal risk of myelosuppression.
What the guideline suggests: Initiate therapy with standard starting dose of mecaptopurine (e.g., 75 mg/m2/day for malignancy or 1.5 mg/kg/day for nonmalignancy). During therapy, adjust the doses of myelosuppressive agents, as per standard clinical practice. It usually takes at least 2 weeks of stable dosing to reach steady state after each dose adjustment.

From the combined TPMT and NUDT15 table in CPIC's thiopurine guideline.

CPIC reads your TPMT and NUDT15 results together for mercaptopurine, so this label reflects both genes.

Nilotinib

Use as directed

Tasigna

Your UGT1A1 result means somewhat lower UGT1A1 activity than usual, but the FDA gives no genetic dosing change for nilotinib at this result.

UGT1A1 Intermediate metabolizer

UGT1A1: Intermediate metabolizer

FDA drug label, UGT1A1

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Pazopanib

Use as directed

Votrient

Your UGT1A1 gene works a bit less than average. The FDA gives no dose change for your result, so the usual dose is used.

UGT1A1 Intermediate metabolizer

UGT1A1: Intermediate metabolizer

FDA drug label, UGT1A1

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Sacituzumab Govitecan-Hziy

Use as directed

Trodelvy

Your body processes this drug a bit slower than average. The FDA gives no dose change for your result, so the usual dose is used.

UGT1A1 Intermediate metabolizer

UGT1A1: Intermediate metabolizer

FDA drug label, UGT1A1

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for this phenotype
What the label suggests: Initiate therapy with recommended starting dose.

Thioguanine

Use as directed

Lanvis, Tabloid

Both genes that affect this drug look normal, so a standard starting dose is expected.

TPMT Normal metabolizerNUDT15 Normal metabolizer

TPMT: Normal metabolizer; NUDT15: Normal metabolizer

CPIC guideline, both genes together

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Both TPMT and NUDT15 predict normal thiopurine metabolism and a normal risk of myelosuppression.
What the guideline suggests: Initiate therapy with standard starting dose of thioguanine (e.g., 40 mg/m2/day for malignancy). During therapy, adjust the doses of myelosuppressive agents, as per standard clinical practice. It usually takes at least 2 weeks of stable dosing to reach steady state after each dose adjustment.

From the combined TPMT and NUDT15 table in CPIC's thiopurine guideline.

CPIC reads your TPMT and NUDT15 results together for thioguanine, so this label reflects both genes.

Estrogen Modulators

Tamoxifen

Consider alternative

Nolvadex, Soltamox

Your body makes very little of this drug's active form, so it may not work well to stop breast cancer from coming back. Another hormone therapy is advised.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

CPIC guideline, CYP2D6

Consider alternative Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Lower endoxifen concentrations compared to normal metabolizers; higher risk of breast cancer recurrence, event-free and recurrence-free survival compared to normal metabolizers.
What the guideline suggests: Recommend alternative hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women given that these approaches are superior to tamoxifen regardless of CYP2D6 genotype and based on knowledge that CYP2D6 poor metabolizers switched from tamoxifen to anastrozole do not have an increased risk of recurrence. Note, higher dose tamoxifen (40 mg/day) increases but does not normalize endoxifen concentrations and can be considered if there are contraindications to aromatase inhibitor therapy.

Immunosuppressants 4 medications

2 Use with caution2 Use as directed

Abrocitinib

Use as directed

Cibinqo

Your body may process this drug a little more slowly. The drug label has no special advice for this, so the usual dose is used.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Use as directed Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for this phenotype
What the label suggests: Abrocitinib - label recommended dosage and administration

Azathioprine

Use as directed

Imuran

Both genes that affect this drug look normal, so a standard starting dose is expected.

TPMT Normal metabolizerNUDT15 Normal metabolizer

TPMT: Normal metabolizer; NUDT15: Normal metabolizer

CPIC guideline, both genes together

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Both TPMT and NUDT15 predict normal thiopurine metabolism and a normal risk of myelosuppression.
What the guideline suggests: Initiate therapy with standard starting dose (e.g., 2 mg/kg/day for autoimmune diseases). During therapy, adjust doses of azathioprine based on disease-specific guidelines. It usually takes at least 2 weeks to reach steady state after each dose adjustment.

From the combined TPMT and NUDT15 table in CPIC's thiopurine guideline.

CPIC reads your TPMT and NUDT15 results together for azathioprine, so this label reflects both genes.

Siponimod

Use with caution

Mayzent

Your body breaks down siponimod slower than normal, causing the drug to reach higher levels in your system. Your doctor will need to adjust your dose based on your specific genetic profile.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer

FDA drug label, CYP2C9

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations. Adjust dosage based on genotype. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Adjust the dosage based on genotype as the FDA label directs.

Tacrolimus

Use with caution

Prograf

Your body breaks down this drug faster than many people do, so the usual dose may fall short. A higher starting dose and blood tests are advised.

CYP3A5 Intermediate metabolizer

CYP3A5: Intermediate metabolizer

CPIC guideline, CYP3A5

Use with caution Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Lower dose-adjusted trough concentrations of tacrolimus and decreased chance of achieving target tacrolimus concentrations
What the guideline suggests: Increase starting dose 1.5 to 2 times recommended starting dose. Total starting dose should not exceed 0.3mg/kg/day. Use therapeutic drug monitoring to guide dose adjustments

CYP3A5: Intermediate metabolizer

FDA drug label, CYP3A5

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body processes tacrolimus at a moderate rate. Your dose may need to be adjusted based on blood level monitoring to make sure you get the right amount.
What it means: Results in lower systemic concentrations, lower probability of achieving target concentrations and may result in higher rejection risk. Measure drug concentrations and adjust dosage based on trough whole blood tacrolimus concentrations.
What the label suggests: Measure drug concentrations and adjust the dosage based on trough whole blood tacrolimus concentrations.

Antivirals 5 medications

5 Use as directed

Antiretrovirals

Atazanavir

Use as directed

Reyataz, Evotaz, Others

Your body processes atazanavir a bit more slowly than normal, but you still have a low chance of developing jaundice (yellowing of skin or eyes). The standard dose is expected to be appropriate.

UGT1A1 Intermediate metabolizer

UGT1A1: Intermediate metabolizer

CPIC guideline, UGT1A1

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Somewhat decreased UGT1A1 activity; low likelihood of bilirubin-related discontinuation of atazanavir.
What the guideline suggests: There is no need to avoid prescribing of atazanavir based on UGT1A1 genetic test result. Inform the patient that some patients stop atazanavir because of jaundice (yellow eyes and skin), but that this patient’s genotype makes this unlikely

Efavirenz

Use as directed

Sustiva

Your body processes efavirenz normally. The standard dose is expected to be appropriate for you.

CYP2B6 Normal metabolizer

CYP2B6: Normal metabolizer

CPIC guideline, CYP2B6

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Normal efavirenz metabolism
What the guideline suggests: Initiate efavirenz with standard dosing (600 mg/day)

CYP2B6: Normal metabolizer

FDA drug label, CYP2B6

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body processes efavirenz at a normal rate. The standard dose should work as expected.
What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Antivirals

Peginterferon Alfa-2A

Use as directed

Pegasys

Your genes make this hepatitis C drug more likely to work. You may be able to take it for a shorter time.

IFNL3 Favorable response genotype

IFNL3: Favorable response genotype

CPIC guideline, IFNL3

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Approximately 70% chance for sustained virologic response (SVR) after 48 weeks of treatment. Consider implications before initiating PEG-IFN alpha and RBV containing regimens.
What the guideline suggests: Approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients are eligible for shortened therapy (24-28 weeks vs. 48 weeks). Weighs in favor of using PEG-IFN alpha and RBV containing regimens.

Peginterferon Alfa-2B

Use as directed

PegIntron

Your genes make this hepatitis C drug more likely to work. You may be able to take it for a shorter time.

IFNL3 Favorable response genotype

IFNL3: Favorable response genotype

CPIC guideline, IFNL3

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Approximately 70% chance for sustained virologic response (SVR) after 48 weeks of treatment. Consider implications before initiating PEG-IFN alpha and RBV containing regimens.
What the guideline suggests: Approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients are eligible for shortened therapy (24-28 weeks vs. 48 weeks). Weighs in favor of using PEG-IFN alpha and RBV containing regimens.

Ribavirin

Use as directed

Copegus, Rebetol, Virazole

Your genes make this hepatitis C treatment more likely to work. You may be able to take it for a shorter time.

IFNL3 Favorable response genotype

IFNL3: Favorable response genotype

CPIC guideline, IFNL3

Use as directed Evidence: strongRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Approximately 70% chance for sustained virologic response (SVR) after 48 weeks of treatment. Consider implications before initiating PEG-IFN alpha and RBV containing regimens.
What the guideline suggests: Approximately 90% chance for SVR after 24-48 weeks of treatment. Approximately 80-90% of patients are eligible for shortened therapy (24-28 weeks vs. 48 weeks). Weighs in favor of using PEG-IFN alpha and RBV containing regimens.

Antifungals 1 medication

1 Use with caution

Voriconazole

Use with caution

Vfend

Your body breaks down this drug more slowly, so levels can rise and side effects are more likely.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

CPIC guideline, CYP2C19

Use as directed Evidence: moderateRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your body breaks down this drug a bit more slowly, so levels may run a little higher. The usual dose is still advised.
What it means: Higher dose-adjusted trough concentrations of voriconazole compared to normal metabolizers.
What the guideline suggests: Initiate therapy with recommended standard of care dosing.

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Use with caution Evidence: moderateSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and may result in higher adverse reaction risk.
What the label suggests: No specific dosing change in the FDA table. Refer to FDA labeling.

Anesthetics 8 medications

1 Use as directed7 Unable to determine

Desflurane

Unable to determine

We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.

RYR1 No resultCACNA1S No result

RYR1: No result; CACNA1S: No result

CPIC guideline, both genes together

Unable to determine Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for desflurane, so this label reflects both genes.

Enflurane

Unable to determine

We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.

RYR1 No resultCACNA1S No result

RYR1: No result; CACNA1S: No result

CPIC guideline, both genes together

Unable to determine Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for enflurane, so this label reflects both genes.

Halothane

Unable to determine

We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.

RYR1 No resultCACNA1S No result

RYR1: No result; CACNA1S: No result

CPIC guideline, both genes together

Unable to determine Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for halothane, so this label reflects both genes.

Isoflurane

Unable to determine

We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.

RYR1 No resultCACNA1S No result

RYR1: No result; CACNA1S: No result

CPIC guideline, both genes together

Unable to determine Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for isoflurane, so this label reflects both genes.

Methoxyflurane

Unable to determine

We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.

RYR1 No resultCACNA1S No result

RYR1: No result; CACNA1S: No result

CPIC guideline, both genes together

Unable to determine Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for methoxyflurane, so this label reflects both genes.

Mivacurium

Use as directed

Mivacron

Your body breaks down this drug normally. Your doctor can use the usual dose.

BCHE Normal metabolizer

BCHE: Normal metabolizer

FDA drug label, BCHE

Use as directed Evidence: strongSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Normal BCHE activity and expected metabolism of mivacurium.
What the label suggests: Initiate therapy with recommended starting dose and adjust per standard clinical practice.

Sevoflurane

Unable to determine

We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.

RYR1 No resultCACNA1S No result

RYR1: No result; CACNA1S: No result

CPIC guideline, both genes together

Unable to determine Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

CPIC reads your RYR1 and CACNA1S results together for sevoflurane, so this label reflects both genes.

Succinylcholine

Unable to determine

Quelicin, Anectine

We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected.

RYR1 No resultCACNA1S No resultBCHE Normal metabolizer

RYR1: No result; CACNA1S: No result

CPIC guideline, both genes together

Unable to determine Read the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

What it means: Malignant hyperthermia susceptibility could not be determined.
What the guideline suggests: Clinical findings, family history and clinical evaluation should guide anesthesia decisions.

BCHE: Normal metabolizer

FDA drug label, BCHE

Use as directed Evidence: strongSee the FDA table (U.S. Food and Drug Administration, opens in a new tab)

In plain words: Your body breaks down this drug normally. Your doctor can use the usual dose.
What it means: Normal BCHE activity and expected metabolism of succinylcholine.
What the label suggests: Initiate therapy with recommended starting dose and adjust per standard clinical practice.

CPIC reads your RYR1 and CACNA1S results together for succinylcholine, so this label reflects both genes.

Weight management 3 medications

2 Use with caution1 Use as directed

Retatrutide

Use with caution

Your GIPR gene raises your chance of nausea or vomiting on retatrutide: roughly 4.4% of people with your genotype vomit, compared with about 2.5% at the lowest risk. Semaglutide is not affected by this gene.

GLP1R Typical responseGIPR Decreased function

GLP1R: Typical response; GIPR: Decreased function

Gene2Rx research summary, both genes together

Use with caution Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

What it means: GLP1R: the more common Pro7/Pro7 form of the signal peptide (rs10305420 C/C). GIPR: one copy of the Gln354 partial loss-of-function allele (rs1800437 G/C). No pharmacogenetic study of retatrutide exists; by extrapolation from the tirzepatide data this pair is expected to carry roughly 1.8-fold the odds of moderate-to-severe vomiting seen with the lowest-risk genotype pair. Expected weight-loss efficacy from the GLP1R arm of retatrutide. The GIPR component of this risk is specific to dual GIP/GLP-1 agonists and does not apply to semaglutide.
What the research suggests: Use standard dosing but consider a slower dose-escalation schedule, and counsel on the elevated chance of nausea and vomiting. If GI symptoms are intolerable, a GLP1R-only agonist such as semaglutide is unaffected by the GIPR variant and may be better tolerated.

Gene2Rx reads your GLP1R and GIPR results together for retatrutide, so this label reflects both genes.

Semaglutide

Use as directed

Ozempic, Wegovy

Your genes point to a typical response to this drug, with average weight loss and side effects.

GLP1R Typical response

GLP1R: Typical response

Gene2Rx research summary, GLP1R

Use as directed Evidence: moderateSee the drug page (Gene2Rx research summaries, opens in a new tab)

What it means: The Pro7/Pro7 form of the GLP1R signal peptide (rs10305420 C/C). The Leu7 (T) allele is the less common one in every ancestry group studied. Expected weight-loss efficacy and typical nausea/vomiting risk.
What the research suggests: Standard dosing and titration are expected to produce an average response.

Tirzepatide

Use with caution

Mounjaro, Zepbound

Your GIPR gene raises your chance of nausea or vomiting on tirzepatide: roughly 4.4% of people with your genotype vomit, compared with about 2.5% at the lowest risk. Semaglutide is not affected by this gene.

GLP1R Typical responseGIPR Decreased function

GLP1R: Typical response; GIPR: Decreased function

Gene2Rx research summary, both genes together

Use with caution Evidence: moderateSee the drug page (Gene2Rx research summaries, opens in a new tab)

What it means: GLP1R: the more common Pro7/Pro7 form of the signal peptide (rs10305420 C/C). GIPR: one copy of the Gln354 partial loss-of-function allele (rs1800437 G/C). Estimated risk of moderate-to-severe vomiting on tirzepatide is about 4.4% versus 2.5% for the lowest-risk genotype pair (odds ratio 1.8), and nausea about 17% versus 14%. Expected weight-loss efficacy from the GLP1R arm of tirzepatide. The GIPR component of this risk is specific to dual GIP/GLP-1 agonists and does not apply to semaglutide.
What the research suggests: Use standard dosing but consider a slower dose-escalation schedule, and counsel on the elevated chance of nausea and vomiting. If GI symptoms are intolerable, semaglutide is unaffected by the GIPR variant and may be better tolerated.

Gene2Rx reads your GLP1R and GIPR results together for tirzepatide, so this label reflects both genes.

Antidiabetics 1 medication

1 Use as directed

Nateglinide

Use as directed

Starlix

Your body breaks down nateglinide slightly slower than normal. The standard dose should work as expected.

CYP2C9 Intermediate metabolizer

CYP2C9: Intermediate metabolizer

FDA drug label, CYP2C9

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for this phenotype
What the label suggests: Initiate therapy with recommended starting dose.

Antihistamines 1 medication

1 Use with caution

Meclizine

Use with caution

Antivert

Your body breaks down meclizine much more slowly than normal, which may cause the drug to build up to higher levels and increase the risk of side effects. Close monitoring is recommended.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: May affect systemic concentrations. Monitor for adverse reactions and clinical effect.
What the label suggests: Monitor for adverse reactions and clinical effect.

Drugs used in addictive disorders 1 medication

1 Use with caution

Lofexidine

Use with caution

Lucemyra

Your body breaks down lofexidine more slowly than normal, causing it to build up in your system. This increases the risk of side effects like low blood pressure and a slow heart rate.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk. Monitor for orthostatic hypotension and bradycardia.
What the label suggests: Monitor for orthostatic hypotension and bradycardia.

Female sexual health 1 medication

1 Use as directed

Flibanserin

Use as directed

Addyi

Your CYP2C19 result means somewhat lower CYP2C19 activity than usual, but the FDA gives no genetic dosing change for flibanserin at this result.

CYP2C19 Intermediate metabolizer

CYP2C19: Intermediate metabolizer

FDA drug label, CYP2C19

Use as directed See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: No FDA guidance for your genotype
What the label suggests: Initiate therapy with recommended starting dose.

Gaucher's disease treatments 1 medication

1 Use with caution

Eliglustat

Use with caution

Cerdelga

Your body breaks down this drug much more slowly, which can raise the risk of heart rhythm problems. Your doctor will set your dose, and some other medicines can't be taken with it.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Alters systemic concentrations, effectiveness, and adverse reaction risk (QT prolongation). Coadministration with strong CYP3A inhibitors is contraindicated in intermediate and poor CYP2D6 metabolizers. Refer to FDA labeling for specific dosing recommendations.
What the label suggests: Use the dosage the FDA label gives for CYP2D6 poor metabolizers. Coadministration with strong CYP3A inhibitors is contraindicated.

Gout 1 medication

1 Use as directed

Allopurinol

Use as directed

Zyloprim

Your ABCG2 genotype does not change how you respond to allopurinol; standard dosing applies.

ABCG2 Normal function

ABCG2: Normal function

DPWG guideline, ABCG2

Use as directed Evidence: moderateRead the guideline (Dutch Pharmacogenetics Working Group, opens in a new tab)

What it means: Normal ABCG2 transporter function. Renal and intestinal uric acid excretion is not impaired by ABCG2 variation at p.Gln141Lys.
What the guideline suggests: Use standard allopurinol dosing.

Hair loss 1 medication

1 Use as directed

Topical minoxidil

Use as directed

Rogaine

Your SULT1A1 result suggests normal enzyme function. This enzyme helps activate topical minoxidil, but hair growth results can vary. Use topical minoxidil as directed and assess hair growth over time with your clinician.

SULT1A1 Normal function

SULT1A1: Normal function

Gene2Rx research summary, SULT1A1

Use as directed Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

What it means: Your SULT1A1 result suggests normal enzyme function. This enzyme helps activate topical minoxidil, but hair growth results can vary.
What the research suggests: Use topical minoxidil as directed and assess hair growth over time with your clinician.

Saliva production stimulators 1 medication

1 Use with caution

Cevimeline

Use with caution

Evoxac

Your body breaks down cevimeline much more slowly than normal, which may increase the risk of side effects. Careful monitoring by your doctor is recommended.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: May result in higher adverse reaction risk. Use with caution.
What the label suggests: Use with caution.

Urologicals 1 medication

1 Use with caution

Tolterodine

Use with caution

Detrol

Your body breaks down tolterodine more slowly than normal, causing it to build up in your system. This increases the risk of side effects, including heart rhythm problems.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

FDA drug label, CYP2D6

Use with caution See the FDA table (U.S. Food and Drug Administration, opens in a new tab)

What it means: Results in higher systemic concentrations and higher adverse reaction risk (QT prolongation).
What the label suggests: No specific dosing change in the FDA table. Refer to FDA labeling.

Other substances 7 medications

5 Use with caution2 Use as directed

Alcohol

Use as directed

Your genes have little effect on how your body handles alcohol.

ADH1B Normal functionALDH2 Normal function

ADH1B: Normal function

Gene2Rx research summary, ADH1B

Use as directed See the drug page (Gene2Rx research summaries, opens in a new tab)

What it means: Two Arg48 alleles (rs1229984). Usual rate of ethanol oxidation. Compared with His48 carriers, associated with higher risk of alcohol dependence and, among heavy drinkers in East Asian studies, higher risk of esophageal and head and neck cancer. Only rs1229984 is assessed: ADH1B*3 (rs2066702), common in people of African ancestry, is not read, so its carriers are reported here.
What the research suggests: Follow standard guidelines for alcohol consumption.

ALDH2: Normal function

Gene2Rx research summary, ALDH2

Use as directed See the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your genes have little effect on how you clear the toxic by-product of alcohol.
What it means: Two Glu504 alleles (rs671 G/G, ALDH2*1/*1). Normal acetaldehyde clearance; typical risk of flushing, hangover and alcohol dependence for this gene.
What the research suggests: Standard advice on drinking limits.

Caffeine

Use with caution

Coffee, Tea

Caffeine may wear off slightly sooner for you than average. The usual advice on caffeine limits applies.

CYP1A2 Rapid metabolizer

CYP1A2: Rapid metabolizer

Gene2Rx research summary, CYP1A2

Use with caution Evidence: moderateSee the drug page (Gene2Rx research summaries, opens in a new tab)

What it means: One rs762551 A allele (*1/*30). Modestly higher CYP1A2 activity, mainly in smokers. Note: in the coffee and cardiovascular literature, A/C carriers are classed as 'slow' metabolizers.
What the research suggests: Caffeine may be cleared somewhat faster than average. Standard advice on moderate intake applies.

Ketamine

Use as directed

Ketalar

Your body processes ketamine at the usual rate.

CYP2B6 Normal metabolizer

CYP2B6: Normal metabolizer

Gene2Rx research summary, CYP2B6

Use as directed Evidence: strongSee the drug page (Gene2Rx research summaries, opens in a new tab)

What it means: Usual CYP2B6 activity and expected N-demethylation of ketamine to norketamine. CYP3A4 contributes to the same step, and the relative roles of the two enzymes are still debated.
What the research suggests: Initiate with standard ketamine doses per clinical practice and titrate to effect.

LSD

Use with caution

Acid

You clear this drug slowly, so its effects may be stronger and last longer. Starting with a lower dose may help avoid a bad experience.

CYP2D6 Poor metabolizer

CYP2D6: Poor metabolizer

Gene2Rx research summary, CYP2D6

Use with caution Evidence: strongSee the drug page (Gene2Rx research summaries, opens in a new tab)

What it means: No functional CYP2D6. In the pooled analysis of 81 participants, poor metabolizers had longer LSD half-lives and about 75% higher area under the curve for LSD and for 2-oxo-3-hydroxy-LSD than carriers of functional CYP2D6, and reported greater alterations of mind and longer-lasting effects. In a separate analysis of 213 participants, acute anxiety was inversely correlated with genetically determined CYP2D6 function, although dose and pre-drug mood were much stronger predictors of the experience.
What the research suggests: Expect higher exposure and a longer duration of effect. In a research setting, consider a lower starting dose with gradual increases and a longer monitoring period.

MDMA

Use with caution

Ecstasy

You have little or no activity of the main enzyme that clears MDMA. Studies have not shown that this makes MDMA poisoning more likely, and no genotype makes MDMA safe.

COMT Intermediate functionCYP2D6 Poor metabolizer

COMT: Intermediate function

Gene2Rx research summary, COMT

Use as directed Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: This is the middle result for this gene. It is not linked to a stronger or weaker reaction to MDMA.
What it means: One rs4680 G and one A allele (Val158/Met158). Intermediate COMT activity; no distinct cardiovascular or subjective pattern was reported for this genotype.
What the research suggests: No genotype-based adjustment. Watch for unexpected cognitive or cardiovascular effects.

CYP2D6: Poor metabolizer

Gene2Rx research summary, CYP2D6

Use with caution Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

What it means: No functional CYP2D6. MDMA clearance depends on CYP2D6 for no more than about 30% of its metabolism in people, and a single typical dose inactivates most CYP2D6 regardless of genotype, so the difference from other phenotypes is smaller than once assumed. No clear link between inherited CYP2D6 deficiency and acute MDMA toxicity has been demonstrated.
What the research suggests: Exposure may be higher than in normal metabolizers, but the size of the effect is not established. If exposure occurs, intensive monitoring of vital signs, temperature and fluid intake is advised.

Nicotine

Use with caution

Cigarettes, Zyn

This variant is linked to heavier smoking and finding it harder to quit. Stop-smoking medicines appear to help people with this result as much as or more than others.

CHRNA5 Increased riskCOMT Intermediate functionCYP2A6 Normal metabolizer

CHRNA5: Increased risk

Gene2Rx research summary, CHRNA5

Use with caution Evidence: strongSee the drug page (Gene2Rx research summaries, opens in a new tab)

What it means: One or two rs16969968 A alleles (Asn398). The Asn398 receptor shows reduced response to nicotinic agonists in vitro. Associated with more cigarettes per day, higher risk of nicotine dependence, later smoking cessation and earlier lung cancer diagnosis in smokers. In a cessation trial, carriers of the high-risk haplotype benefited more from cessation pharmacotherapy than non-carriers.
What the research suggests: Higher risk of heavy, persistent use. For patients who want to quit, offer cessation pharmacotherapy with counseling rather than an unassisted attempt.

COMT: Intermediate function

Gene2Rx research summary, COMT

Use with caution Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: This result has been studied in relation to smoking, but the findings are mixed, so it tells you little about how you respond to nicotine.
What it means: rs4680 Val/Met. Moderately lower COMT activity. Associations with nicotine reward, withdrawal and smoking behavior are inconsistent across studies.
What the research suggests: No genotype-based change to cessation treatment; monitor craving as usual.

CYP2A6: Normal metabolizer

Gene2Rx research summary, CYP2A6

Use as directed Evidence: strongSee the drug page (Gene2Rx research summaries, opens in a new tab)

In plain words: Your body is expected to clear nicotine at a typical rate.
What it means: No reduced-function allele detected among those assessed. Typical nicotine clearance. The CYP2A6*4 deletion, *12 hybrid and duplications are not assessed, so reduced activity cannot be ruled out.
What the research suggests: Typical response to nicotine. In smokers with normal nicotine metabolism, varenicline was more effective than the nicotine patch in a randomized trial.

THC Use with caution Cannabis, Marijuana You may be more likely to feel anxious or paranoid on THC. Starting with a lower dose can help. AKT1 Decreased functionCOMT Intermediate functionCYP2C9 Intermediate metabolizerFAAH Normal function
AKT1: Decreased function Gene2Rx research summary, AKT1 Use with caution Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab) What it means One rs2494732 C allele. In a case-control study of first-episode psychosis the variant was not associated with psychosis, cannabis use or frequency of use on its own, but modified the association between cannabis use and psychotic disorder, and acute psychotomimetic symptoms rose with C-allele count in cannabis users. A later study of 720 people found no such association. What the research suggests Some research suggests that carriers of this variant may have a moderately higher risk of psychotic-like effects from THC. However these findings are not conclusive. Consider starting at a lower dose and monitoring for psychotic-like effects or avoiding THC altogether.
COMT: Intermediate function Gene2Rx research summary, COMT Use as directed Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab) In plain words Your genes point to a typical response to THC, with an average chance of side effects. What it means One rs4680 G and one A allele (Val158/Met158). Intermediate COMT activity and average dopamine clearance. What the research suggests No COMT-based adjustment. A typical response to THC is expected.
CYP2C9: Intermediate metabolizer (activity score 1.5) Gene2Rx research summary, CYP2C9 Use as directed Evidence: weakSee the drug page (Gene2Rx research summaries, opens in a new tab) In plain words Your body may break down THC slightly more slowly than average, so effects could feel a little stronger or last a little longer. What it means Activity score 1.5 (one decreased-function allele, usually 2). Slightly reduced hydroxylation of THC. In the only published pharmacokinetic study of oral THC by CYP2C9 genotype, 2 status alone did not change THC exposure, so any increase at this activity score is expected to be small. What the research suggests Initiate at standard doses. Monitor for increased sedation or psychotropic intensity.
FAAH: Normal function Gene2Rx research summary, FAAH Use as directed Evidence: moderateSee the drug page (Gene2Rx research summaries, opens in a new tab) In plain words This gene works normally, so THC should affect you in the usual way. What it means Two rs324420 C alleles (Pro129). Usual hydrolysis of anandamide and related endocannabinoids, so baseline cannabinoid receptor tone is typical. FAAH does not metabolize THC. What the research suggests No FAAH-based adjustment. Response to THC is expected to match population norms.

Gene details and frequencies

All 30 genes. Frequency context describes populations, not your chance of a side effect. A missing frequency estimate means no supported reference is available for that result.

ABCG2 Normal function

rs2231142G/rs2231142G · Both copies work normally.

A pump that clears uric acid and some drugs, such as rosuvastatin, from the body.

2 medications list this gene. Guidance unchanged

ABCG2 normal function: estimated in 48.0% to 98.8% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean: 93.1%
American: 64.0%
Central/South Asian: 82.2%
East Asian: 48.0%
European: 80.4%
Latino: 60.2%
Near Eastern: 87.4%
Oceanian: 63.2%
Sub-Saharan African: 98.8%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC ABCG2 frequency table and methods. Data retrieved 2026-10-17.

ADH1B Normal function

rs1229984C/rs1229984C · Both copies work normally.

Turns alcohol into acetaldehyde, a toxic by-product.

1 medication lists this gene. Guidance unchanged

ADH1B rs1229984 C allele: 29.6% to 99.7% of DNA copies across ancestry groups

Your result has 2 copies of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the C allele / total DNA copies measured.

African / African American: 98.8%41,031 / 41,534
Admixed American: 93.2%14,240 / 15,282
Amish: 89.9%820 / 912
Ashkenazi Jewish: 73.1%2,539 / 3,472
East Asian: 29.6%1,530 / 5,168
Finnish: 99.7%10,586 / 10,618
Middle Eastern: 78.6%231 / 294
European (non-Finnish): 96.4%65,617 / 68,036
South Asian: 95.9%4,626 / 4,822
Remaining ancestry group: 88.4%1,861 / 2,106

Reference: gnomAD v4.1 genomes, GRCh38 4-99318162-T-C. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.

AKT1 Decreased function

CTrs2494732C/rs2494732T

A signaling gene linked to the risk of psychosis with heavy cannabis use.

You carry one copy of a variant linked to anxiety or paranoia from cannabis.

1 medication lists this gene. Changes the guidance for 1

AKT1 rs2494732 C allele: 33.2% to 72.2% of DNA copies across ancestry groups

Your result has 1 copy of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the C allele / total DNA copies measured.

African / African American: 49.2%20,373 / 41,440
Admixed American: 55.2%8,437 / 15,284
Amish: 33.2%303 / 912
Ashkenazi Jewish: 42.2%1,464 / 3,466
East Asian: 72.2%3,713 / 5,144
Finnish: 43.7%4,616 / 10,572
Middle Eastern: 44.2%130 / 294
European (non-Finnish): 43.3%29,377 / 67,904
South Asian: 59.8%2,887 / 4,824
Remaining ancestry group: 47.3%998 / 2,110

Reference: gnomAD v4.1 genomes, GRCh38 14-104772855-T-C. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.

ALDH2 Normal function

rs671G/rs671G · Both copies work normally.

Clears acetaldehyde, the toxic by-product of alcohol.

1 medication lists this gene. Guidance unchanged

ALDH2 rs671 A allele: 0% to 22.5% of DNA copies across ancestry groups

Your result has 0 copies of this allele. These gnomAD frequencies count DNA copies, not people who share your genotype or phenotype, and do not measure your chance of side effects. No ancestry is assumed for you.

Counts below show copies of the A allele / total DNA copies measured.

African / African American: <0.1%8 / 41,546
Admixed American: <0.1%14 / 15,274
Amish: 0%0 / 912
Ashkenazi Jewish: 0%0 / 3,470
East Asian: 22.5%1,154 / 5,132
Finnish: <0.1%1 / 10,598
Middle Eastern: 0%0 / 294
European (non-Finnish): <0.1%2 / 68,020
South Asian: <0.1%4 / 4,820
Remaining ancestry group: 0.5%10 / 2,108

Reference: gnomAD v4.1 genomes, GRCh38 12-111803962-G-A. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.

BCHE Normal metabolizer

Reference/Reference · Both copies work normally.

Breaks down two muscle relaxers used in surgery. These are succinylcholine and mivacurium.

2 medications list this gene. Guidance unchanged

CACNA1S Not checked

Not determined · We couldn't check this gene from your data. This does not mean that a normal response is expected.

A muscle channel. Rare changes in it can cause a dangerous reaction to some anesthetics.

7 medications list this gene. Shown as "Unable to determine"

CHRNA5 Increased risk

AArs16969968A/rs16969968A

A nicotine receptor in the brain linked to heavy smoking.

You carry a variant linked to heavier smoking and a harder time quitting.

1 medication lists this gene. Changes the guidance for 1

CHRNA5 rs16969968 A allele: 3.2% to 40.7% of DNA copies across ancestry groups

Counts below show copies of the A allele / total DNA copies measured.

African / African American: 5.9%2,458 / 41,526
Admixed American: 22.6%3,458 / 15,290
Amish: 40.7%368 / 904
Ashkenazi Jewish: 37.5%1,302 / 3,470
East Asian: 3.2%166 / 5,186
Finnish: 32.7%3,455 / 10,568
Middle Eastern: 40.1%118 / 294
European (non-Finnish): 34.7%23,587 / 67,982
South Asian: 22.2%1,069 / 4,826
Remaining ancestry group: 27.5%581 / 2,112

Reference: gnomAD v4.1 genomes, GRCh38 15-78590583-G-A. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.

COMT Intermediate function

rs4680A/rs4680G · One copy works and one works less well.

Breaks down dopamine and other brain chemicals.

3 medications list this gene. Changes the guidance for 1

COMT rs4680 A allele: 27.4% to 66.4% of DNA copies across ancestry groups

Counts below show copies of the A allele / total DNA copies measured.

African / African American: 31.0%12,853 / 41,484
Admixed American: 40.4%6,184 / 15,292
Amish: 66.4%604 / 910
Ashkenazi Jewish: 45.3%1,571 / 3,466
East Asian: 27.4%1,414 / 5,152
Finnish: 55.3%5,854 / 10,592
Middle Eastern: 46.9%138 / 294
European (non-Finnish): 51.8%35,191 / 67,942
South Asian: 44.5%2,147 / 4,822
Remaining ancestry group: 41.8%883 / 2,110

Reference: gnomAD v4.1 genomes, GRCh38 22-19963748-G-A. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.

CYP1A2 Rapid metabolizer

*1/*30 · One copy works normally and one works faster than usual.

Breaks down caffeine and some medicines, such as clozapine.

1 medication lists this gene. Changes the guidance for 1

CYP2A6 Normal metabolizer

*1/*1 · Both copies work normally.

Breaks down nicotine.

1 medication lists this gene. Guidance unchanged

CYP2B6 Normal metabolizer

*1/*1 · Both copies work normally.

Breaks down efavirenz, ketamine, methadone and some drugs for depression.

3 medications list this gene. Guidance unchanged

CYP2B6 normal metabolizer: estimated in 13.0% to 48.6% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean: 33.4%
Central/South Asian: 42.2%
East Asian: 48.6%
European: 43.0%
Latino: 33.6%
Near Eastern: 29.1%
Oceanian: 13.0%
Sub-Saharan African: 14.3%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC CYP2B6 frequency table and methods. Data retrieved 2026-10-17.

CYP2C19 Intermediate metabolizer

*1/*2 · One copy works and one doesn't.

Handles several SSRIs, acid reducers such as omeprazole, and the blood thinner clopidogrel.

21 medications list this gene. Changes the guidance for 17

CYP2C19 intermediate metabolizer: estimated in 19.0% to 45.9% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean: 31.4%
American: 21.4%
Central/South Asian: 40.8%
East Asian: 45.9%
European: 26.1%
Latino: 19.0%
Near Eastern: 23.5%
Oceanian: 36.9%
Sub-Saharan African: 29.9%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC CYP2C19 frequency table and methods. Data retrieved 2026-10-17.

CYP2C9 Intermediate metabolizer

*1/*2 · One copy works and one works less well.

Clears warfarin, phenytoin, celecoxib and some other pain relievers.

Activity score: 1.5. Typical range: 2.

16 medications list this gene. Changes the guidance for 8

CYP2C9 intermediate metabolizer: estimated in 8.7% to 36.2% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean: 23.6%
American: 16.4%
Central/South Asian: 36.2%
East Asian: 15.2%
European: 34.5%
Latino: 24.6%
Near Eastern: 35.9%
Oceanian: 8.7%
Sub-Saharan African: 26.3%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC CYP2C9 frequency table and methods. Data retrieved 2026-10-17.

CYP2D6 Poor metabolizer

*4/*4 · Neither copy works.

Turns on or clears about 1 in 4 prescription drugs. These include many drugs for depression, pain and ADHD.

Activity score: 0.0. Typical range: 1.25 to 2.25.

47 medications list this gene. Changes the guidance for 45

CYP2D6 poor metabolizer: estimated in 0.3% to 6.5% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean: 2.3%
American: 2.0%
Central/South Asian: 2.4%
East Asian: 0.8%
European: 6.5%
Latino: 3.1%
Near Eastern: 2.2%
Oceanian: 0.3%
Sub-Saharan African: 2.0%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC CYP2D6 frequency table and methods. Data retrieved 2026-10-17.

CYP3A4 Normal metabolizer

*1/*1 · Both copies work normally.

Breaks down more prescription drugs than any other enzyme.

1 medication lists this gene. Guidance unchanged

CYP3A5 Intermediate metabolizer

*1/*3 · One copy works and one doesn't.

Breaks down tacrolimus, a drug used after organ transplants.

1 medication lists this gene. Changes the guidance for 1

CYP3A5 intermediate metabolizer: estimated in 13.7% to 49.9% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean: 49.6%
Central/South Asian: 44.0%
East Asian: 37.9%
European: 13.7%
Latino: 28.6%
Near Eastern: 21.4%
Sub-Saharan African: 49.9%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC CYP3A5 frequency table and methods. Data retrieved 2026-10-17.

CYP4F2 Intermediate metabolizer

*1/*3 · One copy works and one works less well.

Clears extra vitamin K from the body, which changes how much warfarin you need.

1 medication lists this gene. Changes the guidance for 1

DPYD Normal metabolizer

Reference/Reference · Both copies work normally.

Breaks down the cancer drugs fluorouracil and capecitabine.

Activity score: 2.0. Typical range: 2.

2 medications list this gene. Guidance unchanged

FAAH Normal function

rs324420C/rs324420C · Both copies work normally.

Breaks down chemicals your body makes that act like cannabis.

1 medication lists this gene. Guidance unchanged

FAAH rs324420 A allele: 14.5% to 35.9% of DNA copies across ancestry groups

Counts below show copies of the A allele / total DNA copies measured.

African / African American: 35.9%14,873 / 41,480
Admixed American: 30.4%4,643 / 15,292
Amish: 14.5%132 / 910
Ashkenazi Jewish: 14.7%509 / 3,470
East Asian: 17.6%910 / 5,176
Finnish: 27.8%2,946 / 10,584
Middle Eastern: 15.1%44 / 292
European (non-Finnish): 20.7%14,044 / 67,986
South Asian: 19.6%946 / 4,826
Remaining ancestry group: 23.9%506 / 2,116

Reference: gnomAD v4.1 genomes, GRCh38 1-46405089-C-A. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.

GIPR Decreased function

rs1800437C/rs1800437G · One copy works and one works less well.

A gut-hormone receptor that tirzepatide and retatrutide act on.

2 medications list this gene. Changes the guidance for 2

GIPR rs1800437 C allele: 11.5% to 29.5% of DNA copies across ancestry groups

Counts below show copies of the C allele / total DNA copies measured.

African / African American: 11.5%4,770 / 41,492
Admixed American: 13.2%2,018 / 15,286
Amish: 11.6%106 / 910
Ashkenazi Jewish: 29.5%1,022 / 3,470
East Asian: 19.9%1,021 / 5,142
Finnish: 22.8%2,405 / 10,570
Middle Eastern: 16.0%47 / 294
European (non-Finnish): 20.6%14,004 / 67,974
South Asian: 15.1%726 / 4,818
Remaining ancestry group: 19.8%417 / 2,110

Reference: gnomAD v4.1 genomes, GRCh38 19-45678134-G-C. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.

GLP1R Typical response

CCrs10305420C/rs10305420C

The receptor that semaglutide and other GLP-1 drugs act on.

You have the most common form of this receptor, so GLP-1 drugs should work as expected.

3 medications list this gene. Guidance unchanged

GLP1R rs10305420 T allele: 7.7% to 39.8% of DNA copies across ancestry groups

Counts below show copies of the T allele / total DNA copies measured.

African / African American: 7.7%3,208 / 41,572
Admixed American: 29.9%4,573 / 15,294
Amish: 26.2%239 / 912
Ashkenazi Jewish: 36.9%1,279 / 3,470
East Asian: 14.4%740 / 5,154
Finnish: 39.8%4,217 / 10,590
Middle Eastern: 36.3%106 / 292
European (non-Finnish): 38.2%25,971 / 67,946
South Asian: 19.2%926 / 4,830
Remaining ancestry group: 28.4%601 / 2,114

Reference: gnomAD v4.1 genomes, GRCh38 6-39048860-C-T. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.

IFNL3 Favorable response genotype

CCrs12979860C/rs12979860C

An immune gene that affects how well hepatitis C treatment works.

Hepatitis C treatment with peginterferon is more likely to work for you.

3 medications list this gene. Guidance unchanged

IFNL3 rs12979860 T allele: 7.1% to 60.3% of DNA copies across ancestry groups

Counts below show copies of the T allele / total DNA copies measured.

African / African American: 60.3%25,033 / 41,510
Admixed American: 37.4%5,725 / 15,292
Amish: 36.9%332 / 900
Ashkenazi Jewish: 39.4%1,369 / 3,472
East Asian: 7.1%369 / 5,176
Finnish: 24.1%2,553 / 10,600
Middle Eastern: 38.1%112 / 294
European (non-Finnish): 31.5%21,409 / 67,956
South Asian: 22.7%1,094 / 4,828
Remaining ancestry group: 36.3%767 / 2,114

Reference: gnomAD v4.1 genomes, GRCh38 19-39248147-C-T. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.

NAT2 Poor metabolizer

*16/*5 · Both copies work less well.

Breaks down hydralazine, isoniazid and some other drugs.

1 medication lists this gene. Changes the guidance for 1

NUDT15 Normal metabolizer

*1/*1 · Both copies work normally.

Breaks down the active form of thiopurines such as azathioprine.

3 medications list this gene. Guidance unchanged

NUDT15 normal metabolizer: estimated in 79.2% to 98.6% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

Central/South Asian: 86.6%
East Asian: 79.2%
European: 98.6%
Latino: 87.7%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC NUDT15 frequency table and methods. Data retrieved 2026-10-17.

RYR1 Not checked

Not determined · We couldn't check this gene from your data. This does not mean that a normal response is expected.

A muscle channel. Rare changes in it can cause a dangerous reaction to some anesthetics.

7 medications list this gene. Shown as "Unable to determine"

SLCO1B1 Decreased function

*15/*1A · One copy works and one works less well.

Moves statins into the liver.

7 medications list this gene. Changes the guidance for 6

SLCO1B1 decreased function: estimated in 0% to 36.5% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean: 2.0%
American: 36.5%
Central/South Asian: 13.0%
East Asian: 21.8%
European: 28.3%
Near Eastern: 32.0%
Oceanian: 0%
Sub-Saharan African: 5.4%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC SLCO1B1 frequency table and methods. Data retrieved 2026-10-17.

SULT1A1 Normal function

*1/*1 · Both copies work normally.

Turns topical minoxidil into its active form in the scalp.

1 medication lists this gene. Guidance unchanged

TPMT Normal metabolizer

*1/*1 · Both copies work normally.

Breaks down thiopurines such as azathioprine and mercaptopurine.

3 medications list this gene. Guidance unchanged

TPMT normal metabolizer: estimated in 86.5% to 96.3% of people across population groups

These CPIC estimates describe this phenotype, not your exact DNA combination or your chance of side effects. Frequencies vary by population; no ancestry is assumed for you.

African American/Afro-Caribbean: 86.5%
Central/South Asian: 96.3%
East Asian: 96.0%
European: 90.9%
Latino: 89.2%
Near Eastern: 93.2%
Sub-Saharan African: 89.3%

Estimated from published allele frequencies, rather than a direct count of people with this result. Study coverage and methods vary. Reference: CPIC TPMT frequency table and methods. Data retrieved 2026-10-17.

UGT1A1 Intermediate metabolizer

*1/*28+*60+*80 · One copy works and one works less well.

Clears bilirubin and some drugs, such as the cancer drug irinotecan.

6 medications list this gene. Guidance unchanged

VKORC1 Decreased expression

AG-1639A/-1639G

Recycles vitamin K and is the protein warfarin blocks.

You make less of the protein warfarin blocks, so you may need a lower warfarin dose.

1 medication lists this gene. Changes the guidance for 1

VKORC1 rs9923231 -1639A allele: 10.0% to 89.2% of DNA copies across ancestry groups

Counts below show copies of the -1639A allele / total DNA copies measured.

African / African American: 10.0%4,141 / 41,504
Admixed American: 39.1%5,974 / 15,262
Amish: 44.2%400 / 906
Ashkenazi Jewish: 49.9%1,734 / 3,472
East Asian: 89.2%4,612 / 5,172
Finnish: 39.1%4,127 / 10,558
Middle Eastern: 53.4%156 / 292
European (non-Finnish): 37.8%25,693 / 67,986
South Asian: 17.8%859 / 4,824
Remaining ancestry group: 38.9%824 / 2,116

Reference: gnomAD v4.1 genomes, GRCh38 16-31096368-C-T. Frequencies are allele count divided by allele number within each ancestry group. Study groups are not representative of the worldwide population. Data retrieved 2026-10-17.

About this report

28 of 30 genes have results; 113 medications have a determined guidance label.

Not checked: CACNA1S, RYR1. A result that could not be determined is not a normal result.

CYP2D6 copy number is not measured. Deletions or duplications can change the CYP2D6 result.

Rare variants can be missed. Arrays test selected positions; imputation helps fill the gaps but can still miss rare variants.

How the results were read

Untested array positions are estimated using a reference panel (imputation). The two gene copies are named and matched to published phenotype tables and medication guidance.

Sources

CPIC - Clinical Pharmacogenetics Implementation Consortium: 64 medications. Peer-reviewed prescribing guidelines.

DPWG - Dutch Pharmacogenetics Working Group: 9 medications. Prescribing guidelines used across Europe.

FDA - U.S. Food and Drug Administration: 61 medications. Pharmacogenetic information in drug labels.

Gene2Rx - Gene2Rx research summaries: 11 medications. Published studies we summarize where no guideline exists yet.

Source links in the medication guidance remain clickable in the PDF. Gene2Rx is not affiliated with or endorsed by CPIC, the FDA or DPWG. Research summaries can have different evidence and actionability from clinical guidelines.

Questions

What do I do now?

If you may have an unusual response to a medication you take or are considering, talk with your healthcare provider or a genetic counselor before making changes. The sources beside each finding explain its evidence and limits. Not every finding supports a treatment change.

Should I change medications or my dose based on this report?

No. Do not change a dose or stop a medication without talking to your healthcare provider first. Consumer DNA data is not clinical grade. Use this report to start a conversation with your provider, who may order a clinical lab test. Research on consumer genetic testing.

Are these expert annotations?

Each finding names its source. CPIC, FDA, DPWG and Gene2Rx interpretations have different levels of evidence. These organizations do not endorse Gene2Rx interpretations, which explain the research and its limitations alongside each finding.

Why would my results change?

Your genes do not change, but research does. Guidelines and drug labels are updated when new research meets strict standards and experts agree. Your report preserves the guidance used when it was made; an updated report may use newer guidance.

I do not see my medication. Why not?

Not every medication is affected by genetics, and some need more research before guidance exists. A medication may also be missing because of your report tier, your data or what this report covers. A missing medication may still have guidance from a clinical guideline or drug label.

Why should I confirm results before changing treatment? Consumer data is not clinical grade and the findings are predictions. Additional genetic variation, health conditions and other medicines can affect response. Discuss any treatment decision with your healthcare provider or pharmacist.

More questions: contact@gene2rx.com. Full interactive report: gene2rx.com.

Compact report · Example

Full Report

Prepared for Leslie Knope · Oct 27, 2026 · Version 4.5

23andMe · GRCh37 · 30 genes · 120 medications

All results, summarized. Use the detailed report for full source recommendations, evidence, dose calculations and frequencies. Sources may offer different advice.

Not a clinical test. Do not change or stop a medication without your prescriber. Confirm important findings with a clinical-grade test. Missing or undetermined results do not mean normal results.

Gene results

Gene	Copies	Genotype	Phenotype	Score
ABCG2		rs2231142G/rs2231142G	Normal Function	-
ADH1B		rs1229984C/rs1229984C	Normal Function	-
AKT1	CT	rs2494732C/rs2494732T	Decreased Function	-
ALDH2		rs671G/rs671G	Normal Function	-
BCHE		Reference/Reference	Normal Metabolizer	-
CACNA1S		Not determined	Not checked	-
CHRNA5	AA	rs16969968A/rs16969968A	Increased Risk	-
COMT		rs4680A/rs4680G	Intermediate Function	-
CYP1A2		1/30	Rapid Metabolizer	-
CYP2A6		1/1	Normal Metabolizer	-
CYP2B6		1/1	Normal Metabolizer	-
CYP2C19		1/2	Intermediate Metabolizer	-
CYP2C9		1/2	Intermediate Metabolizer	1.5
CYP2D6		4/4	Poor Metabolizer	0.0
CYP3A4		1/1	Normal Metabolizer	-
CYP3A5		1/3	Intermediate Metabolizer	-
CYP4F2		1/3	Intermediate Metabolizer	-
DPYD		Reference/Reference	Normal Metabolizer	2.0
FAAH		rs324420C/rs324420C	Normal Function	-
GIPR		rs1800437C/rs1800437G	Decreased Function	-
GLP1R	CC	rs10305420C/rs10305420C	Typical Response	-
IFNL3	CC	rs12979860C/rs12979860C	Favorable Response Genotype	-
NAT2		16/5	Poor Metabolizer	-
NUDT15		1/1	Normal Metabolizer	-
RYR1		Not determined	Not checked	-
SLCO1B1		15/1A	Decreased Function	-
SULT1A1		1/1	Normal Function	-
TPMT		1/1	Normal Metabolizer	-
UGT1A1		1/28+60+80	Intermediate Metabolizer	-
VKORC1	AG	-1639A/-1639G	Decreased Expression	-

Score: gene activity score, where defined. Glyph fill shows each copy’s function; color shows the overall phenotype. Full explanations and typical activity ranges are in the detailed report.

Color shows the overall gene result. Dot fill shows each copy’s function; lettered dots show your DNA letters where copy function isn’t defined.

Normal / typical / favorable
Intermediate / decreased
Poor / increased risk
Rapid / increased
Not determined

All medications

Summaries describe the report’s overall guidance. “Use as directed” does not guarantee effectiveness or freedom from side effects. Brand names are shown where available.

Summaries use Gene2Rx wording. Summary sources: CPIC = Clinical Pharmacogenetics Implementation Consortium; DPWG = Dutch Pharmacogenetics Working Group; FDA = U.S. Food and Drug Administration drug information; Gene2Rx = research summary. “Report note” is a report explanation without a source summary. See the detailed report for all sources and recommendations.

CYP2D6 copy number is not measured. Arrays test selected positions; imputation helps fill gaps but can still miss rare variants. Not checked: CACNA1S, RYR1.

Antidepressants 14

Medication	Guidance	Genes	Summary
VenlafaxineEffexor XR	Consider alternative	CYP2D6	Your body breaks down this drug much more slowly, which has been linked to more side effects. A different antidepressant may be a better choice. (Summarized from CPIC)
CitalopramCelexa	Use with caution	CYP2C19	Your body may break down the drug more slowly, increasing side effects. Your doctor may use a lower dose or adjust it more slowly. (Summarized from CPIC)
EscitalopramLexapro	Use with caution	CYP2C19	Your body may break down the drug more slowly, increasing side effects. Your doctor may use a lower dose or adjust it more slowly. (Summarized from CPIC)
FluvoxamineLuvox	Use with caution	CYP2D6	Your body breaks down this drug much more slowly. A lower starting dose, a slower increase, or a different drug may be safer. (Summarized from CPIC)
ParoxetinePaxil, Seroxat	Use with caution	CYP2D6	Your body processes this drug very slowly, so you may need half the usual dose to avoid side effects. (Summarized from CPIC)
SertralineZoloft	Use with caution	CYP2C19CYP2B6	Your body processes this drug a bit more slowly. You can start at the usual dose, but your doctor may raise it slowly, and a lower ongoing dose may be enough. (Summarized from CPIC)
VortioxetineTrintellix, Brintellix	Use with caution	CYP2D6	Your body clears this drug much more slowly. Half the usual starting dose is advised, or a different antidepressant. (Summarized from CPIC)
AmitriptylineElavil	Consider alternative	CYP2D6CYP2C19	Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested. (Summarized from CPIC)
ClomipramineAnafranil	Consider alternative	CYP2D6CYP2C19	Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested. (Summarized from CPIC)
DesipramineNorpramin	Consider alternative	CYP2D6	Your body breaks down this drug much more slowly, so it can build up and cause side effects. A different medicine is usually suggested. (Summarized from CPIC)
DoxepinSinequan, Quitaxon, Aponal	Consider alternative	CYP2D6CYP2C19	Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested. (Summarized from CPIC)
ImipramineTofranil	Consider alternative	CYP2D6CYP2C19	Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested. (Summarized from CPIC)
NortriptylinePamelor	Consider alternative	CYP2D6	Your body breaks down this drug very slowly, so it builds up and side effects are more likely. A different drug is usually suggested. (Summarized from CPIC)
TrimipramineSurmontil	Consider alternative	CYP2D6CYP2C19	Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested. (Summarized from CPIC)

Antipsychotics 12

Medication	Guidance	Genes	Summary
AripiprazoleAbilify	Use with caution	CYP2D6	Your body clears aripiprazole slowly, so more of it builds up and side effects are more likely. A lower maximum dose is advised. (Summarized from DPWG)
Aripiprazole LauroxilAristada	Use with caution	CYP2D6	Your body breaks down aripiprazole lauroxil more slowly than normal, causing higher levels of the drug in your system. A lower dose is recommended to reduce the risk of side effects. (Summarized from FDA)
BrexpiprazoleRexulti	Use with caution	CYP2D6	Your body clears brexpiprazole slowly, so more of it builds up. Half the usual dose is advised. (Summarized from DPWG)
ClozapineClozaril	Use with caution	CYP2D6	Your body breaks down clozapine much more slowly than normal, causing the drug to build up to higher levels in your system. A lower dose may be needed to reduce the risk of side effects. (Summarized from FDA)
HaloperidolHaldol	Use with caution	CYP2D6	Your body clears haloperidol slowly, which raises the concentration in your blood and increases side effect risk. A lower dose is typically recommended. (Summarized from DPWG)
IloperidoneFanapt	Use with caution	CYP2D6	Your body breaks down iloperidone much more slowly than normal, causing the drug to build up and increasing the risk of heart rhythm problems. The dose should be cut in half. (Summarized from FDA)
PerphenazineTrilafon	Use with caution	CYP2D6	Your body breaks down perphenazine much more slowly than normal, causing the drug to build up in your system. This increases your risk of side effects. (Summarized from FDA)
PimozideOrap	Use with caution	CYP2D6	Your body clears pimozide slowly, which could raise the risk of heart rhythm side effects. Half the usual maximum dose is advised. (Summarized from DPWG)
QuetiapineSeroquel	Use as directed	CYP3A4	Your CYP3A4 gene works normally, so the standard dose of this drug is used. (Summarized from DPWG)
RisperidoneRisperdal	Use with caution	CYP2D6	Your body clears risperidone slowly, so more of it builds up and side effects are more likely. About two-thirds of the usual dose is advised, and less if side effects still occur. (Summarized from DPWG)
ThioridazineMellaril	Consider alternative	CYP2D6	Your body breaks down thioridazine much too slowly, causing dangerous levels to build up. This significantly increases your risk of serious heart rhythm problems. This medication should not be used. (Summarized from FDA)
ZuclopenthixolClopixol	Use with caution	CYP2D6	Your body clears this drug slowly, so it builds up in your blood. Half the usual dose is advised. (Summarized from DPWG)

Psychostimulants 2

Medication	Guidance	Genes	Summary
AmphetamineAdzenys ER	Use with caution	CYP2D6	Your body breaks down amphetamine much more slowly than normal, which may cause the drug to build up and increase your risk of side effects. A lower dose or a different medication may be needed. (Summarized from FDA)
AtomoxetineStrattera	Use with caution	CYP2D6	Your body processes this drug very slowly, so it builds up. It may work well but cause more side effects, so your doctor may start low and go slowly. (Summarized from CPIC)

Movement disorders 3

Medication	Guidance	Genes	Summary
DeutetrabenazineAustedo	Use with caution	CYP2D6	Your body breaks down deutetrabenazine much more slowly than normal, causing the drug to build up and raising the risk of heart rhythm problems. A lower maximum dose is recommended. (Summarized from FDA)
TetrabenazineXenazine	Use with caution	CYP2D6	Your body breaks down tetrabenazine much more slowly than normal, causing the drug to reach higher levels in your system. A lower maximum dose is required to avoid side effects. (Summarized from FDA)
ValbenazineIngrezza	Use with caution	CYP2D6	Your body breaks down valbenazine much more slowly than normal, causing the drug to build up. This raises your risk of heart rhythm problems, so a lower dose may be needed. (Summarized from FDA)

Anticonvulsants 4

Medication	Guidance	Genes	Summary
BrivaracetamBriviact	Use with caution	CYP2C19	Your body breaks down this drug more slowly, so more of it builds up. This can raise the risk of side effects. (Summarized from FDA)
ClobazamOnfi, Frisium	Use with caution	CYP2C19	Your body breaks down clobazam more slowly than normal, causing higher levels of the drug's active form to build up. A lower dose may be needed to reduce the risk of side effects. (Summarized from FDA)
FosphenytoinCerebyx	Use with caution	CYP2C9	Your body clears this drug more slowly, so it can build up and cause nervous system side effects. A lower starting dose and blood level checks are suggested. (Summarized from FDA)
PhenytoinDilantin	Use with caution	CYP2C9	Your body breaks down this drug more slowly, so it can build up. That raises the risk of side effects on the brain and nerves. (Summarized from FDA)

Pain management 13

Medication	Guidance	Genes	Summary
CarisoprodolSoma	Use as directed	CYP2C19	Your body breaks down carisoprodol slightly slower than normal. The standard dose should work as expected. (Summarized from FDA)
CelecoxibCelebrex	Use as directed	CYP2C9	Your body slows the drug down slightly, but usually the normal starting dose is fine. (Summarized from CPIC)
CodeineTylenol 3	Consider alternative	CYP2D6	Your body turns very little codeine into its active form, so it likely won't ease your pain. A different pain reliever is usually suggested. (Summarized from CPIC)
FlurbiprofenAnsaid, Ocufen, Strefen	Use as directed	CYP2C9	Your body slows the drug down slightly, but usually the normal starting dose is fine. (Summarized from CPIC)
HydrocodoneHysingla ER	Use with caution	CYP2D6	Your body makes less of hydrocodone's stronger active form. It's not clear this changes pain relief, so the usual dose is recommended, with a different pain medicine to consider if it doesn't work. (Summarized from CPIC)
IbuprofenAdvil	Use as directed	CYP2C9	Your body slows the drug down slightly, but usually the normal starting dose is fine. (Summarized from CPIC)
LornoxicamXefo	Use as directed	CYP2C9	Your body slows the drug down slightly, but usually the normal starting dose is fine. (Summarized from CPIC)
MeloxicamMobic	Use with caution	CYP2C9	Your body breaks down meloxicam slightly slower than normal. While there is no specific FDA guidance, your doctor may want to monitor you for side effects. (Summarized from FDA)
OliceridineOlinvyk	Use with caution	CYP2D6	Your body clears this drug much more slowly, raising the risk of slowed breathing and deep drowsiness. You may need doses less often. (Summarized from FDA)
PiroxicamFeldene	Use with caution	CYP2C9	Your body breaks down piroxicam more slowly than normal, which can cause higher drug levels. Your doctor may need to adjust your dosing. (Summarized from FDA)
PitolisantWakix	Use with caution	CYP2D6	Your body breaks down pitolisant much more slowly than normal, causing the drug to reach higher levels in your system. The lowest starting dose is recommended to reduce the risk of side effects. (Summarized from FDA)
TenoxicamMobiflex	Use as directed	CYP2C9	Your body slows the drug slightly, but the usual starting dose is still fine. (Summarized from CPIC)
TramadolUltram, ConZip	Consider alternative	CYP2D6	Your body can't turn this drug into its active form well, so it may not relieve your pain. A different pain medicine is advised. (Summarized from CPIC)

Cardiovascular 7

Medication	Guidance	Genes	Summary
PropafenoneRythmol SR	Use with caution	CYP2D6	Your body breaks down this drug much more slowly, so an irregular heartbeat is more likely. Some other drugs raise this risk even more. (Summarized from FDA)
HydralazineApresoline	Use with caution	NAT2	Your body breaks down hydralazine slowly, which means you need a lower starting dose. Higher doses may increase side effects, including a rare immune reaction. (Summarized from CPIC)
CarvedilolCoreg, Coreg CR	Use with caution	CYP2D6	Your body breaks down carvedilol much more slowly than normal, causing the drug to build up in your system. This increases your risk of dizziness and other side effects. (Summarized from FDA)
MetoprololLopressor, Toprol XL	Use with caution	CYP2D6	Your body clears this drug very slowly, so it can build up. Your doctor may start with the lowest dose and watch your heart rate. (Summarized from CPIC)
ClopidogrelPlavix	Consider alternative	CYP2C19	Your body turns this drug into its active form more slowly, so it may not protect you as well. A different blood thinner is usually suggested. (Summarized from CPIC)
WarfarinCoumadin	Use with caution	CYP2C9VKORC1CYP4F2	Your genes suggest a lower dose may be safer. Your doctor can decide. (Report note) Estimated dose: 3.2-4.4 mg/day (lower than typical starting dose). See the detailed report for the calculation and its limitations.
MavacamtenCamzyos	Use with caution	CYP2C19	Your body breaks down mavacamten slightly slower than normal, which may lead to higher drug levels. Your doctor will monitor you closely and adjust the dose based on your response. (Summarized from FDA)

Cholesterol medications 7

Medication	Guidance	Genes	Summary
AtorvastatinLipitor	Use with caution	SLCO1B1	More of this statin stays in your blood, which can raise the chance of muscle side effects. Your doctor may limit the dose. (Summarized from CPIC)
FluvastatinLescol	Use with caution	CYP2C9SLCO1B1	Your genes make this statin build up in your blood, which can raise the risk of muscle problems. A lower starting dose or a dose limit is suggested. (Summarized from CPIC)
LovastatinMevacor	Consider alternative	SLCO1B1	Your genes make this statin build up in your blood, which may raise your risk of muscle problems. A different statin, or a low dose of this one, is often suggested. (Summarized from CPIC)
PitavastatinLivalo	Use with caution	SLCO1B1	More of this statin stays in your blood, so muscle side effects are more likely. Your doctor may keep the dose low or suggest another statin. (Summarized from CPIC)
PravastatinPravachol	Use with caution	SLCO1B1	Your body may process this drug more slowly, so higher doses might carry added risks. (Summarized from CPIC)
RosuvastatinCrestor	Use as directed	ABCG2SLCO1B1	Your genes support the usual starting dose of this statin. (Summarized from CPIC)
SimvastatinZocor	Use with caution	SLCO1B1	More of this statin stays in your blood, so muscle side effects are more likely. Your doctor may use a different statin or a lower dose. (Summarized from CPIC)

Antiemetics 4

Medication	Guidance	Genes	Summary
DronabinolSyndros	Use with caution	CYP2C9	Your body breaks down dronabinol more slowly than normal, which may cause the drug to build up and increase the risk of side effects. Extra monitoring is recommended. (Summarized from FDA)
MetoclopramideReglan	Use with caution	CYP2D6	Your body breaks down metoclopramide much more slowly than normal, causing the drug to build up and increasing the risk of side effects. A lower dose is recommended. (Summarized from FDA)
OndansetronZofran	Use as directed	CYP2D6	There is not enough evidence to know how your CYP2D6 result affects your response to ondansetron. CPIC makes no prescribing recommendation based on this result. (Summarized from CPIC)
TropisetronNavoban	Use as directed	CYP2D6	There is not enough evidence to know how your CYP2D6 result affects your response to tropisetron. CPIC makes no prescribing recommendation based on this result. (Summarized from CPIC)

Proton pump inhibitors 4

Medication	Guidance	Genes	Summary
DexlansoprazoleDexilant	Use with caution	CYP2C19	Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects. (Summarized from CPIC)
LansoprazolePrevacid	Use with caution	CYP2C19	Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects. (Summarized from CPIC)
OmeprazolePrilosec, Losec	Use with caution	CYP2C19	Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects. (Summarized from CPIC)
PantoprazoleProtonix	Use with caution	CYP2C19	Your body clears this drug more slowly. A lower dose may be needed for long-term use to prevent side effects. (Summarized from CPIC)

Oncology 13

Medication	Guidance	Genes	Summary
BelinostatBeleodaq	Use as directed	UGT1A1	Your body may process this drug a little more slowly. The FDA has no special advice for this, so the usual dose is used. (Summarized from FDA)
BelzutifanWelireg	Use as directed	CYP2C19	Your CYP2C19 result means somewhat lower CYP2C19 activity than usual, but the FDA gives no genetic dosing change for belzutifan at this result. (Summarized from FDA)
CapecitabineXeloda, Xitabin, Kapetral	Use as directed	DPYD	Your body processes capecitabine normally. You have a typical risk of side effects, and the standard dose is expected to be appropriate. (Summarized from CPIC)
ErdafitinibBalversa	Use as directed	CYP2C9	Your CYP2C9 result means somewhat lower CYP2C9 activity than usual, but the FDA gives no genetic dosing change for erdafitinib at this result. (Summarized from FDA)
FluorouracilAdrucil, Carac	Use as directed	DPYD	Your body breaks down this drug normally. Your risk of side effects is typical, and the usual dose is used. (Summarized from CPIC)
GefitinibIressa	Use with caution	CYP2D6	Your body breaks down gefitinib more slowly than normal, causing higher levels of the drug in your system. This increases the risk of side effects and closer monitoring may be needed. (Summarized from FDA)
IrinotecanCamptosar, Onivyde	Use as directed	UGT1A1	Your body breaks down irinotecan slightly slower than normal. The standard dose should work as expected. (Summarized from FDA)
MercaptopurinePurinethol	Use as directed	TPMTNUDT15	Both genes that affect this drug look normal, so a standard starting dose is expected. (Summarized from CPIC)
NilotinibTasigna	Use as directed	UGT1A1	Your UGT1A1 result means somewhat lower UGT1A1 activity than usual, but the FDA gives no genetic dosing change for nilotinib at this result. (Summarized from FDA)
PazopanibVotrient	Use as directed	UGT1A1	Your UGT1A1 gene works a bit less than average. The FDA gives no dose change for your result, so the usual dose is used. (Summarized from FDA)
Sacituzumab Govitecan-HziyTrodelvy	Use as directed	UGT1A1	Your body processes this drug a bit slower than average. The FDA gives no dose change for your result, so the usual dose is used. (Summarized from FDA)
ThioguanineLanvis, Tabloid	Use as directed	TPMTNUDT15	Both genes that affect this drug look normal, so a standard starting dose is expected. (Summarized from CPIC)
TamoxifenNolvadex, Soltamox	Consider alternative	CYP2D6	Your body makes very little of this drug's active form, so it may not work well to stop breast cancer from coming back. Another hormone therapy is advised. (Summarized from CPIC)

Immunosuppressants 4

Medication	Guidance	Genes	Summary
AbrocitinibCibinqo	Use as directed	CYP2C19	Your body may process this drug a little more slowly. The drug label has no special advice for this, so the usual dose is used. (Summarized from FDA)
AzathioprineImuran	Use as directed	TPMTNUDT15	Both genes that affect this drug look normal, so a standard starting dose is expected. (Summarized from CPIC)
SiponimodMayzent	Use with caution	CYP2C9	Your body breaks down siponimod slower than normal, causing the drug to reach higher levels in your system. Your doctor will need to adjust your dose based on your specific genetic profile. (Summarized from FDA)
TacrolimusPrograf	Use with caution	CYP3A5	Your body breaks down this drug faster than many people do, so the usual dose may fall short. A higher starting dose and blood tests are advised. (Summarized from CPIC)

Antivirals 5

Medication	Guidance	Genes	Summary
AtazanavirReyataz, Evotaz, Others	Use as directed	UGT1A1	Your body processes atazanavir a bit more slowly than normal, but you still have a low chance of developing jaundice (yellowing of skin or eyes). The standard dose is expected to be appropriate. (Summarized from CPIC)
EfavirenzSustiva	Use as directed	CYP2B6	Your body processes efavirenz normally. The standard dose is expected to be appropriate for you. (Summarized from CPIC)
Peginterferon Alfa-2APegasys	Use as directed	IFNL3	Your genes make this hepatitis C drug more likely to work. You may be able to take it for a shorter time. (Summarized from CPIC)
Peginterferon Alfa-2BPegIntron	Use as directed	IFNL3	Your genes make this hepatitis C drug more likely to work. You may be able to take it for a shorter time. (Summarized from CPIC)
RibavirinCopegus, Rebetol, Virazole	Use as directed	IFNL3	Your genes make this hepatitis C treatment more likely to work. You may be able to take it for a shorter time. (Summarized from CPIC)

Antifungals 1

Medication	Guidance	Genes	Summary
VoriconazoleVfend	Use with caution	CYP2C19	Your body breaks down this drug more slowly, so levels can rise and side effects are more likely. (Summarized from FDA)

Anesthetics 8

Medication	Guidance	Genes	Summary
Desflurane	Unable to determine	RYR1CACNA1S	We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected. (Report note)
Enflurane	Unable to determine	RYR1CACNA1S	We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected. (Report note)
Halothane	Unable to determine	RYR1CACNA1S	We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected. (Report note)
Isoflurane	Unable to determine	RYR1CACNA1S	We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected. (Report note)
Methoxyflurane	Unable to determine	RYR1CACNA1S	We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected. (Report note)
MivacuriumMivacron	Use as directed	BCHE	Your body breaks down this drug normally. Your doctor can use the usual dose. (Summarized from FDA)
Sevoflurane	Unable to determine	RYR1CACNA1S	We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected. (Report note)
SuccinylcholineQuelicin, Anectine	Unable to determine	RYR1CACNA1SBCHE	We couldn't check the genes for this anesthesia reaction from your data. This does not mean that a normal response is expected. (Report note)

Weight management 3

Medication	Guidance	Genes	Summary
Retatrutide	Use with caution	GLP1RGIPR	Your GIPR gene raises your chance of nausea or vomiting on retatrutide: roughly 4.4% of people with your genotype vomit, compared with about 2.5% at the lowest risk. Semaglutide is not affected by this gene. (Summarized from Gene2Rx)
SemaglutideOzempic, Wegovy	Use as directed	GLP1R	Your genes point to a typical response to this drug, with average weight loss and side effects. (Summarized from Gene2Rx)
TirzepatideMounjaro, Zepbound	Use with caution	GLP1RGIPR	Your GIPR gene raises your chance of nausea or vomiting on tirzepatide: roughly 4.4% of people with your genotype vomit, compared with about 2.5% at the lowest risk. Semaglutide is not affected by this gene. (Summarized from Gene2Rx)

Antidiabetics 1

Medication	Guidance	Genes	Summary
NateglinideStarlix	Use as directed	CYP2C9	Your body breaks down nateglinide slightly slower than normal. The standard dose should work as expected. (Summarized from FDA)

Antihistamines 1

Medication	Guidance	Genes	Summary
MeclizineAntivert	Use with caution	CYP2D6	Your body breaks down meclizine much more slowly than normal, which may cause the drug to build up to higher levels and increase the risk of side effects. Close monitoring is recommended. (Summarized from FDA)

Drugs used in addictive disorders 1

Medication	Guidance	Genes	Summary
LofexidineLucemyra	Use with caution	CYP2D6	Your body breaks down lofexidine more slowly than normal, causing it to build up in your system. This increases the risk of side effects like low blood pressure and a slow heart rate. (Summarized from FDA)

Female sexual health 1

Medication	Guidance	Genes	Summary
FlibanserinAddyi	Use as directed	CYP2C19	Your CYP2C19 result means somewhat lower CYP2C19 activity than usual, but the FDA gives no genetic dosing change for flibanserin at this result. (Summarized from FDA)

Gaucher's disease treatments 1

Medication	Guidance	Genes	Summary
EliglustatCerdelga	Use with caution	CYP2D6	Your body breaks down this drug much more slowly, which can raise the risk of heart rhythm problems. Your doctor will set your dose, and some other medicines can't be taken with it. (Summarized from FDA)

Gout 1

Medication	Guidance	Genes	Summary
AllopurinolZyloprim	Use as directed	ABCG2	Your ABCG2 genotype does not change how you respond to allopurinol; standard dosing applies. (Summarized from DPWG)

Hair loss 1

Medication	Guidance	Genes	Summary
Topical minoxidilRogaine	Use as directed	SULT1A1	Your SULT1A1 result suggests normal enzyme function. This enzyme helps activate topical minoxidil, but hair growth results can vary. Use topical minoxidil as directed and assess hair growth over time with your clinician. (Summarized from Gene2Rx)

Saliva production stimulators 1

Medication	Guidance	Genes	Summary
CevimelineEvoxac	Use with caution	CYP2D6	Your body breaks down cevimeline much more slowly than normal, which may increase the risk of side effects. Careful monitoring by your doctor is recommended. (Summarized from FDA)

Urologicals 1

Medication	Guidance	Genes	Summary
TolterodineDetrol	Use with caution	CYP2D6	Your body breaks down tolterodine more slowly than normal, causing it to build up in your system. This increases the risk of side effects, including heart rhythm problems. (Summarized from FDA)

Other substances 7

Medication	Guidance	Genes	Summary
Alcohol	Use as directed	ADH1BALDH2	Your genes have little effect on how your body handles alcohol. (Summarized from Gene2Rx)
CaffeineCoffee, Tea	Use with caution	CYP1A2	Caffeine may wear off slightly sooner for you than average. The usual advice on caffeine limits applies. (Summarized from Gene2Rx)
KetamineKetalar	Use as directed	CYP2B6	Your body processes ketamine at the usual rate. (Summarized from Gene2Rx)
LSDAcid	Use with caution	CYP2D6	You clear this drug slowly, so its effects may be stronger and last longer. Starting with a lower dose may help avoid a bad experience. (Summarized from Gene2Rx)
MDMAEcstasy	Use with caution	COMTCYP2D6	You have little or no activity of the main enzyme that clears MDMA. Studies have not shown that this makes MDMA poisoning more likely, and no genotype makes MDMA safe. (Summarized from Gene2Rx)
NicotineCigarettes, Zyn	Use with caution	CHRNA5COMTCYP2A6	This variant is linked to heavier smoking and finding it harder to quit. Stop-smoking medicines appear to help people with this result as much as or more than others. (Summarized from Gene2Rx)
THCCannabis, Marijuana	Use with caution	AKT1COMTCYP2C9FAAH	You may be more likely to feel anxious or paranoid on THC. Starting with a lower dose can help. (Summarized from Gene2Rx)

Coverage depends on your data and report tier. A medication missing here may still have pharmacogenetic guidance. Full source text and references are in the detailed report. Questions: contact@gene2rx.com.

Full Report

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What stands out in your genes

CYP2D6

CYP2C19

CYP2C9

Your genes at a glance

Worth discussing with your prescriber

All medications

Antidepressants14 medications

SNRIs

SSRIs

Tricyclics

Antipsychotics12 medications

Psychostimulants2 medications

Movement disorders3 medications

Involuntary Movement Reducers

Anticonvulsants4 medications

Pain management13 medications

Cardiovascular7 medications

Antiarrhythmics

Antihypertensives

Beta Blockers

Blood Thinners

Cardiomyopathy

Cholesterol medications7 medications

Antiemetics4 medications

Proton pump inhibitors4 medications

Oncology13 medications

Chemotherapies

Estrogen Modulators

Immunosuppressants4 medications

Antivirals5 medications

Antiretrovirals

Antivirals

Antifungals1 medication

Anesthetics8 medications

Weight management3 medications

Antidiabetics1 medication

Antihistamines1 medication

Drugs used in addictive disorders1 medication

Female sexual health1 medication

Gaucher's disease treatments1 medication

Gout1 medication

Hair loss1 medication

Saliva production stimulators1 medication

Urologicals1 medication

Other substances7 medications

Consider alternative 14 medications

Use with caution 63 medications

Use as directed 36 medications

Unable to determine 7 medications

Your genes

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About this report

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What the data can show

Where the guidance comes from

How we read your DNA

Questions

Report contents

Your genes at a glance

Complete medication guidance

Antidepressants 14 medications

SNRIs

Venlafaxine

SSRIs

Citalopram

Escitalopram

Fluvoxamine

Paroxetine

Sertraline

Vortioxetine

Tricyclics

Amitriptyline

Clomipramine

Desipramine