This report contains pharmacogenetic alleles and implications for drug response for the genetic data submitted. Both the genotypes presented and implicated medications are predictions based on the submitted data and published pharmacogenetics literature. This is not a clinical report and the data contained here in no way should be used as clinical guidance.
Sources include CPIC, FDA, DPWG, and published research interpreted by Gene2Rx. Each finding identifies its source. Evidence and clinical applicability differ; an emerging association is not an established prescribing recommendation. Gene2Rx is not affiliated with or endorsed by CPIC or the FDA.
This report includes information about how your pharmacogenetics may influence your response to drugs used for psychiatric purposes, including but not limited to depression, bipolar disorder, schizophrenia, and ADHD. This report does not contain information about all drugs used for psychiatric purposes, only those that have known pharmacogenetic interactions. A medication missing from this report may still have guidance from a clinical guideline or product label.
The implications of taking medication for which you may have an atypical response are based on probabilities. You may or may not experience any side effects or altered efficaciousness. Consult your healthcare provider before making any changes to your healthcare.
The quality of uploaded data is not verified and may contain errors that result in alterations to your pharmacogenetic report. Genotyping panels (such as those used by direct to consumer genetics services) offer an incomplete representation of an individual's genetics. You may harbor additional genetic variation that can affect drug response.
Drugs by class 28 drugs
This table contains the specific variants identified in each of the genes assessed for your Gene2Rx report. Evidence and actionability differ by gene and medication.
The "Genotype" column indicates the specific alleles identified in your DNA. These correspond to patterns of genetic variants within each gene. There are two alleles for each gene, one for each copy.
The "Phenotype" column indicates the predicted effect that your genotype will have on the function of the proteins encoded by each gene. A predicted phenotype does not measure enzyme activity directly or determine your individual treatment response. See the legend below for descriptions of the symbols associated with each phenotype.
A few genes (including CYP2D6, CYP2C9, and DPYD) get a number called an activity score instead of a single category. The score is the sum of the activity values of your two gene copies, and a higher number means more enzyme activity. Dosing guidelines for these genes are often based on the score, so we show it next to the phenotype when it applies.
| Gene | Genotype | Phenotype | |
|---|---|---|---|
| CYP2B6 |
*1/*1
|
Normal Metabolizer | |
| CYP2C19 |
*1/*2
|
Intermediate Metabolizer | |
| CYP2D6 |
*4/*4
|
Poor Metabolizer (Activity Score 0.0) | |
| CYP3A4 |
*1/*1
|
Normal Metabolizer |
Each symbol represents the predicted function of the gene. A non-normal allele does not necessarily lead to a change in drug response.
Drugs are grouped by clinical class. For each class with three or more drugs in your report, a scoreboard summarizes which medications you are likely to use as directed, which warrant caution, and which guidelines suggest you consider an alternative for. The detailed tables below each scoreboard show the underlying gene-drug findings.
Each row in the detail tables shows the generic name, brand names, gene, your gene phenotype, and how your genotype may affect drug response. Source links identify the guideline, drug label, or research used for the finding.
Therapeutic Guidance Legend
Note: A gray question mark identifies informational, uncertain, or unavailable findings. An unable-to-determine result is not clearance to use an anesthetic.
Antidepressants
14 drugsEach card shows the gene driving the recommendation. Use as directed = your genetics suggest a typical response. Use with caution = consider dose adjustment or monitoring. Consider alternative = guidelines suggest discussing a different drug with your provider.
Antidepressants - SNRI
| Generic Name | Brand Names | Gene | Your Gene Phenotype | Implication | Source | ||
|---|---|---|---|---|---|---|---|
| Venlafaxine | Effexor XR | CYP2D6 | Poor Metabolizer | CPIC: Implication: 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.
Therapeutic recommendation: Consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6. FDA: Alters systemic parent drug and metabolite concentrations. Consider dosage reductions. |
CPIC, FDA |
FDA: Alters systemic parent drug and metabolite concentrations. Consider dosage reductions.
Antidepressants - SSRI
| Generic Name | Brand Names | Gene | Your Gene Phenotype | Implication | Source | ||
|---|---|---|---|---|---|---|---|
| Citalopram | Celexa | CYP2C19 | Intermediate Metabolizer | CPIC: Implication: Reduced metabolism when compared with CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
Therapeutic recommendation: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers. FDA: No FDA guidance for your genotype |
CPIC, FDA | ||
| Escitalopram | Lexapro | CYP2C19 | Intermediate Metabolizer | Implication: Reduced metabolism when compared with CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects. Therapeutic recommendation: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers. | CPIC | ||
| Fluvoxamine | Luvox | CYP2D6 | Poor Metabolizer | Implication: Greatly reduced metabolism of fluvoxamine to less active compounds compared with normal metabolizers. Higher plasma concentrations may increase the probability of side effects. Therapeutic recommendation: 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. | CPIC | ||
| Paroxetine | Paxil, Seroxat | CYP2D6 | Poor Metabolizer | Implication: Greatly reduced metabolism compared with CYP2D6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects. Therapeutic recommendation: Consider a 50% reduction in recommended starting dose, slower titration schedule, and a 50% lower maintenance dose as compared with normal metabolizers. | CPIC | ||
| Sertraline | Zoloft | CYP2C19 | Intermediate Metabolizer | Combined implication: CYP2C19: Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. CYP2B6: Normal metabolism of sertraline to less active compounds. Recommendation: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose. Evidence strength: Moderate From the combined CYP2C19 and CYP2B6 table in CPIC's guideline for serotonin reuptake inhibitor antidepressants. | CPIC | ||
| CYP2B6 | Normal Metabolizer | ||||||
| Vortioxetine | Trintellix, Brintellix | CYP2D6 | Poor Metabolizer | CPIC: Implication: Greatly reduced metabolism of vortioxetine to inactive compounds compared with normal metabolizers. Higher plasma concentrations may increase the probability of side effects.
Therapeutic recommendation: 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: Results in higher systemic concentrations. The maximum recommended dose is 10 mg. |
CPIC, FDA |
FDA: No FDA guidance for your genotype
Recommendation: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose.
Evidence strength: Moderate
From the combined CYP2C19 and CYP2B6 table in CPIC's guideline for serotonin reuptake inhibitor antidepressants.
FDA: Results in higher systemic concentrations. The maximum recommended dose is 10 mg.
Antidepressants - TCA
| Generic Name | Brand Names | Gene | Your Gene Phenotype | Implication | Source | ||
|---|---|---|---|---|---|---|---|
| Amitriptyline | Elavil | CYP2D6 | Poor Metabolizer (Activity Score 0.0) | Combined implication: 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 Recommendation: 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. Evidence strength: Optional From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score. | CPIC | ||
| CYP2C19 | Intermediate Metabolizer | ||||||
| Clomipramine | Anafranil | CYP2D6 | Poor Metabolizer (Activity Score 0.0) | Combined implication: 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 Recommendation: 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. Evidence strength: Optional From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score. | CPIC | ||
| CYP2C19 | Intermediate Metabolizer | ||||||
| Desipramine | Norpramin | CYP2D6 | Poor Metabolizer | Implication: 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. Therapeutic recommendation: 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. | CPIC | ||
| Doxepin | Sinequan, Quitaxon, Aponal | CYP2D6 | Poor Metabolizer (Activity Score 0.0) | Combined implication: 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 Recommendation: 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. Evidence strength: Optional From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score. | CPIC | ||
| CYP2C19 | Intermediate Metabolizer | ||||||
| Imipramine | Tofranil | CYP2D6 | Poor Metabolizer (Activity Score 0.0) | Combined implication: 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 Recommendation: 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. Evidence strength: Optional From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score. | CPIC | ||
| CYP2C19 | Intermediate Metabolizer | ||||||
| Nortriptyline | Pamelor | CYP2D6 | Poor Metabolizer | Implication: 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. Therapeutic recommendation: 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. | CPIC | ||
| Trimipramine | Surmontil | CYP2D6 | Poor Metabolizer (Activity Score 0.0) | Combined implication: 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 Recommendation: 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. Evidence strength: Optional From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score. | CPIC | ||
| CYP2C19 | Intermediate Metabolizer |
Recommendation: 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.
Evidence strength: Optional
From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.
Recommendation: 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.
Evidence strength: Optional
From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.
Recommendation: 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.
Evidence strength: Optional
From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.
Recommendation: 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.
Evidence strength: Optional
From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.
Recommendation: 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.
Evidence strength: Optional
From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.
Antipsychotics
12 drugsEach card shows the gene driving the recommendation. Use as directed = your genetics suggest a typical response. Use with caution = consider dose adjustment or monitoring. Consider alternative = guidelines suggest discussing a different drug with your provider.
Antipsychotics
| Generic Name | Brand Names | Gene | Your Gene Phenotype | Implication | Source | ||
|---|---|---|---|---|---|---|---|
| Aripiprazole Lauroxil | Aristada | CYP2D6 | Poor Metabolizer | Results in higher systemic concentrations. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations. | FDA | ||
| Aripiprazole | Abilify | CYP2D6 | Poor Metabolizer | DPWG: Decreased CYP2D6 activity raises the combined blood level of aripiprazole and its active metabolite, increasing the risk of side effects. FDA: Results in higher systemic concentrations and higher adverse reaction risk. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations. |
DPWG, FDA | ||
| Brexpiprazole | Rexulti | CYP2D6 | Poor Metabolizer | DPWG: Decreased CYP2D6 activity reduces the metabolism of brexpiprazole, so the risk of side effects is theoretically increased. FDA: Results in higher systemic concentrations. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations. |
DPWG, FDA | ||
| Clozapine | Clozaril | CYP2D6 | Poor Metabolizer | DPWG: CYP2D6 variation can change clozapine blood levels, but this has no clinical consequences. FDA: Results in higher systemic concentrations. Dosage reductions may be necessary. |
DPWG, FDA | ||
| Haloperidol | Haldol | CYP2D6 | Poor Metabolizer | Decreased CYP2D6 activity reduces conversion of haloperidol, increasing plasma concentration approximately 1.7-fold. This is associated with an increased risk of side effects. | DPWG | ||
| Iloperidone | Fanapt | CYP2D6 | Poor Metabolizer | Results in higher systemic concentrations and higher adverse reaction risk (QT prolongation). Reduce dosage by 50%. | FDA | ||
| Perphenazine | Trilafon | CYP2D6 | Poor Metabolizer | Results in higher systemic concentrations and higher adverse reaction risk. | FDA | ||
| Pimozide | Orap | CYP2D6 | Poor Metabolizer | DPWG: 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. FDA: 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. |
DPWG, FDA | ||
| Quetiapine | Seroquel | CYP3A4 | Normal Metabolizer | No clinically significant effect on quetiapine metabolism. | DPWG | ||
| Risperidone | Risperdal | CYP2D6 | Poor Metabolizer | 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%. | DPWG | ||
| Thioridazine | Mellaril | CYP2D6 | Poor Metabolizer | Results in higher systemic concentrations and higher adverse reaction risk (QT prolongation). Predicted effect based on experience with CYP2D6 inhibitors. Contraindicated in poor metabolizers. | FDA | ||
| Zuclopenthixol | Clopixol | CYP2D6 | Poor Metabolizer | Markedly decreased CYP2D6 activity reduces conversion of zuclopenthixol, raising plasma concentration approximately 1.6-fold and elevating side effect risk. | DPWG |
FDA: Results in higher systemic concentrations and higher adverse reaction risk. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations.
FDA: 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.
Psychostimulants
2 drugsPsychostimulants
| Generic Name | Brand Names | Gene | Your Gene Phenotype | Implication | Source | ||
|---|---|---|---|---|---|---|---|
| Amphetamine | Adzenys ER | CYP2D6 | Poor Metabolizer | May affect systemic concentrations and adverse reaction risk. Consider lower starting dosage or use alternative agent. | FDA | ||
| Atomoxetine | Strattera | CYP2D6 | Poor Metabolizer (Activity Score 0.0) | CPIC: Implication: 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.
Therapeutic recommendation: 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: 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. |
CPIC, FDA |
FDA: 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 do I do now?
If you find that you may have an atypical response to a medication you take or are considering taking, it is important that you first consult with your healthcare provider or a genetic counselor before making any changes. The sources linked beside each finding explain its evidence and limitations. Not every finding supports a treatment change.
Should I change medications or dosage based on my report?
No! Do not alter your medication dosage or stop taking your medication without first consulting your healthcare provider. Direct-to-consumer data is not clinical grade, so anything included in the report should be used as a conversation starter with your healthcare provider to seek the appropriate clinical laboratory test. Again, do not alter your medication dosage or stop taking your medication without first consulting your healthcare provider.
Why shouldn't I change my medication based on this report?
Our service relies on the genetic information provided to you by the direct-to-consumer service you paid for. Unfortunately, direct-to-consumer data is not clinical grade, so anything included in the report should be used as a conversation starter with your healthcare provider to seek the appropriate clinical laboratory test. DO NOT alter your medication dosage or stop taking your medication without first consulting your healthcare provider. Read more here and read primary research here.
Are these expert annotations?
The source is identified beside each finding. This report includes CPIC, FDA, DPWG, and Gene2Rx interpretations with different levels of evidence. Gene2Rx interpretations are not necessarily endorsed by those organizations. Gene2Rx interpretations explain the supporting research and its limitations alongside the finding.
Why would my PGx annotations change?
While your genetics don't change over the course of your life, research is an ongoing process and what we know about how an individual's genetics influences their drug response changes over time. As new research is conducted and published, the CPIC guidelines and FDA drug labels are updated accordingly. These updates only happen once new research meets strict validation requirements and experts agree it's time for a guideline change. Your report preserves the interpretations used when it was generated. Updated reports may use revised definitions or research.
I don't see my medication in the report. Why not?
Not all drugs are influenced by pharmacogenetics, and some need more research to verify an association. A medication can be absent because of your report tier, unsupported or missing genetic data, or the scope of the report. Its absence does not mean no clinical guideline exists.
Does Gene2Rx determine structural variants for CYP2D6?
Structural variations for CYP2D6 are not called and may affect your response to drugs metabolized by CYP2D6.
More questions?
Contact us at contact@gene2rx.com.