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.
The information presented in this report is based on allele mappings and therapeutic implications developed by the Clinical Pharmacogenomics Implementation Consortium (CPIC®) and the US Food and Drug administration (FDA). Gene2Rx is not affiliated with CPIC or the FDA in any way. The contents of this page have not been endorsed by CPIC or the FDA and are the sole responsibility of Gene2Rx.
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. If you do not see your medication listed here, there is currently no prescription guidance based on pharmacogenetics published by either the FDA or CPIC.
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 26 drugs
This table contains the specific variants identified in each of the genes assessed for your Gene2Rx report. These genes are important for modulating response to medications and have been determined to be clinically actionable for some medications.
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. These phenotypes will determine how you will respond to different medications. See the legend below for descriptions of the symbols associated with each phenotype.
| Gene | Genotype | Phenotype | |
|---|---|---|---|
| CYP2B6 |
*1/*1
|
Normal Metabolizer | |
| CYP2C19 |
*1/*2
|
Intermediate Metabolizer | |
| CYP2D6 |
*4/*4
|
Poor Metabolizer | |
| 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 point to the CPIC guideline or FDA drug label that informed the recommendation.
Therapeutic Guidance Legend
Note: Phenotypes with an unknown effect on drug response are categorized as use as directed.
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, Cipralex, Lexapro | 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 25–50% 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 | CYP2B6 | Normal Metabolizer | Implication: Normal metabolism of sertraline to less active compounds. Therapeutic recommendation: Initiate therapy with recommended starting dose. | CPIC | ||
| CYP2C19 | Intermediate Metabolizer | Implication: Reduced metabolism of sertraline to less active compounds when compared with CYP2C19 normal metabolizers. Therapeutic recommendation: Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than CYP2C19 normal metabolizers. | CPIC | ||||
| 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
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 | CYP2C19 | Intermediate Metabolizer | Implication: Reduced metabolism of tertiary amines compared to normal metabolizers. Therapeutic recommendation: Initiate therapy with recommended starting dose. | CPIC | ||
| 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.g Utilize therapeutic drug monitoring to guide dose adjustments. | CPIC | ||||
| Clomipramine | Anafranil | CYP2C19 | Intermediate Metabolizer | Implication: Reduced metabolism of tertiary amines compared to normal metabolizers. Therapeutic recommendation: Initiate therapy with recommended starting dose. | CPIC | ||
| 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.g Utilize therapeutic drug monitoring to guide dose adjustments. | CPIC | ||||
| 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.g Utilize therapeutic drug monitoring to guide dose adjustments. | CPIC | ||
| Doxepin | Sinequan, Quitaxon, Aponal | CYP2C19 | Intermediate Metabolizer | Implication: Reduced metabolism of tertiary amines compared to normal metabolizers. Therapeutic recommendation: Initiate therapy with recommended starting dose. | CPIC | ||
| 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.g Utilize therapeutic drug monitoring to guide dose adjustments. | CPIC | ||||
| Imipramine | Tofranil | CYP2C19 | Intermediate Metabolizer | Implication: Reduced metabolism of tertiary amines compared to normal metabolizers. Therapeutic recommendation: Initiate therapy with recommended starting dose. | CPIC | ||
| 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.g Utilize therapeutic drug monitoring to guide dose adjustments. | CPIC | ||||
| 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.g Utilize therapeutic drug monitoring to guide dose adjustments. | CPIC | ||
| Trimipramine | Surmontil | CYP2C19 | Intermediate Metabolizer | Implication: Reduced metabolism of tertiary amines compared to normal metabolizers. Therapeutic recommendation: Initiate therapy with recommended starting dose. | CPIC | ||
| 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.g Utilize therapeutic drug monitoring to guide dose adjustments. | CPIC |
Antipsychotics
10 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 | Results in higher systemic concentrations and higher adverse reaction risk. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations. | FDA | ||
| Brexpiprazole | Rexulti | CYP2D6 | Poor Metabolizer | Results in higher systemic concentrations. Dosage adjustment is recommended. Refer to FDA labeling for specific dosing recommendations. | FDA | ||
| Clozapine | Clozaril | CYP2D6 | Poor Metabolizer | Results in higher systemic concentrations. Dosage reductions may be necessary. | 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 | 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. | FDA | ||
| Quetiapine | Seroquel | CYP3A4 | Normal Metabolizer | No clinically significant effect on quetiapine metabolism. | DPWG | ||
| 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 |
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 | 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.e,f 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 guidelines linked next to each finding (either CPIC or FDA) provide therapeutic guidance that include treatment recommendations.
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?
Yes, The Clinical Pharmacogenetics Implementation Consortium (CPIC®) is a group of PGx experts that volunteer their time to curate genetic guidance for drug response, based on the most recent research. They have high standards for the evidence required to include a drug-gene guideline. The US Food and Drug Administration (FDA) has evaluated all pharmacogenetic associations presented in this report and believes there is sufficient scientific evidence to provide clinical guidance for prescribing practices. Read more here.
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. Gene2Rx provides the most recent CPIC and FDA guidance at the time of the report.
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. If you don't see your medication listed, it means that there is not yet a CPIC guideline for providing clinical guidance for pharmacogenetic dosing.
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.