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  • Critical guidelines
  • Amitriptyline

    Reason: CYP2D6 ultrarapid metabolizer (DPWG definition)
    Insufficient data to allow calculation of dose adjustment. Select alternative drug (e.g., citalopram,sertraline) or monitor (E-10-hydroxy)amitriptyline plasma concentration.
    Last guideline update: 2011-03-16 00:00:00
  • Azathioprine

    Reason: TPMT poor metabolizer (DPWG definition)
    Select alternative drug or reduce dose by 90%. Increase dose in response of hematologic monitoring and efficacy.
    Last guideline update: 2011-03-16 00:00:00
  • Clomipramine

    Reason: CYP2D6 ultrarapid metabolizer (DPWG definition)
    Select alternative drug (e.g., citalopram, sertralin) or monitor (desmethyl)clomipramine plasma concentration.
    Last guideline update: 2011-03-16 00:00:00
  • Clopidogrel

    Reason: CYP2C19 poor metabolizer (DPWG definition)
    Consider alternative drug. Prasugrel is not or to a much smaller extent metabolized by CYP2C19 but is associated with an increased bleeding risk compared to clopidogrel
    Last guideline update: 2011-03-16 00:00:00
  • Codeine

    Reason: CYP2D6 ultrarapid metabolizer (DPWG definition)
    Analgesia: select alternative drug (e.g., acetaminophen, NSAID, morphine-not tramadol or oxycodone) or be alert to ADE. Cough: be extra alert to ADEs due to increased morphine plasma concentration.
    Last guideline update: 2011-03-16 00:00:00
  • Haloperidol

    Reason: CYP2D6 ultrarapid metabolizer (DPWG definition)
    Insufficient data to allow calculation of dose adjustent. Be alert to decreased haloperidol plasma concentration and adjust maintenance dose in response to haloperidol plasma concentration or select alternative drug (e.g., pimozide, flupenthixol, fluphenazine, quetiapine, olanzapine, clozapine).
    Last guideline update: 2011-03-16 00:00:00
  • Mercaptopurine

    Reason: TPMT poor metabolizer (DPWG definition)
    Select alternative drug or reduce dose by 90%. Increase dose in response of hematologic monitoring and efficacy.
    Last guideline update: 2011-03-16 00:00:00
  • Metoprolol

    Reason: CYP2D6 ultrarapid metabolizer (DPWG definition)
    Heart failure: select alternative drug (e.g., bisoprolol, carvedilol) or titrate dose to a maximum of 250% of the normal dose in response to efficacy and ADE. Other indications: select alternative drug (e.g., atenolol, bisoprolol) or titrate dose to a maximum of 250% of the normal dose in response to efficacy and ADE.
    Last guideline update: 2011-03-16 00:00:00
  • Nortriptyline

    Reason: CYP2D6 ultrarapid metabolizer (DPWG definition)
    Select alternative drug (e.g., citalopram, sertraline) or increase dose by 60% and monitor nortriptyline + 10-hydroxynortriptyline plasma concentrations.
    Last guideline update: 2011-03-16 00:00:00
  • Paroxetine

    Reason: CYP2D6 ultrarapid metabolizer (DPWG definition)
    Insufficient data to allow calculation of dose adjustment. Select alternative drug (e.g., citalopram, sertraline).
    Last guideline update: 2011-03-16 00:00:00
  • Propafenone

    Reason: CYP2D6 ultrarapid metabolizer (DPWG definition)
    Insufficient data to allow calculation of dose adjustment. Adjust dose in response to plasma concentration and record ECG or select alternative drug (e.g., sotalol, disopyramide, quinidine, amiodarone)
    Last guideline update: 2011-03-16 00:00:00
  • Risperidone

    Reason: CYP2D6 ultrarapid metabolizer (DPWG definition)
    Insufficient data to allow calculation of dose adjustment. Select alternative drug (e.g., quetiapine, olanzapine, clozapine) or be extra alert to ADEs and adjust dose to clinical response.
    Last guideline update: 2011-03-16 00:00:00
  • Sertraline

    Reason: CYP2C19 poor metabolizer (DPWG definition)
    Reduce dose by 50%.
    Last guideline update: 2011-03-16 00:00:00
  • Thioguanine

    Reason: TPMT poor metabolizer (DPWG definition)
    Select alternative drug. Insufficient data to allow calculation of dose adjustment.
    Last guideline update: 2011-03-16 00:00:00
  • Tramadol

    Reason: CYP2D6 ultrarapid metabolizer (DPWG definition)
    Reduce dose by 30% and be alert to ADEs (e.g., nausea, vomiting, constipation, respiratory depression, confusion, urinary retention) or select alternative drug (e.g., acetaminophen, NSAID, morphine-not oxycodone or codeine).
    Last guideline update: 2011-03-16 00:00:00

Show pharmacogenomic data

GenePhenotypeHaplotype 1Haplotype 2
ABCB1Wild-type phenotype*1*1
ADRB1Wild-type phenotypeH1H1
BRCA1Wild-type phenotype11
COMTWild-type phenotypeHaplotype high activityHaplotype high activity
CYP1A2Wild-type phenotype*1A*1A
CYP2A6Wild-type phenotype*1A*1A
CYP2B6Wild-type phenotype*1*1
CYP2C19Poor metabolizer*1*1
CYP2C9Wild-type phenotype*1*1
CYP2D6Ultrarapid metabolizer*1*2
CYP3A4Wild-type phenotype*1*1
CYP3A5Wild-type phenotype*1*1
DPYDWild-type phenotype*1*1
G6PDWild-type phenotypeB (wildtype)B (wildtype)
HMGCRWild-type phenotypeH2 H2
P2RY12Wild-type phenotypeH1H1
SULT1A1Wild-type phenotype*1*2
TPMTPoor metabolizer*2*3A
UGT1A1Wild-type phenotype*1a*1a
VKORC1Wild-type phenotype*1*2
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