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GX Sciences, LLC
4150 Friedrich Ln, Suite H • Austin, TX 78744
Phone: (985) 212-0062
Laboratory Director: James Jacobson, Ph.D.
CLIA ID Number: 45D2144988
http://www.gxsciences.com/
This report combines (i) an analysis of the patient’s DNA by GX Sciences, LLC, identifying relevant genetic variants that are informative for medication efficacy,
safety, and dosing, with (ii) an interpretation of the identified DNA variants by Coriell Life Sciences to bring you immediately actionable clinical guidance
regarding safer, more effective medications and dosages for the patient.
Patient: Doe, Jane
Date of Birth: Jan 01, 1990
Gender: Female
Physician: Dr. Example
Practice: Example Health Associates
Specimen type: Buccal swab
Sample ID: gxdemo
GeneDose Live
Individualized, additional therapeutic decision support
information based on Jane Doe's genetics, drug regimen,
indications, demographics, and lifestyle indicators are
available at GeneDose Live via this secured URL:
https://alpha.genedose.com?token=prompt
GeneDose Key: AYZ6XXR4GSample ID: gxdemo
Table of Contents
Genetic Summary Information
Pg. 1Genetic Summary
Pg. 2Thrombosis Profile
Pg. 3ApoE Genotype Information
Pg. 3Medications Summary
Pg. 8Medication Report Details (by therapeutic class)
Pg. 27References
Pg. 28Patient Information Card
AppendixSNP Report
† When multiple activities are listed, check information in MedicationReport Details (Pg. 8) for specific medication of interest.Uncertain = No known diplotype/result (name) or activity for thiscombination of genetic variants; Uninterpretable Genotype.
Genetic Summary
Gene Result Activity †
ApoE ɛ3|ɛ3 See ApoE Genotype Info.
COMT(Val158Met) G|G Multiple statuses; see per-drug detail
CYP1A2 *1A|*1A Extensive metabolizer
CYP2B6 *1A|*1A Extensive metabolizer
CYP2C19 *8|*8 Poor metabolizer
CYP2C9 *1|*1 Extensive metabolizer
CYP2D6 *1|*1x2 Ultrarapid metabolizer
CYP3A4 *1B|*1B Multiple statuses; see per-drug detail
CYP3A5 *1D|*1D; or*1A|*1A; or*1A|*1D
Extensive metabolizer
CYP4F2 *1|*1 n/a
Factor V Leiden Variant See Thrombosis Profile
MTHFR (A1298C) Variant See Thrombosis Profile
MTHFR (C677T) Variant See Thrombosis Profile
Prothrombin (F2) Normal See Thrombosis Profile
SLCO1B1 *1|*1 Normal liver uptakeactivity
VKORC1 *1|*1 Normal (with respect toWarfarin)
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 1 of 28
SAMPLE
Thrombosis Profile
Tested Genes (Alleles) Genotype Predicted Phenotype Clinical Guidance
Prothrombin (F2) Normal
Factor V Leiden Homozygous
variant
MTHFR (A1298C) Homozygous
variant
MTHFR (C677T) Homozygous
variant
Variant alleles detected. It is
important for individuals
possessing this allelic variant
to understand the clinical
risks and the genetic
implications of their result.
Patients should be
counseled by their physician
or genetic counselor
Individuals homozygous for the Factor V Leiden
mutation have an approximately 80-fold increased
risk of venous thrombosis as compared to
individuals without the mutation. Patients who
are homozygous for either MTHFR variant may
have a further increased risk for venous
thrombosis if they also possess the Factor V
Leiden 1691A allele.
General Description
References and Useful Information:
• Factor V Leiden Working Group; ACMG Laboratory Quality Assurance Molecular Subcommittee of the ACMG Laboratory Quality Assurance
Committee AMERICAN COLLEGE OF MEDICAL GENETICS; Standards and Guidelines for Clinical Genetics Laboratories; 2006 Edition
◦ Middeldorp S, Henkens CM, Koopman MM, van Pampus ECM,Hamulyák K, van der Meer J, Prins MH, Büller HR. The incidence of venous
thromboembolism in family members of patients with factor V Leiden mutation and venous thrombosis. Ann Intern Med 1998;128:15-20.
◦ Vandenbroucke JP, Koster T, Briet E, Reitsma PH, Bertina RM, Rosendaal FR. Increased risk of venous thrombosis in oral contraceptive users
who are carriers of factor V Leiden mutation. Lancet 1994;344:1453-1457.
◦ Rosendaal FR, Koster T, Vandenbroucke JP, Reitsma PH. High risk of thrombosis in patients homozygous for factor V Leiden (activated
protein C resistance). Blood 1995;85(6):1504-1508.
◦ Reich LM, Bower M, Key NS. Role of the geneticist in testing and counseling for inherited thrombophilia. Genet Med 2003;5:133-143.
◦ Tosetto A, Rodeghiero F, Martinelli I, De Stefano V, Missiaglia E, Chiusolo P, Mannucci PM. Additional genetic risk factors for venous
thromboembolism in carriers of the factor V Leiden mutation. Br J Haematol 1998;103:871-876.
◦ De Stefano V, Martinelli I, Mannucci PM, Paciaroni K, Chiusolo P, Casorelli I, Rossi E, Leone G. The risk of recurrent deep venous thrombosis
among heterozygous carriers of both factor V Leiden and the G20210A prothrombin mutation. N Engl J Med 1999;341:801-806.
• M. Adams, P.D. Smith, D. Martin, J.R. Thompson, D. Lodwick, N.J. Samani. Genetic analysis of thermolabile methylenetetrahydrofolate reductase as a risk
factor for myocardial infarction. QJM. 1996 Jun;89(6):437-44.
Genetic analyses of three genes (four alleles) considered to increase the risk for venous thrombosis were performed using molecular genetic
techniques. The presence of the Prothrombin (Factor 2) gene allele 20210A and Factor V Leiden allele 1691A are risk factors for venous
thrombosis. This risk may be further increased by the use of estrogen therapy, oral contraceptives, pregnancy, and surgery.
Patients who are homozygous for MTHFR 677T or MTHFR 1298C may have a further increased risk for venous thrombosis if they also possess
the Factor V Leiden 1691A allele. However the MTHFR alleles alone do not predict a significant risk for venous thrombosis.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 2 of 28
SAMPLE
ApoE Genotype Information†
Tested Genes (Alleles) Genotype Predicted Phenotype Clinical Guidance
ApoE (ɛ2, ɛ3, ɛ4) ɛ3|ɛ3 Often associated with
normal lipid metabolism.
Typical cardiovascular disease risk expected.
General Description
Medication Summary (more alternatives discoverable at GeneDose Live)Secured URL: https://alpha.genedose.com/?token=AYZ6XXR4G
Cardiac
Therapeutic Class Standard Precautions Caution / Info Change recommended
Antiarrhythmics
Anticoagulants
Anticonvulsants
Antiplatelet Agents
Beta Blockers
Statins
Genetic analysis in the ApoE gene was performed using molecular genetic techniques. The genotype is based on genotyping results for this
patient at SNPs rs429358 and rs7412.
ApoE ɛ3 is the most common allele—found in about 60% of people. The presence of ɛ2 or ɛ4 alleles may be a risk factor for multiple conditions
including cardiovascular disease. ApoE ɛ2 carriers may be more likely to develop familial dysbetalipoproteinemia or type III
hyperlipoproteinemia.
† Predicted phenotype, clinical significance, relative risk, and interpretations reported for each genotype are associated with cardiovascular risk
only. The interpretations should not be used to determine the relative risk of other diseases. Other factors important to understanding total risk
should be considered.
Flecainide
Propafenone
Acenocoumarol
Warfarin (CYP4F2)
Warfarin
Phenytoin
Prasugrel Ticagrelor Clopidogrel
Carvedilol
Nebivolol
Propranolol
Timolol
Metoprolol
Simvastatin Atorvastatin
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 3 of 28
SAMPLE
Gastroenterology
Therapeutic Class Standard Precautions Caution / Info Change recommended
Antidepressants
Antiemetics
Endocrine-Metabolic
Agents
Immunosuppressants
Nonsteroidal Anti-
Inflamatory Drugs
(NSAIDs)
Proton Pump
Inhibitors (PPIs)
Selective Serotonin
Reuptake Inhibitors
(SSRIs)
Infectious Disease
Therapeutic Class Standard Precautions Caution / Info Change recommended
Antifungals
Pain
Therapeutic Class Standard Precautions Caution / Info Change recommended
Anticonvulsants
Antidepressants
Mirtazapine Amitriptyline
Clomipramine
Desipramine
Doxepin
Nortriptyline
Trazodone
Ondansetron
Tropisetron
Eliglustat
Cyclosporine
Celecoxib
Dexlansoprazole
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
Citalopram
Paroxetine
Voriconazole Ketoconazole
Phenytoin Clobazam
Duloxetine
Flupenthixol
Mirtazapine
Moclobemide
Amitriptyline
Clomipramine
Desipramine
Doxepin
Nortriptyline
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 4 of 28
SAMPLE
Pain
Therapeutic Class Standard Precautions Caution / Info Change recommended
Antipsychotics
Beta Blockers
Endocrine-Metabolic
Agents
Immunosuppressants
Muscle Relaxants
Nonsteroidal Anti-
Inflamatory Drugs
(NSAIDs)
Opioids
Selective Serotonin
Reuptake Inhibitors
(SSRIs)
Psychotropic
Therapeutic Class Standard Precautions Caution / Info Change recommended
Anti-ADHD Agents
Anticonvulsants
Antidementia
Protriptyline
Trazodone
Venlafaxine
Vortioxetine
Olanzapine
Nebivolol
Propranolol
Timolol
Eliglustat
Cyclosporine
Tacrolimus
Carisoprodol
Celecoxib
Diclofenac
Flurbiprofen
Meloxicam
Fentanyl
Oxycodone (CYP3A5)
Buprenorphine
Codeine
Hydrocodone
Oxycodone
Tramadol
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Amphetamine
Dexmethylphenidate
Dextroamphetamine
Lisdexamfetamine
Methylphenidate (COMT)
Atomoxetine
Guanfacine
Phenytoin Clobazam
Donepezil
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 5 of 28
SAMPLE
Psychotropic
Therapeutic Class Standard Precautions Caution / Info Change recommended
Agents
Antidepressants
Antipsychotics
Anxiolytics
Beta Blockers
Central
Monoamine-
Depleting Agents
Central Nervous
System Agents
Cholinesterase
Inhibitors
Hypnotics
Selective Serotonin
Reuptake Inhibitors
(SSRIs)
Duloxetine
Flupenthixol
Mirtazapine
Moclobemide
Amitriptyline
Clomipramine
Desipramine
Doxepin
Nortriptyline
Protriptyline
Trazodone
Venlafaxine
Vortioxetine
Aripiprazole
Brexpiprazole
Clozapine
Iloperidone
Olanzapine
Perphenazine
Haloperidol
Pimozide
Quetiapine
Risperidone
Thioridazine
Zuclopenthixol
Alprazolam
Buspirone
Clonazepam
Diazepam
Propranolol
Tetrabenazine
Dextromethorphan-Quinidine
Galantamine
Eszopiclone
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 6 of 28
SAMPLE
Surgery
Therapeutic Class Standard Precautions Caution / Info Change recommended
Anticholinergic
Agents
Antiemetics
Opioids
Other Drugs
Therapeutic Class Standard Precautions Caution / Info Change recommended
Alpha-1 Blockers
Anticholinergic
Agents
Antidiabetics
Beta-3 Adrenergic
Agonists
Cholinergic Agonists
EGFR Inhibitors
Immunosuppressants
Tolterodine
Ondansetron
Tropisetron
Fentanyl
Tamsulosin
Fesoterodine
Glibenclamide
Gliclazide
Glimepiride
Tolbutamide
Saxagliptin
Mirabegron
Cevimeline
Gefitinib
Sirolimus
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 7 of 28
SAMPLE
Legend Clinical Evidence Level
Typical response is expected Additional information available Strong
Change recommended Response is uncertain Moderate
Consider alternative therapy Emerging
Medication Report Details (by therapeutic class)
Drug Finding Recommendation Concern Evidence
Alpha-1 Blockers
Tamsulosin
(Flomax)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 8 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Anti-ADHD Agents
Amphetamine
(Adzenys, Evekeo)
COMT(Val158Met):
Increased function.
Two alleles with
increased activity.
Typical response is expected. No additional therapeutic
recommendations.
Atomoxetine
(Strattera)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism; the resultant lower plasma
concentrations may increase the probability of
pharmacotherapy failure. However, there is insufficient
evidence to allow calculation of dose adjustment. Be alert
to reduced efficacy or select alternative drug (e.g.,
methylphenidate, clonidine).
Efficacy
Dexmethylphenidate
(Focalin)
COMT(Val158Met):
Increased function.
Two alleles with
increased activity.
Typical response is expected. No additional therapeutic
recommendations.
Dextroamphetamine
(Zenzedi, Dexedrine)
COMT(Val158Met):
Increased function.
Two alleles with
increased activity.
Typical response is expected. No additional therapeutic
recommendations.
Guanfacine
(Tenex, Intuniv)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status may be at an
increased risk of therapeutic failure due to increased
metabolic clearance.
Efficacy
Lisdexamfetamine
(Vyvanse)
COMT(Val158Met):
Increased function.
Two alleles with
increased activity.
Typical response is expected. No additional therapeutic
recommendations.
Methylphenidate
(COMT)
(Concerta, Metadate,
Ritalin, Ritalin LA,
Quillivant, Daytrana,
Methylin)
COMT(Val158Met):
Increased function.
Two alleles with
increased activity.
Typical response is expected. No additional therapeutic
recommendations.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 9 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Antiarrhythmics
Flecainide
(Tambocor)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have the
potential for increased elimination. Record ECG and
monitor plasma concentration or select alternative drug
(e.g. sotalol, disopyramide, quinidine, amiodarone).
Efficacy
Propafenone
(Rythmol)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism to less active compounds; the
resultant decreased plasma concentrations may increase
the risk of pharmacotherapeutic failure. Insufficient
evidence 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).
Efficacy
Anticholinergic Agents
Fesoterodine
(Toviaz)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
Tolterodine
(Detrol)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 10 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Anticoagulants
Acenocoumarol
(Sintrom, Acitrom)
CYP2C9: Extensive
metabolizer. Two
alleles showing normal
activity.
Typical response is expected; no additional therapeutic
recommendations.
Warfarin
(Coumadin)
Multigenic:
VKORC1, CYP2C9:
Two alleles showing
normal activity.;
Extensive metabolizer.
Two alleles showing
normal activity.
Individuals with this combination of alleles may benefit
from an increased dose of Warfarin. The FDA table
recommends a therapeutic dose of 5-7 mg/day.
Warfarin (CYP4F2)
(Coumadin)
Multigenic:
CYP2C9, VKORC1,
CYP4F2:
Extensive metabolizer.
Two alleles showing
normal activity.; Two
alleles showing normal
activity.; Normal
function. Two alleles
with normal activity.
Individuals with this combination of alleles may benefit
from a standard therapeutic dose of warfarin. Consider a
regimen of 4.1-5.9 mg/day (29-41 mg/week).
ADR &
Efficacy
Anticonvulsants
Clobazam
(Onfi)
CYP2C19: Poor
metabolizer. Two null
alleles showing
reduced activity.
Individuals with poor metabolizer status may be at an
increased risk of adverse drug reaction due to the
presence of higher concentrations of clobazam's active
metabolite. Consider reducing the initial dose. The FDA
approved labeling text for ONFI states that "For this
reason, the initial dose in patients known to be CYP2C19
poor metabolizers should be 5 mg/day. These patients
should be titrated initially to 10-20 mg/day, and may be
titrated further to a maximum daily dose of 40 mg if
tolerated."
ADR
Phenytoin
(Dilantin)
CYP2C9: Extensive
metabolizer. Two
alleles showing normal
activity.
Typical response is expected; no additional therapeutic
recommendations.
Antidementia Agents
Donepezil CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 11 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Antidepressants
Amitriptyline
(Elavil)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of amitriptyline to less active
compounds; the resultant lower plasma concentrations will
increase the probability of pharmacotherapy failure. Select
an alternative drug or consider increasing the
recommended starting dose.
Efficacy
Clomipramine
(Anafranil)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism to less active compounds; the
resultant lower plasma concentrations may increase the
probability of pharmacotherapy failure. Select alternative
drug (e.g. citalopram; sertralin) or monitor (desmethyl)
clomipramine plasma concentration.
Efficacy
Desipramine
(Norpramin)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of tricyclic antidepressants; the
resultant lower plasma concentrations may increase the
probability of pharmacotherapy failure. Select an
alternative drug or consider increasing the recommended
starting dose.
Efficacy
Doxepin
(Deptran)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism to less active compounds. Lower
plasma concentrations will increase the probability of
pharmacotherapy failure. Select alternative drug
(citalopram, sertraline) or increase dose by 100%. Adjust
maintenance dose in response to (nor)doxepin plasma
concentration.
Efficacy
Duloxetine
(Cymbalta)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Typical response is expected; no additional therapeutic
recommendations.
Flupenthixol CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Typical response is expected; no additional therapeutic
recommendations.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 12 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Imipramine
(Tofranil)
Multigenic:
CYP2C19, CYP2D6:
Poor metabolizer. Two
null alleles likely
showing little or no
activity. Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Multiple results from uncorrelated genes.
CYP2C19: Potential dosage adjustment or alternate drug
suggested CYP2D6: Consider alternative therapy
Mirtazapine CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Typical response is expected; no additional therapeutic
recommendations.
Moclobemide CYP2C19: Poor
metabolizer. Two null
alleles likely showing
reduced activity.
Typical response is expected; no additional therapeutic
recommendations.
Nortriptyline
(Pamelor)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of tricyclics to less active
compounds when compared to extensive metabolizers; the
resultant lower plasma concentrations will increase
probability of pharmacotherapy failure. Consider
alternative therapy--select alternative drug (e.g.
citalopram, sertraline) or increase dose by 60% and
monitor nortriptyline 10-hydroxynortriptyline plasma
concentrations.
Efficacy
Protriptyline
(Vivactil)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of tricyclic antidepressants; the
resultant lower plasma concentrations may increase the
probability of pharmacotherapy failure. Select an
alternative drug or consider increasing the recommended
starting dose.
Efficacy
Trazodone
(Oleptro, Desyrel)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of trazodone; the resultant lower
plasma concentrations may increase the probability of
pharmacotherapy failure. Select an alternative drug or
monitor patient for a need to increase the dose.
Efficacy
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 13 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Venlafaxine
(Effexor)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Be alert to decreased venlafaxine and increased (O-
desmethyl) venlafaxine plasma concentration. Titrate dose
to a maximum of 150% of the normal dose or select
alternative drug (e.g. citalopram, sertraline).
Vortioxetine
(Brintellix)
CYP2D6: *1|*1x2 Individuals with ultrarapid metabolizer status have
increased clearance of vortioxetine; the resultant lower
plasma concentrations may increase the probability of
pharmacotherapy failure. Consider increasing the dose.
Efficacy
Antidiabetics
Glibenclamide
(Glyburide)
CYP2C9: Extensive
metabolizer. Two
alleles showing normal
activity.
Typical response is expected; no additional therapeutic
recommendations.
Gliclazide CYP2C9: Extensive
metabolizer. Two
alleles showing normal
activity.
Typical response is expected; no additional therapeutic
recommendations.
Glimepiride CYP2C9: Extensive
metabolizer. Two
alleles showing normal
activity.
Typical response is expected; no additional therapeutic
recommendations.
Saxagliptin
(Onglyza)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of saxagliptin; the resultant lower
plasma concentrations may increase the probability of
pharmacotherapy failure. Select an alternative drug or
monitor patient for efficacy and adjust dose appropriately.
Efficacy
Tolbutamide
(Orinase)
CYP2C9: Extensive
metabolizer. Two
alleles showing normal
activity.
Typical response is expected; no additional therapeutic
recommendations.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 14 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Antiemetics
Ondansetron
(Zofran)
CYP2D6: *1|*1x2 Individuals with ultrarapid metabolizer status may be at an
increased risk of therapeutic failure due to increased
metabolic clearance. Consider an alternative therapy (e.g.
granisetron).
Efficacy
Tropisetron CYP2D6: *1|*1x2 Individuals with ultrarapid metabolizer status may be at an
increased risk of therapeutic failure due to increased
metabolic clearance. Consider an alternative therapy (e.g.
granisetron).
Efficacy
Antifungals
Ketoconazole
(Nizoral)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of ketoconazole; the resultant lower
plasma concentrations may increase the probability of
pharmacotherapy failure. Ketoconazole is not
recommended.
Efficacy
Voriconazole CYP2C19: Poor
metabolizer. Two null
alleles likely showing
reduced activity.
Individuals with poor metabolizer status may have higher
voriconazole exposure. Adjust the dose and monitor for
adverse events or lack of efficacy.
ADR &
Efficacy
Antiplatelet Agents
Clopidogrel
(Plavix)
CYP2C19: Poor
metabolizer. Two
alleles showing
reduced activity.
Individuals with poor metabolizer status are at an
increased risk of therapeutic failure due to reduced
activation of the prodrug and low plasma concentrations of
the active compound. Clopidogrel is not recommended.
Efficacy
Prasugrel
(Effient)
CYP2C19: *8|*8 Typical response is expected; no additional therapeutic
recommendations.
Ticagrelor
(Brilinta)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status may be at an
increased risk of adverse drug reactions and decreased
efficacy due to reduced metabolism of the prodrug to the
active metabolite. Insufficient evidence to allow
calculation of dose adjustment. Consider alternative drug.
ADR &
Efficacy
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 15 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Antipsychotics
Aripiprazole
(Abilify)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Typical response is expected; no additional therapeutic
recommendations.
Brexpiprazole
(Rexulti)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
Clozapine CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Typical response is expected; no additional therapeutic
recommendations.
Haloperidol
(Haldol)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism to less active compounds; the
resultant decreased plasma concentrations may increase
the probability of pharmacotherapy failure. Insufficient
evidence to allow calculation of dose adjustment. Monitor
and adjust maintenance dose in response to haloperidol
plasma concentration or select alternative drug (e.g.
pimozide; flupenthixol; fluphenazine; quetiapine;
olanzapine; clozapine).
Efficacy
Iloperidone
(Fanapt)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
Olanzapine
(Zalasta, Zyprexa)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Typical response is expected; no additional therapeutic
recommendations.
Perphenazine
(Trilafon, Etrafon)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 16 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Pimozide
(Orap)
CYP2D6: *1|*1x2 Individuals with ultrarapid metabolizer status may be at
increased risk of therapeutic failure due to lower plasma
concentrations. For children, the drug label recommends
an initial dose of 0.05 mg/kg followed by titration to
response up to a maximum of 0.2 mg/kg and not to exceed
10 mg/day. In adults the drug label recommends an intial
dose of 1 to 2 mg a day in divided doses followed by
titration to response up to a maximum of 0.2 mg/kg/day or
10 mg/day.
Efficacy
Quetiapine
(Seroquel)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status have
increased clearance of quetiapin; the resultant lower
plasma concentrations may increase the probability of
pharmacotherapy failure. Select an alternative drug or
consider increasing the recommended starting dose.
Efficacy
Risperidone
(Risperdal)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Insufficient evidence to allow calculation of dose
adjustment. Select alternative drug (e.g. quetiapine,
olanzapine, clozapine) or be extra alert to decreased
response and titrate dose in response to clinical effect and
adverse drug events.
Thioridazine CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status may be at
risk of reduced efficacy due to increased metabolism of
thioridazine. Select an alternative drug or consider
increasing the recommended starting dose.
Efficacy
Zuclopenthixol CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism to less active compounds; the
resultant decreased plasma concentrations may increase
the probability of pharmacotherapy failure. Insufficient
evidence to allow calculation of dose adjustment. Be alert
to low zuclopenthixol plasma concentrations or select
alternative drug (e.g. flupenthixol, quetiapine, olanzapine,
clozapine).
Efficacy
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 17 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Anxiolytics
Alprazolam
(Xanax, Niravam)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of alprazolam; the resultant lower
plasma levels may increase the probability of
pharmacotherapy failure. Select an alternative drug or
consider increasing the recommended starting dose.
Efficacy
Buspirone
(Buspar)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of buspirone; the resultant lower
plasma levels may increase the probability of
pharmacotherapy failure. Select an alternative drug or
consider increasing the recommended starting dose.
Efficacy
Clonazepam
(Klonopin)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of clonazepam; the resultant lower
plasma concentrations may increase the probability of
pharmacotherapy failure. Select an alternative drug or
monitor patient for efficacy and adjust dose appropriately.
Efficacy
Diazepam
(Diastat, Valium)
CYP2C19: *8|*8 Individuals with poor metabolizer status may emerge from
anesthesia less rapidly due to decreased metabolic
clearance. Insufficient evidence to allow calculation of
dose adjustment. Be alert to symptoms of excessive drug
exposure.
ADR &
Efficacy
Beta-3 Adrenergic Agonists
Mirabegron
(Myrbetriq)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 18 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Beta Blockers
Carvedilol
(Coreg)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Typical response is expected; no additional therapeutic
recommendations.
Metoprolol
(Lopressor)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism when compared to extensive
metabolizers; the resultant lower plasma concentrations
may increase probability of pharmacotherapy failure. For
heart failure (indication): select alternative drug (e.g.
bisoprolol, carvedilol) or titrate dose to a maximum of
250% of the normal dose in response to efficacy and
adverse drug events. For 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 adverse drug events.
ADR &
Efficacy
Nebivolol
(Bystolic)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
Propranolol
(Inderal)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
Timolol
(Blocadren)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
Central Monoamine-Depleting Agents
Tetrabenazine
(Xenazine)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
Central Nervous System Agents
Dextromethorphan-
Quinidine
(Nuedexta)
CYP2D6: *1|*1x2 Individuals with ultrarapid metabolizer status may be at an
increased risk of therapeutic failure due to increased
metabolic clearance. Consider dose increase or select an
alternative therapy based upon assessment of clinical
benefit and tolerability.
Efficacy
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 19 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Cholinergic Agonists
Cevimeline
(Evoxac)
CYP2D6: *1|*1x2 Individuals with ultrarapid metabolizer status have
increased clearance of cevimeline; the resultant lower
plasma concentrations may increase the probability of
pharmacotherapy failure. Insufficient evidence to allow
calculation of dose adjustment. Consider alternative drug.
Efficacy
Cholinesterase Inhibitors
Galantamine
(Razadyne)
CYP2D6: *1|*1x2 Individuals with ultrarapid metabolizer status may be at an
increased risk of adverse drug reactions and/or
therapeutic failure. Insufficient evidence to allow
calculation of dose adjustment. Be alert to adverse
reactions and/or symptoms of insufficient therapy.
ADR &
Efficacy
EGFR Inhibitors
Gefitinib
(Iressa)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
Endocrine-Metabolic Agents
Eliglustat
(Cerdelga)
CYP2D6: *1|*1x2 Individuals with ultrarapid metabolizer status may be at an
increased risk of therapeutic failure due to increased
metabolic clearance. Insufficient evidence to allow
calculation of dose adjustment. Be alert to symptoms of
insufficient therapy.
Efficacy
Hypnotics
Eszopiclone
(Lunesta)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of eszopiclone; the resultant lower
blood concentrations may increase the probability of
pharmacotherapy failure. Consider selecting an alternative
drug.
Efficacy
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 20 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Immunosuppressants
Cyclosporine
(Gengraf, Neoral)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of cyclosporine; the resultant lower
plasma concentrations may increase the probability of
pharmacotherapy failure. Select an alternative drug or
monitor circulating cyclosporine concentrations and adjust
dose appropriately.
Efficacy
Sirolimus
(Rapamune)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status have
increased metabolism of sirolimus; the resultant lower
plasma concentrations may increase the probability of
pharmacotherapy failure. Select an alternative drug or
monitor sirolimus trough concentrations and adjust dose
appropriately.
Efficacy
Tacrolimus
(Prograf, Hecoria)
CYP3A5: Two alleles
showing normal
activity.
Individuals with extensive metabolizer status have lower
dose-adjusted trough concentrations of tacrolimus; the
resultant decreased concentrations may increase the
probability of pharmacotherapy failure. Consider
increasing the recommended starting dose by 1.5 to 2
times (with a total starting dose not exceeding 0.3 mg/kg/
day). In liver transplant patients, donor genotype should be
considered as well as the recipient's.
Efficacy
Muscle Relaxants
Carisoprodol
(Soma)
CYP2C19: Poor
metabolizer. Two null
alleles likely showing
reduced activity.
Individuals with poor metabolizer status may be at an
increased risk of adverse drug reactions due to reduced
carisoprodol metabolism. Carisoprodol should be
administered with caution.
ADR
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
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not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 21 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Non-drug
ApoE ApoE: Often
associated with normal
lipid metabolism.
Typical cardiovascular disease risk expected.
COMT(Val158Met) COMT(Val158Met):
Increased function.
Two alleles with
increased activity.
Increased function. Two alleles with increased activity.
CYP1A2 CYP1A2: Extensive
metabolizer. Two
alleles showing normal
activity.
No additional therapeutic recommendations.
CYP2B6 CYP2B6: Extensive
metabolizer. Two
alleles showing normal
activity.
No additional therapeutic recommendations.
Nonsteroidal Anti-Inflamatory Drugs (NSAIDs)
Celecoxib
(Celebrex)
CYP2C9: Extensive
metabolizer. Two
alleles showing normal
activity.
Typical response is expected; no additional therapeutic
recommendations.
Diclofenac
(Cataflam)
CYP2C9:rs1057910:
Two alleles showing
normal activity.
Typical response is expected; no additional therapeutic
recommendations.
Flurbiprofen
(Ocufen)
CYP2C9: Extensive
metabolizer. Two
alleles showing normal
activity.
Typical response is expected; no additional therapeutic
recommendations.
Meloxicam
(Mobic)
CYP2C9: Extensive
metabolizer. Two
alleles showing normal
activity.
Typical response is expected; no additional therapeutic
recommendations.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
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not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 22 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Opioids
Buprenorphine
(Butrans, Buprenex)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status may have
increased clearance of buprenorphine; the resultant lower
plasma concentrations may increase the probability of
pharmacotherapy failure. It is recommended that patients
be monitored for signs and symptoms of opioid
withdrawal. Consider an alternative medication.
Efficacy
Codeine CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
For analgesia, select alternative drug (e.g. acetaminophen,
NSAID, morphine; not tramadol or oxycodone). Be extra
alert to adverse drug events due to increased morphine
plasma concentration.
ADR
Fentanyl
(Duragesic, Sublimaze)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Typical response is expected; no additional therapeutic
recommendations.
Hydrocodone CYP2D6: *1|*1x2 Individuals with ultrarapid metabolizer status may be at an
increased risk of adverse drug reactions and/or
therapeutic failure. Insufficient evidence to allow
calculation of dose adjustment. Be alert to adverse
reactions and/or symptoms of insufficient therapy.
ADR
Oxycodone
(Oxycontin)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status are at risk of
possible adverse drug reaction. Insufficient evidence to
allow calculation of dose adjustment. Select alternative
drug (not tramadol or codeine) or be alert to adverse drug
events (e.g. nausea; vomiting; constipation; respiratory
depression; confusion; urinary retention).
ADR
Oxycodone (CYP3A5)
(Oxycontin)
CYP3A5: Two alleles
showing normal
activity.
Typical response is expected; no additional therapeutic
recommendations.
Tramadol
(Ultracet, Ultram)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Individuals with ultrarapid metabolizer status have
increased metabolism to more active compounds; the
resultant increased plasma concentrations may increase
the probability of adverse drug reactions. Reduce dose by
30% and be alert to adverse drug events (e.g. nausea;
vomiting; constipation; respiratory depression; confusion;
urinary retention) or select alternative drug (e.g.
acetaminophen; NSAID; morphine - not oxycodone or
codeine).
ADR
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
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not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 23 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Proton Pump Inhibitors (PPIs)
Dexlansoprazole
(Kapidex, Dexilant)
CYP2C19: Poor
metabolizer. Two null
alleles showing
reduced activity.
Individuals with poor metabolizer status have decreased
metabolism to less active compounds; the resultant
increased concentrations may increase drug efficacy.
Individual is expected to respond well to PPI treatment; no
additional therapeutic recommendations.
Efficacy
Esomeprazole
(Nexium)
CYP2C19: Poor
metabolizer. Two null
alleles showing
reduced activity.
Individuals with poor metabolizer status have decreased
metabolism to less active compounds; the resultant
increased concentrations may increase drug efficacy.
Individual is expected to respond well to PPI treatment; no
additional therapeutic recommendations.
Efficacy
Lansoprazole
(Prevacid)
CYP2C19: Poor
metabolizer. Two null
alleles showing
reduced activity.
Individuals with poor metabolizer status have decreased
metabolism to less active compounds; the resultant
increased concentrations may increase drug efficacy.
Individual is expected to respond well to PPI treatment; no
additional therapeutic recommendations.
Efficacy
Omeprazole
(Prilosec, Zegerid)
CYP2C19: Poor
metabolizer. Two null
alleles showing
reduced activity.
Individuals with poor metabolizer status have decreased
metabolism to less active compounds; the resultant
increased concentrations may increase drug efficacy.
Individual is expected to respond well to PPI treatment; no
additional therapeutic recommendations.
Efficacy
Pantoprazole
(Protonix)
CYP2C19: Poor
metabolizer. Two null
alleles showing
reduced activity.
Individuals with poor metabolizer status have decreased
metabolism to less active compounds; the resultant
increased concentrations may increase drug efficacy.
Individual is expected to respond well to PPI treatment; no
additional therapeutic recommendations.
Efficacy
Rabeprazole
(Aciphex)
CYP2C19: Poor
metabolizer. Two null
alleles showing
reduced activity.
Individuals with poor metabolizer status have decreased
metabolism to less active compounds; the resultant
increased concentrations may increase drug efficacy.
Individual is expected to respond well to PPI treatment; no
additional therapeutic recommendations.
Efficacy
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 24 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Selective Serotonin Reuptake Inhibitors (SSRIs)
Citalopram
(Celexa)
CYP2C19: Poor
metabolizer. Two null
alleles likely showing
reduced activity.
Typical response is expected. However, individuals with
poor metabolizer status have increased bioavailability
increasing the probability of side effects.
ADR
Escitalopram
(Lexapro)
CYP2C19: Poor
metabolizer. Two null
alleles likely showing
reduced activity.
Typical response is expected. However, individuals with
poor metabolizer status have increased bioavailability
increasing the probability of side effects.
ADR
Fluoxetine
(Prozac)
CYP2D6: *1|*1x2 Individuals taking fluoxetine should be alert to
concomitant use of drugs metabolized by CYP2D6. Briefly,
fluoxetine is a potent inhibitor of CYP2D6 enzyme
pathway. Fluoxetine inhibits the activity of CYP2D6, and
may make individuals with normal CYP2D6 metabolic
activity resemble a poor metabolizer. Coadministration of
fluoxetine with other drugs that are metabolized by
CYP2D6, including certain antidepressants (e.g. TCAs),
antipsychotics (e.g. phenothiazines and most atypicals),
and antiarrhythmics (e.g. propafenone, flecainide, and
others) should be approached with caution.
ADR &
Efficacy
Fluvoxamine
(Luvox)
CYP2D6: *1|*1x2 Typical response is expected; no additional therapeutic
recommendations.
Paroxetine
(Paxil)
CYP2D6: Ultrarapid
metabolizer. One allele
showing normal
activity and one
duplicated allele
showing increased
activity.
Insufficient evidence to allow calculation of dose
adjustment. Consider selecting alternative drug (e.g.
citalopram, sertraline).
Efficacy
Sertraline
(Zoloft)
CYP2C19: Poor
metabolizer. Two null
alleles likely showing
reduced activity.
Individuals with poor metabolizer status may have higher
plasma concentrations and decreased clearance. Reduce
dose by 50%.
ADR
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
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not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 25 of 28
SAMPLE
Drug Finding Recommendation Concern Evidence
Statins
Atorvastatin
(Lipitor, Caduet)
CYP3A4: Ultra-rapid
metabolizer. Two
alleles showing
increased activity.
Individuals with ultrarapid metabolizer status eliminate
atorvastatin more rapidly than extensive/normal
metabolizers and may not respond well to a standard dose.
Increased dose may be needed.
Simvastatin
(Zocor)
SLCO1B1: Normal
liver uptake activity.
Individuals with normal SLCO1B1 liver uptake activity are
expected to have a typical response to a standard dose of
simvastatin.
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
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Clinical Evidence Levels
• Includes gene-drug pairs approved by the Coriell Institute for Medical Research Pharmacogenomics Advisory Group.
• Includes gene-drug pairs supported by multiple studies documenting consistent effects of specific genetic variant(s) on clinical outcomes.
• Includes gene-drug pairs approved by the Dutch Pharmacogenetics Working Group (DPWG) and/or guidelines published in Clinical Pharmacology and
Therapeutics by the Clinical Pharmacogenetics Implementation Consortium (CPIC).
• Includes gene-drug pairs supported by pharmacokinetic, pharmacodynamic, or molecular/cellular functional studies showing consistent effects of
genetic variant(s).
• Includes Drug product information (e.g. This interpretation is based on guidance available in the FDA (Food and Drug Administration) drug label for
ABILIFY® (10/2013).
• Includes gene-drug pairs for which potential clinical outcomes are inferred from similar gene-drug interactions approved by the Dutch
Pharmacogenetics Working Group (DPWG), and/or guidelines published in Clinical Pharmacology and Therapeutics by the Clinical Pharmacogenetics
Implementation Consortium (CPIC), and/or pharmacogenomic reports and submission from the Coriell Institute for Medical Research.
• Includes gene-drug pairs supported by published studies of the drug, related drug, or a probing compound of interest involving limited data and/or
inconsistent findings.
Strong
Moderate
Emerging
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
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Patient Information Card
GX Sciences, LLC
http://www.gxsciences.com/
Patient: Doe, Jane
DOB: Sample ID: GeneDose Key:
1990-01-01 gxdemo AYZ6XXR4G
Pharmacogenomic Summary
ApoE ɛ3|ɛ3 See full GeneDose report
CYP2C9:rs1057910 A|A Uncertain
Factor V Leiden Variant See full GeneDose report
MTHFR (A1298C) Variant See full GeneDose report
MTHFR (C677T) Variant See full GeneDose report
Prothrombin (F2) Normal See full GeneDose report
COMT(Val158Met) G|GMultiple statuses; see
per-drug detail
CYP1A2 *1A|*1A Extensive metabolizer
CYP2B6 *1A|*1A Extensive metabolizer
CYP2C19 *8|*8 Poor metabolizer
CYP2C9 *1|*1 Extensive metabolizer
CYP2D6 *1|*1x2 Ultrarapid metabolizer
CYP3A4 *1B|*1BMultiple statuses; see
per-drug detail
CYP3A5*1D|*1D; or
*1A|*1A; or *1A|*1DExtensive metabolizer
CYP4F2 *1|*1 n/a
SLCO1B1 *1|*1Normal liver uptake
activity
VKORC1 *1|*1Normal (with respect to
Warfarin)
Powered by: Coriell Life Sciences
↑ Cut on dotted lines. ↑ Fold Here
This card contains an abbreviated genetic summary.
It is not intended as a replacement for the complete GeneDose™ report.
This card shows information about your genetics that relate to
drug metabolism. Show to your doctors before being prescribed
new medications.
For additional support and guidance:
• Physicians can visit
https://alpha.genedose.com?token=prompt
GeneDose Genetic Response Report
gxdemo - Doe, Jane - Reported May 29, 2018 - DRAFT Powered by:
The information contained in this report is intended to be interpreted by a licensed physician or other licensed healthcare professional. This report is
not intended to take the place of professional medical advice. Decisions regarding use of prescribed medications must be made only after consulting
with a licensed physician or other licensed healthcare professional, and should consider each patient's medical history and current treatment regimen.
Page 28 of 28
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