CYP2C9
|
PHENYTOIN*
|
828
|
EM
|
518
|
No action
|
IM
|
294
|
Lower dose required at start therapy
|
PM
|
17
|
Lower dose required at start therapy
|
CYP2C19
|
CITALOPRAM < 65 years*
|
41,338
|
EM
|
29,557
|
No action
|
IM
|
8,888
|
Guard maximum daily dose
|
PM
|
1240
|
Guard maximum daily dose
|
UM
|
1654
|
No action
|
CITALOPRAM ≥ 65 years*
|
15,242
|
EM
|
10,898
|
No action
|
IM
|
3277
|
Guard maximum daily dose
|
PM
|
457
|
Guard maximum daily dose
|
UM
|
610
|
No action
|
CLOPIDOGREL*
|
98,709
|
EM
|
70,577
|
No action
|
IM
|
21,222
|
Switch to alternate drug at start therapy
|
PM
|
2961
|
Switch to alternate drug at start therapy
|
UM
|
3948
|
Observe status of patient carefully
|
ESCITALOPRAM < 65 years*
|
21,427
|
EM
|
15,320
|
No action
|
IM
|
4607
|
Guard maximum daily dose
|
PM
|
643
|
Guard maximum daily dose
|
UM
|
857
|
No action
|
ESCITALOPRAM ≥ 65 years*
|
3027
|
EM
|
2164
|
No action
|
IM
|
651
|
Guard maximum daily dose
|
PM
|
91
|
Guard maximum daily dose
|
UM
|
121
|
No action
|
ESOMEPRAZOLE
|
65,370
|
EM
|
46,740
|
No action
|
IM
|
14,055
|
No action
|
PM
|
1961
|
No action
|
UM
|
2615
|
Optional increase of dose
|
ESOMEPRAZOLE AND NAPROXEN
|
673
|
EM
|
481
|
No action
|
IM
|
145
|
No action
|
PM
|
20
|
No action
|
UM
|
27
|
Optional increase of dose
|
LANSOPRAZOLE
|
1536
|
EM
|
1098
|
No action
|
IM
|
330
|
No action
|
PM
|
46
|
No action
|
UM
|
61
|
Optional increase of dose
|
OMEPRAZOLE
|
575,353
|
EM
|
411,377
|
No action
|
IM
|
123,701
|
No action
|
PM
|
17,261
|
No action
|
UM
|
23,014
|
Optional increase of dose
|
PANTOPRAZOLE
|
361,741
|
EM
|
258,645
|
No action
|
IM
|
77,774
|
No action
|
PM
|
10,852
|
No action
|
UM
|
14,470
|
Optional increase of dose
|
PANTOPAC
|
21,768
|
EM
|
15,564
|
No action
|
IM
|
4680
|
No action
|
PM
|
653
|
No action
|
UM
|
871
|
Higher dose required at start therapy
|
SERTRALINE*
|
28,861
|
EM
|
20,636
|
No action
|
IM
|
6205
|
Guard maximum daily dose
|
PM
|
866
|
Guard maximum daily dose
|
UM
|
1154
|
No action
|
VORICONAZOLE*
|
891
|
EM
|
637
|
No action
|
IM
|
192
|
Observe status of patient carefully
|
PM
|
27
|
Observe status of patient carefully
|
UM
|
36
|
Higher dose required at start therapy
|
CYP2D6
|
AMITRIPTYLINE*
|
98,750
|
EM
|
52,338
|
No action
|
IM
|
39,994
|
Switch to alternate drug at start therapy
|
PM
|
4938
|
Switch to alternate drug at start therapy
|
UM
|
1481
|
Switch to alternate drug at start therapy
|
ARIPIPRAZOLE
|
13,869
|
EM
|
7351
|
No action
|
IM
|
5617
|
No action
|
PM
|
693
|
Guard maximum daily dose
|
UM
|
208
|
No action
|
ATOMOXETINE*
|
1987
|
EM
|
1053
|
No action
|
IM
|
805
|
Optional decrease of dose
|
PM
|
99
|
Optional decrease of dose
|
UM
|
30
|
Observe status of patient carefully
|
CLOMIPRAMINE*
|
7079
|
EM
|
3752
|
No action
|
IM
|
2867
|
Lower dose required at start therapy
|
PM
|
354
|
Lower dose required at start therapy
|
UM
|
106
|
Switch to alternate drug at start therapy
|
CODEINE*
|
519,728
|
EM
|
275,456
|
No action
|
IM
|
210,490
|
No action
|
PM
|
25,986
|
No action
|
UM
|
7796
|
Switch to alternate drug at start therapy
|
CODEINE AND PARACETAMOL*
|
69,300
|
EM
|
36,729
|
No action
|
IM
|
28,067
|
Optional increase of dose
|
PM
|
3465
|
Switch to alternate drug at start therapy
|
UM
|
1040
|
Switch to alternate drug at start therapy
|
DOXEPIN*
|
270
|
EM
|
143
|
No action
|
IM
|
109
|
Lower dose required at start therapy
|
PM
|
14
|
Lower dose required at start therapy
|
UM
|
4
|
Switch to alternate drug at start therapy
|
FLECAINIDE
|
13,605
|
EM
|
7211
|
No action
|
IM
|
5510
|
Lower dose required at start therapy
|
PM
|
680
|
Lower dose required at start therapy
|
UM
|
204
|
Observe status of patient carefully
|
HALOPERIDOL
|
51,217
|
EM
|
27,145
|
No action
|
IM
|
20,743
|
No action
|
PM
|
2561
|
Lower dose required at start therapy
|
UM
|
768
|
Optional increase of dose
|
IMIPRAMINE (TOTAL)
|
988
| | | |
IMIPRAMINE (CYP2C19 EM, IM, UM)*
|
958
|
EM
|
508
|
No action
|
IM
|
388
|
Lower dose required at start therapy
|
PM
|
48
|
Lower dose required at start therapy
|
UM
|
14
|
Switch to alternate drug at start therapy
|
IMIPRAMINE (CYP2C19 PM) *
|
30
|
EM
|
16
|
Lower dose required at start therapy
|
IM
|
12
|
Lower dose required at start therapy
|
PM
|
2
|
Lower dose required at start therapy
|
UM
|
0
|
Switch to alternate drug at start therapy
|
METOPROLOL
|
194,724
|
EM
|
103,204
|
No action
|
IM
|
78,863
|
Optional decrease of dose
|
PM
|
9736
|
Optional decrease of dose
|
UM
|
2921
|
Optional increase of dose
|
METOPROLOL AND THIAZIDE
|
1908
|
EM
|
1011
|
No action
|
IM
|
773
|
Optional decrease of dose
|
PM
|
95
|
Optional decrease of dose
|
UM
|
29
|
Optional increase of dose
|
NORTRIPTYLINE*
|
20,717
|
EM
|
10,980
|
No action
|
IM
|
8390
|
Lower dose required at start therapy
|
PM
|
1036
|
Lower dose required at start therapy
|
UM
|
311
|
Switch to alternate drug at start therapy
|
OXYCODONE
|
464,799
|
EM
|
246,343
|
No action
|
IM
|
188,244
|
Observe status of patient carefully
|
PM
|
23,240
|
Observe status of patient carefully
|
UM
|
6972
|
Observe status of patient carefully
|
OXYCODONE AND NALOXONE
|
82
|
EM
|
43
|
No action
|
IM
|
33
|
Observe status of patient carefully
|
PM
|
4
|
Observe status of patient carefully
|
UM
|
1
|
Observe status of patient carefully
|
PAROXETINE*
|
27,018
|
EM
|
14,320
|
No action
|
IM
|
10,942
|
No action
|
PM
|
1351
|
No action
|
UM
|
405
|
Switch to alternate drug at start therapy
|
PIMOZIDE
|
1060
|
EM
|
562
|
No action
|
IM
|
429
|
Lower dose required at start therapy
|
PM
|
53
|
Lower dose required at start therapy
|
UM
|
16
|
No action
|
PROPAFENON
|
409
|
EM
|
217
|
No action
|
IM
|
166
|
Optional decrease of dose
|
PM
|
20
|
Lower dose required at start therapy
|
UM
|
6
|
Observe status of patient carefully
|
TAMOXIFEN*
|
10,807
|
EM
|
5728
|
No action
|
IM
|
4377
|
Switch to alternate drug at start therapy
|
PM
|
540
|
Switch to alternate drug at start therapy
|
UM
|
162
|
No action
|
TRAMADOL*
|
357,389
|
EM
|
189,416
|
No action
|
IM
|
144,743
|
Optional increase of dose
|
PM
|
17,869
|
Optional increase of dose
|
UM
|
5361
|
Lower dose required at start therapy
|
TRAMADOL AND PARACETAMOL*
|
124,951
|
EM
|
66,224
|
No action
|
IM
|
50,605
|
Optional increase of dose
|
PM
|
6248
|
Optional increase of dose
|
UM
|
1874
|
Lower dose required at start therapy
|
VENLAFAXINE
|
26,603
|
EM
|
14,100
|
No action
|
IM
|
10,774
|
Switch to alternate drug at start therapy
|
PM
|
1330
|
Switch to alternate drug at start therapy
|
UM
|
399
|
Optional increase of dose
|
ZUCLOPENTHIXOL
|
1873
|
EM
|
993
|
No action
|
IM
|
759
|
Lower dose required at start therapy
|
PM
|
94
|
Lower dose required at start therapy
|
UM
|
28
|
Optional increase of dose
|
CYP3A5
|
TACROLIMUS*
|
2722
|
Non-Ex
|
2314
|
No action
|
Het-Ex
|
395
|
Higher dose required at start therapy
|
Homo-Ex
|
14
|
Higher dose required at start therapy
|
SLCO1B1
|
ATORVASTATIN (TOTAL)
|
111,840
| | | |
ATORVASTATIN (WITHOUT CYP3A4 INHIBITOR)
|
108,400
|
NT (521TT)
|
80,758
|
No action
|
PT (521TC)
|
25,474
|
Observe status of patient carefully
|
PT (521CC)
|
2168
|
Observe status of patient carefully
|
ATORVASTATIN (WITH CYP3A4 INHIBITOR)
|
3440
|
NT (521TT)
|
2563
|
No action
|
PT (521TC)
|
808
|
Switch to alternate drug at start therapy
|
PT (521CC)
|
69
|
Switch to alternate drug at start therapy
|
ATORVASTATIN AND EZETIMIBE
|
1909
| | | |
ATORVASTATIN AND EZETIMIBE (WITHOUT CYP3A4 INHIBITOR)
|
1739
|
NT (521TT)
|
1296
|
No action
|
PT (521TC)
|
409
|
Observe status of patient carefully
|
PT (521CC)
|
35
|
Observe status of patient carefully
|
ATORVASTATIN AND EZETIMIBE (WITH CYP3A4 INHIBITOR)
|
170
|
NT (521TT)
|
127
|
No action
|
PT (521TC)
|
40
|
Switch to alternate drug at start therapy
|
PT (521CC)
|
3
|
Switch to alternate drug at start therapy
|
SIMVASTATIN*
|
187,362
|
NT (521TT)
|
139,585
|
No action
|
PT (521TC)
|
44,030
|
Switch to alternate drug at start therapy
|
PT (521CC)
|
3747
|
Switch to alternate drug at start therapy
|
SIMVASTATIN AND EZETIMIBE*
|
4888
|
NT (521TT)
|
3642
|
No action
|
PT (521TC)
|
1149
|
Switch to alternate drug at start therapy
|
PT (521CC)
|
98
|
Switch to alternate drug at start therapy
|
TPMT
|
AZATHIOPRINE*
|
6943
|
EM
|
5867
|
No action
|
IM
|
1041
|
Lower dose required at start therapy
|
PM
|
35
|
Switch to alternate drug at start therapy
|
MERCAPTOPURINE*
|
2598
|
EM
|
2195
|
No action
|
IM
|
390
|
Lower dose required at start therapy
|
PM
|
13
|
Switch to alternate drug at start therapy
|
TIOGUANINE*
|
1888
|
EM
|
1591
|
No action
|
IM
|
282
|
Lower dose required at start therapy
|
PM
|
9
|
Switch to alternate drug at start therapy
|
VKORC1
|
ACENOCOUMAROL
|
49,934
|
NS (1173CC)
|
16,478
|
No action
|
NS (1173CT)
|
25,217
|
No action
|
HS (1173TT)
|
8239
|
Lower dose required at start therapy
|
FENPROCOUMON
|
12,621
|
NS (1173CC)
|
4165
|
No action
|
NS (1173CT)
|
6374
|
No action
|
HS (1173TT)
|
2082
|
Lower dose required at start therapy
|