Download CYP2C9 Master Drug List

CYP2C9 Master Drug List
Warfarin
Celecoxib
Ibuprofen
Meloxicam
Diclofenac
Naproxen
Glyburide
Glipizide
Tolbutamide
Glimepiride
Phenytoin
Fluvastatin
Rosuvastatin
Losartan
Coumadin
Celebrex
Advil, Motrin
Mobic
Cataflam, Voltaren XR
Aleve
Diabeta
Glucotrol
Orinase
Amaryl
Dilantin
Lescol
Crestor
Cozaar
LAB NOTES
CYP2C9 is a liver enzyme that metabolizes approximately 10% of all drugs, including warfarin,
phenytoin, non-steroidal anti-inflammatory drugs (NSAIDs), and antihyperglycemic sulphonylureas.
Detecting variants of the CYP2C9 gene that cause altered enzymatic activity can identify patients
who may be at increased risk of having adverse drug reactions while taking standard dosages of
CYP2C9 substrates. Roughly 3% of the population are 2C9 Poor Metabolizers (PMs), meaning
they have no 2C9 enzymatic activity. Another 36% of the population are considered Intermediate
Metabolizers (IMs) with decreased activity. Both IMs and PMs exhibit decreased metabolic activity,
which puts them at risk for side effects to drugs normally inactivated by 2C9. With respect to
warfarin, 2C9 deficiency can lead to increased bleeding risk, decreased dose requirement, and a
longer time to reach stable therapy. The combination of CYP2C9 genotyping with VKORC1 - the
target of warfarin’s effect – and with patient physical characteristics can accurately estimate a
patient’s warfarin sensitivity level, dose requirement, and ultimately provide practitioners with better
guidance for optimal INR interpretation and management.
PGXL Master Drug List 062013
© 2012-3 by PGXL Laboratories
CYP2C19 Master Drug List
CYP2C19
Clopidogrel**
Citalopram
Escitalopram
Imipramine
Sertraline
Diazepam
Omeprazole
Esomeprazole
Pantoprazole
Rabeprazole
Lansoprazole
Nelfinavir
Methadone
(active portion)
Carisoprodol**
Voriconazole
Plavix
Celexa
Lexapro, various
Tofranil
Zoloft
Valium
Prilosec
Nexium
Protonix
Aciphex
Prevacid
Viracept
Various brands
Soma
Vfend
**indicates prodrug
LAB NOTES
CYP2C19 is a liver enzyme responsible for metabolizing 10-15% of medications, including
clopidogrel, proton pump inhibitors, and many antidepressants. Detecting variants of the CYP2C19
gene that cause altered CYP2C19 enzymatic activity can identify patients who may be at increased
risk of having adverse drug reactions or therapeutic failure to standard dosages of medications
metabolized by CYP2C19. Roughly 2% of the population are 2C19 Poor Metabolizers (PMs),
meaning they have no 2C19 enzymatic activity. Another 30% of the population are considered
Intermediate Metabolizers (IMs) with decreased activity. Still another 28% of people are UltraRapid Metabolizers. Both IMs and PMs exhibit decreased metabolic activity, which puts them at
risk for side effects to drugs normally inactivated by 2C19 (e.g.,sertraline, diazepam), or lack of
efficacy for drugs requiring activation by 2C19 (e.g., prodrugs such as clopidogrel). The FDA
required clopidogrel to be labeled with a box warning indicating that PM patients taking clopidogrel
are at increased risk of thrombotic events due to failure to convert clopidogrel to its activate
component. CYP2C19 UMs are the other extreme, having higher than normal enzymatic activity.
UMs are at increased risk of failure to active drugs because they clear the drugs too rapidly to
benefit from a standard dose. UMs are also at risk of toxic side effects from prodrugs, such as
bleeding on clopidogrel, because they convert the drug into an active form more so than expected.
PGXL Master Drug List 062013
© 2012-3 by PGXL Laboratories
CYP2D6 Master Drug List
Pain Management
Codeine**
Oxycodone**
Hydrocodone**
Tramadol**
Various brands
Oxycontin, various
Various brands
Ultram, various
Cardiology
Carvedilol
Metoprolol
Propanolol
Nebivolol
Timolol
Propafenone
Flecainide
Coreg
Toprol-XL
Inderal, various
Bystolic
Blocadren
Rythmol
Tambocor
Other
Loratadine
Donepezil
Dextromethorphan
Tamoxifen**
Fesoterodine
Tamulosin
Claritin
Aricept
Various brands
Various brands
Toriaz
Flomax
Psychiatry
Antidepressants
Fluoxetine
Fluvoxamine
Paroxetine
Venlafaxine
Duloxetine
Maprotiline
Mirtazapine
Amitriptyline
Clomipramine
Desipramine
Doxepin
Imipramine
Nortriptyline
Trimipramine
Prozac
Luvox
Paxil
Effexor
Cymbalta
Ludiomil
Remeron
Various brands
Ananfranil
Norpramin
Sinequan
Tofranil
Pamelor,
Aventyl
Surmontil
Antipsychotics
Haloperidol
Risperidone
Aripiprazole
Zuclopenthixol
Perphenazine
Thioridazine
Iloperidine
Chlorpromazine
Atomoxetine
Amphetamine
Haldol
Risperdal
Abilify
Various brands
Trilafon
Mellaril
Fanapt
Thorazine
Strattera
Adderall
**indicates prodrug
LAB NOTES
CYP2D6 is a liver enzyme responsible for metabolizing roughly 25% of all drugs, including opioids, many
antidepressants, antipsychotics, beta-blockers, and tamoxifen. Detecting variants of the CYP2D6 gene that
cause altered CYP2D6 enzymatic activity can identify patients who may be at increased risk of having
adverse drug reactions or therapeutic failure to standard dosages of medications metabolized by CYP2D6.
Roughly 10% of the population are 2D6 Poor Metabolizers (PMs), meaning they have no 2D6 enzymatic
activity. Another 35% of the population are considered Intermediate Metabolizers (IMs) with decreased
activity. Still another 1-3% of people are Ultra-Rapid Metabolizers. Both IMs and PMs exhibit decreased
metabolic activity, which puts them at risk for side effects to drugs normally inactivated by 2D6 (e.g.,
venlafaxine, metoprolol), or lack of efficacy for drugs requiring activation by 2D6 (e.g., prodrugs such as
opioids, tamoxifen). UMs are the other extreme, having higher than normal enzymatic activity. UMs are at
increased risk of failure to active drugs because they clear the drugs too rapidly to benefit from a standard
dose. UMs are also at risk of toxic side effects from prodrugs because they convert the drug into an active
form more so than expected.
PGXL Master Drug List 062013
© 2012-3 by PGXL Laboratories
CYP1A2 Master Drug List
Psychiatry
Olanzapine
Clozapine
Imipramine
Clomipramine
Mirtazapine
Bupropion
Duloxetine
Promazine
Asenapine
Zyprexa
Clozaril
Tofranil
Anafranil
Remeron
Wellbutrin
Cymbalta
Sparine
Saphris
Other
Ropivicaine
Lidocaine
Theophylline
Frovatriptan
Zolmipitran
Triamterene
Flutamide
Tizanidine
Tacrine
Cyclobenzaprine
Rasagiline
Ropinirole
Caffeine
17-beta estradiol
Various brands
Various brands
Aerolate
Frova
Zomig
Dyrenium
Eulexin
Zanaflex
Cognex
Flexeril
Azilect
Requip
LAB NOTES
CYP1A2 is a liver enzyme that metabolizes many medications, including theophylline, diazepam, caffeine,
many antidepressants, and antipsychotics. CYP1A2 enzymatic activity can be induced by several
medications, substrates, and constituents of tobacco smoke. CYP1A2 can also be inhibited by several
medications. Detecting inherited variants of the CYP1A2 gene that cause altered enzymatic activity,
particularly in the presence of an inducer, can identify patients who may be at increased risk of having
adverse drug reactions or therapeutic failure to standard dosages of CYP1A2 medications.
PGXL Master Drug List 062013
© 2012-3 by PGXL Laboratories
CYP3A4 and CYP3A5 Master Drug List
PSYCHIATRY
Benzodiazepines
Alprazolam
Midazolam
Triazolam
Xanax
Versed
Halcion
Antipsychotics
Quetiapine
Ziprasidone
Buspirone
Lurasidone
Carbamazepine
Seroquel
Geodon
Buspar
Latuda
Various brands
Antidepressants
Desvenlafaxine
Vilazodone
Trazadone
Nefazadone
Reboxetine
Nortriptyline
Pristiq
Viibryd
Desyrel
Serzone
Edronax
Pamelor, Aventyl
CARDIOLOGY
Quinidine
Ticareglor
Rivaroxaban
Various brands
Brilinta
Xarelto
Statins
Atorvastatin
Lovastatin
Mevastatin
Simvastatin
Lipitor, Caduet
Mevacor, Advicor
Compactin
Zocor, Vytorin, Simcor
UROLOGY
Sildenafil
Tidalafil
Alfuzosin
Doxazosin
Finasteride
Dutasteride
Viagra
Cialis
Uroxatral
Cardura
Procar
Avodart
OTHER
Antimicrobials/antivirals
Clarithromycin
Erythromycin
Telithromycin
Indinavir
Nelfinavir
Ritonavir
Saquinavir
Biaxin
E-Mycin
Ketek
Crixivan
Viracept
Norvir
Fortovase
Steroids
Estradiol
Hydrocortisone
Progesterone
Testosterone
Various brands
Various brands
Various brands
Various brands
Chemotherapeutics
Vincristine
Docetaxel
Oncovin
Taxotere
Pain Management
Cyclobenzaprine
Fentanyl
Alfentanil
Flexeril
Actiq, Duragesic
Alfenta
Immunosuppressants
Cyclosporine
Tacrolimus
Gengraf
Prograf
Other
Guanfacine
Eletriptan
Zolpidem
Intuniv
Relpax
Ambien
Ca Channel Blockers
Amiodipine
Diltiazem
Felodipine
Lercanidipine
Nifedipine
Nisoldipine
Nitrendipine
Verapamil
Norvasc
Cardizem
Plendil
Zanidip
Adalat
Sular
Various brands
Various brands
LAB NOTES
CYP3A4 is a liver enzyme that, in concert with CYP3A5, metabolizes approximately 50% of
medications, including many of the statins, benzodiazepines, antibiotics, and antipsychotics.
Detecting variants of the CYP3A4 gene that cause altered enzymatic activity can identify
patients who may be at increased risk of having adverse drug reactions while taking standard
PGXL Master Drug List 062013
© 2012-3 by PGXL Laboratories
dosages of 3A4 substrates. Roughly 4-10% of the general population possesses inherited
differences in 3A4 that cause decreased metabolism. These Decreased Metabolizers may be
at increased risk for dose-dependent side effects to drugs normally inactivated by 3A4.
CYP3A4 and CYP3A5 Master Drug List (continued)
CYP3A5 is a liver enzyme that, in concert with CYP3A4, metabolizes approximately 50% of
medications, including many of the statins, benzodiazepines, antibiotics, and antipsychotics.
Detecting variants of the CYP3A5 gene that cause altered enzymatic activity can identify
patients who may be at increased risk of having adverse drug reactions while taking standard
dosages of 3A5 substrates. More than half of the general population (60-80%) possesses
inherited differences in 3A5 that cause decreased metabolism. These Decreased Metabolizers
may be at increased risk for dose-dependent side effects to drugs normally inactivated by 3A5.
PGXL Master Drug List 062013
© 2012-3 by PGXL Laboratories