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.
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 |
Symbols in the Gene Summary table represent the predicted function of the gene. A non-normal allele does not necessarily lead to a change in drug response.
Based on your genetics, you may have an atypical response to medications listed in this section. Listed below are drug classes followed by tables containing drugs within those classes and how your pharmacogenetics may influence how you respond to the drug.
Each table contains generic names for the drug, brand names, the associated gene, your gene phenotype, and a description of how your genotype may affect your drug response. Each row also contains a link to the CPIC guideline or FDA drug label from which the information was derived, which also contains therapeutic recommendations for your healthcare provider.
Some drugs have guidance based on multiple genes. Results are assessed for each gene individually and grouped together in the report.
Drugs are often used for multiple indications and can belong to multiple drug classes. We have grouped the drugs in this report based on their most common use, but you may find that some drugs are used for purposes other than indicated by the drug classes in this report.
Note: Phenotypes with an unknown effect on drug response will have normal therapeutic guidance, despite the effect being unknown.
| 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 |
| 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 | |
| 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 |
| 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 |
| 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 | |
| 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 |
| 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 |
Based on your genetics, you are likely to respond normally to medications listed in this section.
| Generic Name | Brand Names | Gene | Your Gene Phenotype | Implication | Source | |
|---|---|---|---|---|---|---|
| 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 |
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.
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.
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.
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.
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.
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.
Structural variations for CYP2D6 are not called and may affect your response to drugs metabolized by CYP2D6.
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