Disclaimer: ClawBio is a research and educational tool. It is not a medical device and does not provide clinical diagnoses. Consult a healthcare professional before making any medical decisions.

# Your Medication Report

How your genes affect your medications

### Summary

⛔
1 drug(s) to avoid Warfarin (Coumadin)
⚠️
20 drug(s) requiring caution Dose adjustments or alternatives may be recommended.

## Drug Recommendations

Drug | Recommendation | Evidence | Class | Genes
--- | --- | --- | --- | ---
Warfarin (Coumadin) | Avoid Consider alternative medication. | 1A ✓ | Anticoagulant | CYP2C9:rs1799853 CYP2C9:rs1057910 VKORC1:rs9923231
Amitriptyline (Elavil) | Caution CPIC Consider 25% reduction of recommended starting dose. | 1A ✓ | Tricyclic Antidepressant | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Celecoxib (Celebrex) | Caution CPIC Initiate therapy with recommended starting dose. | 1A ✓ | NSAID | CYP2C9:rs1799853 CYP2C9:rs1057910
Clomipramine (Anafranil) | Caution CPIC Consider 25% reduction of recommended starting dose. | 1A ✓ | Tricyclic Antidepressant | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Clopidogrel (Plavix) | Caution CPIC Avoid standard dose clopidogrel (75 mg) if possible. | 1A | Antiplatelet Agent | CYP2C19:rs4244285 CYP2C19:rs4986893 CYP2C19:rs12248560
Codeine (Tylenol w/ Codeine) | Caution CPIC Use codeine label recommended age- or weight-specific dosing. | 1A | Opioid Analgesic | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Desipramine (Norpramin) | Caution CPIC Consider 25% reduction of recommended starting dose. | 1A ✓ | Tricyclic Antidepressant | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Doxepin (Sinequan) | Caution CPIC Consider 25% reduction of recommended starting dose. | 1A ✓ | Tricyclic Antidepressant | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Efavirenz (Sustiva) | Caution CPIC Consider initiating efavirenz with decreased dose of 400 mg/daya,b. | 1A ✓ | Antiretroviral | CYP2B6:rs3745274
Flurbiprofen (Ansaid) | Caution CPIC Initiate therapy with recommended starting dose. | 1A ✓ | NSAID | CYP2C9:rs1799853 CYP2C9:rs1057910
Haloperidol (Haldol) | Caution Dose adjustment or monitoring may be needed. | 1A | Antipsychotic | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Hydrocodone (Vicodin) | Caution CPIC Use hydrocodone label recommended age- or weight-specific dosing. | 1A | Opioid Analgesic | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Imipramine (Tofranil) | Caution CPIC Consider 25% reduction of recommended starting dose. | 1A ✓ | Tricyclic Antidepressant | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Meloxicam (Mobic) | Caution CPIC Initiate therapy with recommended starting dose. | 1A ✓ | NSAID | CYP2C9:rs1799853 CYP2C9:rs1057910
Nortriptyline (Pamelor) | Caution CPIC Consider 25% reduction of recommended starting dose. | 1A ✓ | Tricyclic Antidepressant | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Phenytoin (Dilantin) | Caution CPIC Consider 25% reduction of recommended starting maintenance dose d. | 1A ✓ | Antiepileptic | CYP2C9:rs1799853 CYP2C9:rs1057910
Piroxicam (Feldene) | Caution CPIC Initiate therapy with recommended starting dose. | 1A | NSAID | CYP2C9:rs1799853 CYP2C9:rs1057910
Risperidone (Risperdal) | Caution Dose adjustment or monitoring may be needed. | 1A | Antipsychotic | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Tamoxifen (Nolvadex) | Caution CPIC Consider hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with o... CPNDS Grade B—moderate. | 1A ✓ | SERM (Oncology) | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Tramadol (Ultram) | Caution CPIC Use tramadol label recommended age- or weight-specific dosing. | 1A | Opioid Analgesic | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Trimipramine (Surmontil) | Caution CPIC Consider 25% reduction of recommended starting dose. | 1A ✓ | Tricyclic Antidepressant | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725

Standard Drugs (30 medications — click to expand)

Drug | Recommendation | Evidence | Class | Genes
--- | --- | --- | --- | ---
Aripiprazole (Abilify) | Standard Standard dosing expected to be effective. | 1A | Antipsychotic | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Atazanavir (Reyataz) | Standard Standard dosing expected to be effective. | 1A | Antiretroviral | UGT1A1:rs4148323
Atomoxetine (Strattera) | Standard CPIC Initiate with a dose of 0.5 mg/kg and increase to 1.2 mg/kg/day after 3 days If no clinical response and in the absen... | 1A ✓ | ADHD Medication | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Atorvastatin (Lipitor) | Standard CPIC Prescribe desired starting dose and adjust doses based on disease-specific guidelines. | 1A ✓ | Statin | SLCO1B1:rs4149056
Azathioprine (Imuran) | Standard Standard dosing expected to be effective. | 1A ✓ | Immunosuppressant | TPMT:rs1800460 TPMT:rs1142345
Capecitabine (Xeloda) | Standard CPIC Based on genotype, there is no indication to change dose or therapy. SEFF/SEOM According to the data sheet. | 1A ✓ | Antineoplastic | DPYD:rs3918290 DPYD:rs67376798
Citalopram (Celexa) | Standard CPIC Initiate therapy with recommended starting dose. | 1A ✓ | SSRI Antidepressant | CYP2C19:rs4244285 CYP2C19:rs4986893 CYP2C19:rs12248560
Clozapine (Clozaril) | Standard Standard dosing expected to be effective. | 3 | Antipsychotic | CYP1A2:rs762551 CYP1A2:rs2069514
Dexlansoprazole (Dexilant) | Standard CPIC Initiate standard starting daily dose. | 1A ✓ | Proton Pump Inhibitor | CYP2C19:rs4244285 CYP2C19:rs4986893 CYP2C19:rs12248560
Escitalopram (Lexapro) | Standard CPIC Initiate therapy with recommended starting dose. | 1A ✓ | SSRI Antidepressant | CYP2C19:rs4244285 CYP2C19:rs4986893 CYP2C19:rs12248560
Esomeprazole (Nexium) | Standard Standard dosing expected to be effective. | 3 | Proton Pump Inhibitor | CYP2C19:rs4244285 CYP2C19:rs4986893 CYP2C19:rs12248560
Fluorouracil (5-FU) | Standard CPIC Based on genotype, there is no indication to change dose or therapy. SEFF/SEOM According to the data sheet. | 1A ✓ | Antineoplastic | DPYD:rs3918290 DPYD:rs67376798
Fluoxetine (Prozac) | Standard CPIC No action recommended based on genotype for fluoxetine because of minimal evidence regarding the impact on efficacy o... | 3 | SSRI Antidepressant | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Irinotecan (Camptosar) | Standard Standard dosing expected to be effective. | 1A | Antineoplastic | UGT1A1:rs4148323
Lansoprazole (Prevacid) | Standard CPIC Initiate standard starting daily dose. | 1A ✓ | Proton Pump Inhibitor | CYP2C19:rs4244285 CYP2C19:rs4986893 CYP2C19:rs12248560
Mercaptopurine (Purinethol) | Standard Standard dosing expected to be effective. | 1A ✓ | Immunosuppressant | TPMT:rs1800460 TPMT:rs1142345
Metoprolol (Lopressor) | Standard CPIC Initiate standard dosing. | 1A | Beta-Blocker | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Omeprazole (Prilosec) | Standard CPIC Initiate standard starting daily dose. | 1A ✓ | Proton Pump Inhibitor | CYP2C19:rs4244285 CYP2C19:rs4986893 CYP2C19:rs12248560
Ondansetron (Zofran) | Standard CPIC Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. | 1A | Antiemetic | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Oxycodone (OxyContin) | Standard CPIC No recommendation for oxycodone therapy because of weak evidence regarding adverse events or analgesia. | 2A | Opioid Analgesic | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Pantoprazole (Protonix) | Standard CPIC Initiate standard starting daily dose. | 1A ✓ | Proton Pump Inhibitor | CYP2C19:rs4244285 CYP2C19:rs4986893 CYP2C19:rs12248560
Paroxetine (Paxil) | Standard CPIC Consider a lower starting dose and slower titration schedule as compared to normal metabolizers. | 1A ✓ | SSRI Antidepressant | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Pravastatin (Pravachol) | Standard CPIC Prescribe desired starting dose and adjust doses based on disease-specific guidelines. | 1A ✓ | Statin | SLCO1B1:rs4149056
Rosuvastatin (Crestor) | Standard CPIC Prescribe desired starting dose and adjust doses based on disease-specific guidelines. | 1A ✓ | Statin | SLCO1B1:rs4149056
Sertraline (Zoloft) | Standard CPIC Initiate therapy with recommended starting dose. | 1A ✓ | SSRI Antidepressant | CYP2C19:rs4244285 CYP2C19:rs4986893 CYP2C19:rs12248560
Simvastatin (Zocor) | Standard CPIC Prescribe desired starting dose and adjust doses based on disease-specific guidelines. | 1A ✓ | Statin | SLCO1B1:rs4149056
Tacrolimus (Prograf) | Standard Standard dosing expected to be effective. | 1A ✓ | Immunosuppressant | CYP3A5:rs776746
Thioguanine (Tabloid) | Standard Standard dosing expected to be effective. | 1A ✓ | Immunosuppressant | TPMT:rs1800460 TPMT:rs1142345
Venlafaxine (Effexor) | Standard CPIC No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy ... | 1A | SNRI Antidepressant | CYP2D6:rs3892097 CYP2D6:rs16947 CYP2D6:rs1065852 CYP2D6:rs28371725
Voriconazole (Vfend) | Standard CPIC Initiate therapy with recommended standard of care dosing.f. | 1A ✓ | Antifungal | CYP2C19:rs4244285 CYP2C19:rs4986893 CYP2C19:rs12248560

Gene Profiles (click to expand)

Gene | Full Name | Diplotype | Phenotype
--- | --- | --- | ---
CYP2C19 | Cytochrome P450 2C19 | *17/*2 | Intermediate Metabolizer
CYP2D6 | Cytochrome P450 2D6 | *2/*41 | Intermediate Metabolizer
CYP2C9 | Cytochrome P450 2C9 | *1/*2 | Intermediate Metabolizer
VKORC1 | Vitamin K Epoxide Reductase | TT | High Warfarin Sensitivity
SLCO1B1 | Solute Carrier Organic Anion Transporter 1B1 | TT | Normal Function
DPYD | Dihydropyrimidine Dehydrogenase | Normal/Normal (2/3 SNPs tested) | Normal Metabolizer
TPMT | Thiopurine S-Methyltransferase | *1/*1 (2/3 SNPs tested) | Normal Metabolizer
UGT1A1 | UDP-Glucuronosyltransferase 1A1 | *1/*1 (1/2 SNPs tested) | Normal Metabolizer
CYP3A5 | Cytochrome P450 3A5 | *3/*3 | CYP3A5 Non-expressor
CYP2B6 | Cytochrome P450 2B6 | *1/*9 | Intermediate Metabolizer
NUDT15 | Nudix Hydrolase 15 | *1/*1 (1/2 SNPs tested) | Normal Metabolizer
CYP1A2 | Cytochrome P450 1A2 | *1/*1F | Normal Metabolizer

Detected Variants (click to expand)

rsID | Gene | Star Allele | Genotype | Effect
--- | --- | --- | --- | ---
rs762551 | CYP1A2 | *1F | AC | increased_function
rs2069514 | CYP1A2 | *1C | GG | decreased_function
rs3745274 | CYP2B6 | *9 | GT | decreased_function
rs4244285 | CYP2C19 | *2 | AG | no_function
rs4986893 | CYP2C19 | *3 | GG | no_function
rs12248560 | CYP2C19 | *17 | CT | increased_function
rs1799853 | CYP2C9 | *2 | CT | decreased_function
rs1057910 | CYP2C9 | *3 | AA | decreased_function
rs3892097 | CYP2D6 | *4 | CC | no_function
rs16947 | CYP2D6 | *2 | AG | normal_function
rs1065852 | CYP2D6 | *10 | CC | decreased_function
rs28371725 | CYP2D6 | *41 | CT | decreased_function
rs776746 | CYP3A5 | *3 | GG | no_function
rs3918290 | DPYD | *2A | CC | no_function
rs67376798 | DPYD | D949V | TT | decreased_function
rs116855232 | NUDT15 | *3 | CC | no_function
rs4149056 | SLCO1B1 | *5 | TT | decreased_function
rs1800460 | TPMT | *3B | CC | no_function
rs1142345 | TPMT | *3C | AA | no_function
rs4148323 | UGT1A1 | *6 | GG | decreased_function
rs9923231 | VKORC1 | -1639G>A | TT | decreased_expression

Input Details (click to expand)

Input file: demo_patient.txt

Format detected: 23andme

Checksum (SHA-256): 1e6bb1246289465a7afa7facdeb587123ed50290f4c654810c905414b9207338

Total SNPs in file: 21

Pharmacogenomic SNPs found: 21/30

Genes profiled: 12

Drugs assessed: 51

Disclaimer: ClawBio is a research and educational tool. It is not a medical device and does not provide clinical diagnoses. Consult a healthcare professional before making any medical decisions.