pharmacogenetic test - compleremed medical...

Date of Birth:Collected Date:

Gender:1/1/1900

NA17104Ordering Physician:

Reported Date: 6/13/2016Received Date:

Patient Name: Patient NA17104Patient

Ordered By

Specimen

Specimen Type:Accession #:Test(s) Requested:

Requisition #:

Physician ID:Client:

Indication for testing:

Vantari Test Provider

ANKK1, APOE, COMT, CYP1A2, CYP2B6, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, DPYD, F2, F5, GRIK4, MTHFR, OPRM1, SLCO1B1, UGT2B15, VKORC1

None provided.

Test DetailsGene Genotype PhenotypeANKK1/DRD2 DRD2:Taq1A GG Unaltered DRD2 function

Apolipoprotein E ε2/ε4 Increased Risk of Hyperlipidemia/Atherosclerotic Vascular Disease

COMT Val158Met AA Low COMT Activity

CYP1A2 *1A/*1L Normal Metabolizer- Possible Inducibility

CYP2B6 *1/*6 Intermediate Metabolizer

CYP2C19 *1/*17 Rapid Metabolizer

CYP2C9 *1/*1 Normal Metabolizer

CYP2D6 *2/*2 XN Rapid Metabolizer

CYP3A4 *1B/*1B Intermediate Metabolizer

CYP3A5 *7/*7 Poor Metabolizer

DPYD *1/*1 Normal DPD ActivityFactor IIFactor V Leiden

20210G>A GG1691G>A GG No Increased Risk of Thrombosis

GRIK4 83-10039T>C CC Good Response to Citalopram

MTHFR 677C>T CC Normal MTHFR Activity

MTHFR 1298A>C AA677C>T CC No Increased Risk of Hyperhomocysteinemia

OPRM1 A118G AA Normal OPRM1 Function

SLCO1B1 521T>C TT Normal Transporter Function

UGT2B15 *1/*1 Normal Metabolizer

VKORC1 -1639G>A G/G Low Warfarin Sensitivity

PHARMACOGENETIC TEST

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Patient Name: Patient NA17104Patient Date of Birth: 1/1/1900Specimen Collection Date:

Page27 Technology Drive, Irvine, CA 92618, P: 949.783.5300, F: 949.783.5302Laboratory Director Mario Kohan, MD CLIA #: 05D2111917 22of

Part number: VANP28VER03

Gene - Basic physical unit of inheritance. Genes are passed from parents to offspring and contain the information needed to specify traits.Genotype - A set of alleles (alternative versions of a gene) that determines the expression of a particular characteristics or trait (here: drug metabolism).Phenotype - The physical manifestation of the genotype (here: drug metabolizer status).

Definitions

Disclaimer

The information presented on this report is provided as general educational health information. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Only a physician, pharmacist or other healthcare professional should advise a patient on the use of the medications prescribed.

None provided.Report Comment:


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Interpretation Guide

Guidance Levels

Evidence Levels

Based upon the patient's genotype, a medication has potentially reduced efficacy or increased toxicity or the patient has an increased risk for the indicated condition.Based upon the patient's genotype, guidelines exist for adjusting dosage or increased vigilance or the patient has a moderate risk for the indicated condition. Based on this patient's genotype, the medication can be prescribed according to standard regimens or the patient's risk for the indicated condition is not increased.

*Actionable - Recommendations based upon publications by international pharmacogenetic expert groups, consortia or regulatory bodies(CPIC, DPWG, FDA, EMA). Recommendations are suitable for implementation in a clinical setting. Guidelines may change as newknowledge arises. **Informative - There are insufficient or contradictory findings documenting the impact of a given genetic polymorphism or druginteraction. Recommendations are informative and implementation in a clinical setting is optional.

Medications Affected by Patient Genetic ResultsAlprazolam (Xanax)Normal Response to AlprazolamPharmacogenetic guidance: Alprazolam is primarily eliminated by metabolism via CYP3A4 and CYP3A5. Geneticpolymorphisms of these genes are not expected to affect the efficacy or safety profiles of this drug. Polypharmacyguidance: The concomitant use of alprazolam with CYP3A4 inhibitors may result in increased alprazolam levels andprolonged sedation. Impairment of motor skills are also observed with some combinations. Monitor patients forexaggerated sedative effects. If possible, alprazolam should be avoided in patients receiving strong inhibitors of CYP3A4such as ketoconazole, itraconazole and ritonavir. Drugs that induce CYP3A enzymes may decrease alprazolam levels, whichresults in a loss of efficacy.

Bupropion (Wellbutrin, Zyban, Aplenzin, Contrave)Possibly Decreased Response to Bupropion (CYP2B6 *1/*6 Intermediate Metabolizer)Bupropion is metabolized to its active metabolite hydroxybupropion by CYP2B6. This metabolite contributes to thetherapeutic effects of bupropion when used as a smoking cessation agent or as an antidepressant. Individuals who areCYP2B6 intermediate metabolizers may or may not have lower blood levels of hydroxybupropion which may or may notresult in a reduced response to bupropion treatment. Bupropion can be prescribed at standard label-recommended dosagewith careful monitoring of the patient's response. Therapeutic monitoring of hydroxybupropion levels may be considered toguide dosing adjustment.

Patient Medications

Current Medication List:Albuterol, Alprazolam, Amoxicillin, Bupropion, Cephalexin, Diltiazem, Hydrocodone, Lisinopril, Metformin, Metoclopramide, Metoprolol, Mirtazapine, Omeprazole, Pravastatin, Prednisone, Venlafaxine


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Hydrocodone (Vicodin)Possible Altered Response to Hydrocodone (CYP2D6 *2/*2 XN Rapid Metabolizer)Increased conversion of hydrocodone to the more active metabolite hydromorphone is expected in CYP2D6 rapidmetabolizers. Usually, adequate pain relief without an increase in adverse events can be achieved by using standard orlower hydrocodone doses. Other opioids not metabolized by CYP2D6 (e.g., morphine, oxymorphone, buprenorphine,fentanyl, methadone, and hydromorphone) may also be considered if excessive side effects are reported.

Metoclopramide (Reglan)Normal Response to Metoclopramide (CYP2D6 *2/*2 XN Rapid Metabolizer)Metoclopramide is metabolized at a faster rate in CYP2D6 rapid metabolizers, which may result in lower serumconcentrations of the drug, but the clinical impact of this change is unknown. Metoclopramide can be prescribed atstandard label-recommended dosage and administration.

Metoprolol (Lopressor)Possible Non-Responder to Metoprolol (CYP2D6 *2/*2 XN Rapid Metabolizer)The patient may experience a decrease in the pharmacological effect when taking metoprolol at standard dosage. HeartFailure: Consider alternative beta-blockers such as bisoprolol or carvedilol, or prescribe metoprolol at a higher dose. Otherindications: Consider alternative beta-blockers such as bisoprolol or atenolol, or prescribe metoprolol at a higher dose. Ifmetoprolol is prescribed, titrate the dose to a maximum of 250% of the normal dose in response to efficacy and adverseevents.

Mirtazapine (Remeron)Normal Sensitivity to Mirtazapine (CYP2D6 *2/*2 XN Rapid Metabolizer)Mirtazapine can be prescribed at standard label-recommended dosage and administration. If higher doses are prescribed,there is an increased risk of cardiovascular adverse events. Therefore, careful titration is recommended until a favorableresponse is achieved.

Omeprazole (Prilosec)Insufficient Response to Omeprazole (CYP2C19 *1/*17 Rapid Metabolizer)

Helicobacter pylori eradication: increase dose by 100-200% and be alert to insufficient response.•Other: be extra alert to insufficient response and consider dose increase of 100-200%.•

Pravastatin (Pravachol)Normal Myopathy Risk (SLCO1B1 521T>C TT Normal Transporter Function)Pravastatin plasma concentrations are not expected to increase, and unless other genetic or circumstantial risk factors arepresent, pravastatin can be prescribed at standard FDA-recommended starting doses and adjusted based on disease-specific guidelines. (Other myopathy predisposing factors include advanced age (≥65), uncontrolled hypothyroidism, renalimpairment, high statin dose, comedications, and female gender.)

Venlafaxine (Effexor)Non-Response to Venlafaxine (CYP2D6 *2/*2 XN Rapid Metabolizer)The patient is unlikely to achieve adequate serum levels of venlafaxine and O-desmethylvenlafaxine when taking standarddoses of venlafaxine. Consider an alternative drug, or increase the venlafaxine dose to a maximum of 150% of the normaldose and monitor venlafaxine and O-desmethylvenlafaxine plasma concentrations.

Patient Medications for which there is no clinically established Pharmacogenetic Guidance*:


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* Medications that are metabolized by multiple enzymes or by enzymes which activity varies very little among individuals are expected to beless sensitive to the pharmacogenetic markers detected by this assay.

Albuterol, Amoxicillin, Cephalexin, Diltiazem, Lisinopril, Metformin, Prednisone

Potentially Impacted MedicationsDrug Class Standard Precautions Use With Caution Consider Alternatives

Anticancer Agents

Cardiovascular

Category

Antifolates Methotrexate (Trexall)

Angiotensin II Receptor Antagonists

Azilsartan (Edarbi, Edarbyclor)Candesartan (Atacand)Eprosartan (Teveten)Irbesartan (Avapro)

Losartan (Cozaar, Hyzaar)Olmesartan (Benicar)Telmisartan (Micardis)

Valsartan (Diovan, Entresto)

Antianginal Agents Ranolazine (Ranexa)

Antiarrhythmics Mexiletine (Mexitil)Propafenone (Rythmol) Flecainide (Tambocor)

Anticoagulants

Apixaban (Eliquis)Dabigatran Etexilate (Pradaxa)

Edoxaban (Savaysa)Fondaparinux (Arixtra)Rivaroxaban (Xarelto)Warfarin (Coumadin)

AntiplateletsPrasugrel (Effient)Ticagrelor (Brilinta)

Vorapaxar (Zontivity)Clopidogrel (Plavix)

Beta Blockers

Carvedilol (Coreg)Labetalol (Normodyne,

Trandate)Nebivolol (Bystolic)

Propranolol (Inderal)Timolol (Timoptic)

Metoprolol (Lopressor)

Diuretics Torsemide (Demadex)

Statins

Atorvastatin (Lipitor)Fluvastatin (Lescol)

Lovastatin (Mevacor, Altoprev, Advicor)

Pitavastatin (Livalo)Pravastatin (Pravachol)Rosuvastatin (Crestor)Simvastatin (Zocor)


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Drug Class Standard Precautions Use With Caution Consider Alternatives

Diabetes

Gastrointestinal

Infections

Category

MeglitinidesNateglinide (Starlix)

Repaglinide (Prandin, Prandimet)

Sulfonylureas

Chlorpropamide (Diabenese)Glimepiride (Amaryl)Glipizide (Glucotrol)

Glyburide (Micronase)Tolbutamide (Orinase)

Antiemetics Metoclopramide (Reglan) Dolasetron (Anzemet)Palonosetron (Aloxi) Ondansetron (Zofran, Zuplenz)

Proton Pump Inhibitors Rabeprazole (Aciphex)

Dexlansoprazole (Dexilant, Kapidex)

Esomeprazole (Nexium)Lansoprazole (Prevacid)Omeprazole (Prilosec)

Pantoprazole (Protonix)

Antifungals Voriconazole (Vfend)

Antimalarials Proguanil (Malarone)


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Pain

Category

Fibromyalgia Agents Milnacipran (Savella)

Muscle RelaxantsCyclobenzaprine (Flexeril,

Amrix)Metaxalone (Skelaxin)

Methocarbamol (Robaxin)

Carisoprodol (Soma)Tizanidine (Zanaflex)

NSAIDs

Celecoxib (Celebrex)Diclofenac (Voltaren)Flurbiprofen (Ansaid)

Ibuprofen (Advil, Motrin)Indomethacin (Indocin)

Ketoprofen (Orudis)Ketorolac (Toradol)Meloxicam (Mobic)

Nabumetone (Relafen)Naproxen (Aleve)

Piroxicam (Feldene)Sulindac (Clinoril)

Opioids

Alfentanil (Alfenta)Buprenorphine (Butrans,

Buprenex)Fentanyl (Actiq)

Hydromorphone (Dilaudid, Exalgo)

Levorphanol (Levo Dromoran)Meperidine (Demerol)Oxymorphone (Opana,

Numorphan)Sufentanil (Sufenta)

Tapentadol (Nucynta)

Dihydrocodeine (Synalgos-DC)Hydrocodone (Vicodin)Methadone (Dolophine)Morphine (MS Contin)Oxycodone (Percocet,

Oxycontin)

Codeine (Codeine; Fioricet with Codeine)

Tramadol (Ultram)

AntiaddictivesBupropion (Wellbutrin, Zyban,

Aplenzin, Contrave)Naltrexone (Vivitrol, Contrave)

Anti-ADHD Agents Guanfacine (Intuniv)

Amphetamine (Adderall)Clonidine (Kapvay)

Dexmethylphenidate (Focalin)Dextroamphetamine

(Dexedrine)Lisdexamfetamine (Vyvanse)

Methylphenidate (Ritalin)

Atomoxetine (Strattera)


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Psychotropic

Category

Anticonvulsants

Brivaracetam (Briviact)Carbamazepine (Tegretol,

Carbatrol, Epitol)Eslicarbazepine (Aptiom)Ethosuximide (Zarontin)

Ezogabine (Potiga)Felbamate (Felbatol)

Fosphenytoin (Cerebyx)Gabapentin (Neurontin)Lacosamide (Vimpat)Lamotrigine (Lamictal)Levetiracetam (Keppra)

Oxcarbazepine (Trileptal, Oxtellar XR)

Perampanel (Fycompa)Phenobarbital (Luminal)

Phenytoin (Dilantin)Pregabalin (Lyrica)

Primidone (Mysoline)Rufinamide (Banzel)Tiagabine (Gabitril)

Topiramate (Topamax)Valproic Acid (Depakote,

Depakene)Vigabatrin (Sabril)

Zonisamide (Zonegran)

Antidementia Agents Galantamine (Razadyne)Memantine (Namenda) Donepezil (Aricept)

Antidepressants

Desvenlafaxine (Pristiq)Duloxetine (Cymbalta)

Fluoxetine (Prozac, Sarafem)Levomilnacipran (Fetzima)

Mirtazapine (Remeron)Nefazodone (Serzone)Vilazodone (Viibryd)

Vortioxetine (Brintellix)

Amoxapine (Amoxapine)Fluvoxamine (Luvox)Maprotiline (Ludiomil)

Sertraline (Zoloft)

Amitriptyline (Elavil)Citalopram (Celexa)

Clomipramine (Anafranil)Desipramine (Norpramin)

Doxepin (Silenor)Escitalopram (Lexapro)Imipramine (Tofranil)Nortriptyline (Pamelor)

Paroxetine (Paxil, Brisdelle)Protriptyline (Vivactil)

Trimipramine (Surmontil)Venlafaxine (Effexor)


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Rheumatology

Transplantation

Urologicals

Category

Antipsychotics

Aripiprazole (Abilify)Asenapine (Saphris)

Brexpiprazole (Rexulti)Iloperidone (Fanapt)

Loxapine (Loxitane, Adasuve)Lurasidone (Latuda)

Paliperidone (Invega)Quetiapine (Seroquel)Thioridazine (Mellaril)Thiothixene (Navane)Trazodone (Oleptro)

Trifluoperazine (Stelazine)Ziprasidone (Geodon)

Chlorpromazine (Thorazine)Clozapine (Clozaril)

Fluphenazine (Prolixin)Olanzapine (Zyprexa)

Perphenazine (Trilafon)Pimozide (Orap)

Tetrabenazine (Xenazine)

Haloperidol (Haldol)Risperidone (Risperdal)

Benzodiazepines

Alprazolam (Xanax)Clobazam (Onfi)

Clonazepam (Klonopin)Lorazepam (Ativan)Oxazepam (Serax)

Diazepam (Valium)

Other Neurological Agents

Dextromethorphan / Quinidine (Nuedexta)

ImmunomodulatorsApremilast (Otezla)Leflunomide (Arava)Tofacitinib (Xeljanz)

Immunosupressants Tacrolimus (Prograf)

5-Alpha Reductase Inhibitors for Benign Prostatic Hyperplasia

Dutasteride (Avodart)Finasteride (Proscar)

Alpha-Blockers for Benign Prostatic

Hyperplasia

Alfuzosin (UroXatral)Doxazosin (Cardura)Silodosin (Rapaflo)

Tamsulosin (Flomax)Terazosin (Hytrin)

Antispasmodics for Overactive Bladder

Darifenacin (Enablex)Fesoterodine (Toviaz)

Mirabegron (Myrbetriq)Oxybutynin (Ditropan)Solifenacin (Vesicare)Tolterodine (Detrol)Trospium (Sanctura)

Phosphodiesterase Inhibitors for Erectile

Dysfunction

Avanafil (Stendra)Sildenafil (Viagra)Tadalafil (Cialis)

Vardenafil (Levitra)


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Dosing GuidanceAmitriptyline (Elavil)

Non-Response to Amitriptyline (CYP2D6 *2/*2 XN RapidMetabolizer)

Consider an alternative drug, or prescribe amitriptyline at an increased doseand monitor the plasma concentration of amitriptyline and metabolites.

*

Amitriptyline (Elavil)

Increased Sensitivity to Amitriptyline (CYP2C19 *1/*17 Rapid Metabolizer)

Consider an alternative drug, or consider prescribing amitriptyline at standarddose and monitor the plasma concentrations of amitriptyline and nortriptylineto guide dose adjustments.

**

Atomoxetine (Strattera)

Non-Response to Atomoxetine (CYP2D6 *2/*2 XN RapidMetabolizer)

The patient may fail to achieve adequate plasma levels of atomoxetine if thedrug is prescribed at standard recommended doses. Consider prescribingatomoxetine with careful titration and monitoring for reduced efficacy. Thereis insufficient data to calculate dose adjustment. Or consider an alternativemedication.

**

Citalopram (Celexa)

Insufficient Response to Citalopram (CYP2C19 *1/*17 Rapid Metabolizer)

At standard label-recommended dosage, citalopram plasma concentrationslevels are expected to be low which may result in a loss of efficacy. Consideran alternative medication. If citalopram is warranted, consider increasing thedose to a maximum of 150% and titrate based on the clinical response andtolerability.

*

Clomipramine (Anafranil)

Non-Response to Clomipramine (CYP2D6 *2/*2 XN Rapid Metabolizer)

Consider an alternative drug, or prescribe clomipramine at an increased doseand monitor the plasma concentration of clomipramine anddesmethylclomipramine.

*

Clomipramine (Anafranil)

Increased Sensitivity to Clomipramine (CYP2C19 *1/*17 Rapid Metabolizer)

Consider an alternative drug, or consider prescribing clomipramine atstandard dose and monitor the plasma concentrations of clomipramine anddesmethyl-clomipramine to guide dose adjustments.

**

Codeine (Codeine; Fioricet with Codeine)

Increased Response to Codeine (CYP2D6 *2/*2 XN RapidMetabolizer)

Codeine is converted into its active metabolite morphine by CYP2D6. Sincethis patient is a rapid metabolizer, greatly increased morphine levels areexpected, and the patient is at high risk of toxicity when taking codeine.Avoid prescribing codeine, and consider an alternative opioid or a non-opioidanalgesic such as a NSAID or a COX-2 inhibitor. Unless contraindicated,available alternative opioids not sensitive to CYP2D6 function include:fentanyl, morphine, hydromorphone, oxymorphone, and tapentadol.

*

Desipramine (Norpramin)

Non-Response to Desipramine (CYP2D6 *2/*2 XN RapidMetabolizer)

Consider an alternative drug, or prescribe desipramine at increaseddosage and observe the patient for decreased efficacy. Adjust dosage inresponse to desipramine and metabolites plasma concentrations and clinicalresponse.

*


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Doxepin (Silenor) Non-Response to Doxepin (CYP2D6 *2/*2 XN RapidMetabolizer)

Consider an alternative drug or increase doxepin dose by 100%. Adjustmaintenance dose according to nordoxepin plasma concentrations.

*

Doxepin (Silenor) Increased Sensitivity to Doxepin (CYP2C19 *1/*17 RapidMetabolizer)

Consider an alternative drug, or consider prescribing doxepin at standarddose and monitor the plasma concentrations of doxepin and desmethyl-doxepin to guide dose adjustments.

**

Escitalopram (Lexapro)

Insufficient Reponse to Escitalopram (CYP2C19 *1/*17 Rapid Metabolizer)

At standard label-recommended dosage, escitalopram plasma concentrationslevels are expected to be low which may result in a loss of efficacy. Consideran alternative medication. If escitalopram is warranted, consider increasingthe dose to a maximum of 150% and titrate based on the clinical responseand tolerability.

*

Flecainide (Tambocor)

Altered Response to Flecainide (CYP2D6 *2/*2 XN RapidMetabolizer)

Titrate carefully and consider adjusting the dose in response to plasmaconcentration and ECG monitoring, OR consider an alternative drug. Examplesof alternatives drugs not affected by CYP2D6 include: sotalol, disopyramide,quinidine, and amiodarone.

*

Haloperidol (Haldol)

Non-Response to Haloperidol (CYP2D6 *2/*2 XN RapidMetabolizer)

Consider an alternative drug, or prescribe haloperidol at the standard doseand adjust dosage to achieve a favorable clinical response. Be alert todecreased haloperidol plasma concentrations.

*

Imipramine (Tofranil)

Non-Response to Imipramine (CYP2D6 *2/*2 XN RapidMetabolizer)

Consider an alternative drug or consider prescribing imipramine at anincreased dose, then adjust dosage in response to imipramine anddesipramine plasma concentrations.

*

Imipramine (Tofranil)

Increased Sensitivity to Imipramine (CYP2C19 *1/*17 Rapid Metabolizer)

Consider an alternative drug, or consider prescribing imipramine at thestandard dose and monitor the plasma concentrations of imipramine anddesipramine to guide dose adjustments.

**

Metoprolol (Lopressor)

Possible Non-Responder to Metoprolol (CYP2D6 *2/*2 XN RapidMetabolizer)

The patient may experience a decrease in the pharmacological effect whentaking metoprolol at standard dosage. Heart Failure: Consider alternativebeta-blockers such as bisoprolol or carvedilol, or prescribe metoprolol at ahigher dose. Other indications: Consider alternative beta-blockers suchas bisoprolol or atenolol, or prescribe metoprolol at a higher dose. Ifmetoprolol is prescribed, titrate the dose to a maximum of 250% of thenormal dose in response to efficacy and adverse events.

*

Nortriptyline (Pamelor)

Non-Response to Nortriptyline (CYP2D6 *2/*2 XN RapidMetabolizer)

Consider an alternative drug, or prescribe nortriptyline at an increased doseand monitor the plasma concentration of amitriptyline andhydroxynortriptyline.

*


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Ondansetron (Zofran, Zuplenz)

Non-Response to Ondansetron (CYP2D6 *2/*2 XN RapidMetabolizer)

A substantially decreased antiemetic effect has been reported in CYP2D6rapid metabolizers when taking standard doses of this medication. Considerprescribing an alternative drug not metabolized by CYP2D6 such asgranisetron.

**

Paroxetine (Paxil, Brisdelle)

Reduced Response to Paroxetine (CYP2D6 *2/*2 XN RapidMetabolizer)

There is a risk for decreased efficacy at standard dosage. If a standard doseis prescribed to a CYP2D6 rapid metabolizer, suboptimal plasmaconcentrations of the drug are likely. Consider an alternative medication.

*

Protriptyline (Vivactil)

Non-Response to Protriptyline (CYP2D6 *2/*2 XN RapidMetabolizer)

Consider alternative drugs or prescribe protriptyline at increased dosage andobserve the patient for decreased efficacy. Adjust dosage in response toprotriptyline and metabolites plasma concentrations and clinical response.

*

Risperidone (Risperdal)

Non-Response to Risperidone (CYP2D6 *2/*2 XN RapidMetabolizer)

Consider an alternative drug, OR prescribe risperidone , be extra alert toinsufficient response, and adjust dosage in response to clinical response andadverse events.

*

Tramadol (Ultram)

Increased Response to Tramadol (CYP2D6 *2/*2 XN RapidMetabolizer)

The patient is at high risk of toxicity when taking tramadol at standarddosing. Consider reducing tramadol dose by 30%. Careful monitoring for sideeffects and weekly titration are recommended. If toxicity, consider alternativeopioids other than codeine, or a non-opioid analgesic such as a NSAID or aCOX-2 inhibitor. Unless contraindicated, available alternative opioids notsensitive to CYP2D6 function include: fentanyl, morphine, hydromorphone,oxymorphone, and tapentadol.

*

Trimipramine (Surmontil)

Non-Response to Trimipramine (CYP2D6 *2/*2 XN RapidMetabolizer)

Consider an alternative drug, or consider prescribing trimipramine at anincreased dose, then adjust dosage in response to trimipramine plasmaconcentrations.

*

Trimipramine (Surmontil)

Increased Sensitivity to Trimipramine (CYP2C19 *1/*17 Rapid Metabolizer)

Consider an alternative drug, or consider prescribing trimipramine at standarddose and monitor the plasma concentrations of trimipramine and desmethyl-trimipramine to guide dose adjustments.

**

Venlafaxine (Effexor)

Non-Response to Venlafaxine (CYP2D6 *2/*2 XN RapidMetabolizer)

The patient is unlikely to achieve adequate serum levels of venlafaxine and O-desmethylvenlafaxine when taking standard doses of venlafaxine. Consider analternative drug, or increase the venlafaxine dose to a maximum of 150% ofthe normal dose and monitor venlafaxine and O-desmethylvenlafaxine plasmaconcentrations.

*


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Amoxapine (Amoxapine)

Possible Non-Response to Amoxapine (CYP2D6 *2/*2 XN RapidMetabolizer)

Like other tricyclic and tetracyclic antidepressants, amoxapine is metabolizedby CYP2D6. However, the overall contribution of this enzyme in themetabolism of this drug is not well documented. Patients with increasedCYP2D6 function may metabolize amoxapine more rapidly which can result insub-therapeutic drug concentrations; these patients may require higher dosesto achieve adequate plasma concentrations. There are no established dosingadjustments for patients with increased CYP2D6 function; therapy must beinitiated cautiously and adjusted according to the patient's response.

**

Amphetamine (Adderall)

Poor Response to Amphetamine salts (COMT Val158Met AA Low COMT Activity)

The patient's genotype result predicts a reduced therapeutic response toamphetamine stimulants. If prescribed, amphetamines should beadministered at the lowest effective dose, and dosage should be individuallyadjusted.

**

Bupropion (Wellbutrin, Zyban, Aplenzin, Contrave)

Possibly Decreased Response to Bupropion (CYP2B6 *1/*6 IntermediateMetabolizer)

Bupropion is metabolized to its active metabolite hydroxybupropion byCYP2B6. This metabolite contributes to the therapeutic effects of bupropionwhen used as a smoking cessation agent or as an antidepressant. Individualswho are CYP2B6 intermediate metabolizers may or may not have lower bloodlevels of hydroxybupropion which may or may not result in a reducedresponse to bupropion treatment. Bupropion can be prescribed at standardlabel-recommended dosage with careful monitoring of the patient's response.Therapeutic monitoring of hydroxybupropion levels may be considered toguide dosing adjustment.

**

Carisoprodol (Soma)

Altered Sensitivity to Carisoprodol (CYP2C19 *1/*17 Rapid Metabolizer)

There is insufficient data to allow calculation of dose adjustment. Ifcarisoprodol is prescribed, it is recommended to use a lower dose, and tocarefully monitor the patient for side effects.

**

Chlorpromazine (Thorazine)

Possible Non-Response to Chlorpromazine (CYP2D6 *2/*2 XN Rapid Metabolizer)

Chlorpromazine is metabolized by CYP2D6, CYP3A4 and flavin-containingmonooxygenases. Subjects with increased CYP2D6 function will metabolizechlorpromazine more rapidly which can result in sub-therapeutic drugconcentrations. Consider a standard dose and adjust dosage according to thepatient's tolerability and response. Higher doses may be necessary to achieveefficacy.

**

Clonidine (Kapvay)

Possible Altered Response to Clonidine (CYP2D6 *2/*2 XN Rapid Metabolizer)

Treatment with clonidine can cause dose related decreases in blood pressureand heart rate Measure heart rate and blood pressure prior to initiation oftherapy, following dose increases, and periodically while on therapy. TitrateClonidine slowly in patients with a history of hypotension, and those withunderlying conditions that may be worsened by hypotension and bradycardia.

**

Clopidogrel (Plavix)

Increased Response to Clopidogrel (CYP2C19 *1/*17 RapidMetabolizer)

Clopidogrel can be prescribed at standard label-recommended dosage.Individuals with the *17 allele may have an increased risk of bleeding whiletaking clopidogrel.

*


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Clozapine (Clozaril)

Possible Non-Response to Clozapine (CYP1A2 *1A/*1L Normal Metabolizer- Possible Inducibility)

Smokers may be at risk for non-response at standard doses and may requirehigher doses. There is an association between high clozapine doses and therisk of seizures, and therefore careful monitoring is recommended duringdosing adjustment. Smoking cessation may increase plasma drug levels,leading to adverse events. Therefore, therapeutic drug monitoringaccompanied by dose reduction is recommended in patients who have quitsmoking.

**

Dexlansoprazole (Dexilant, Kapidex)

Insufficient Response to Dexlansoprazole (CYP2C19 *1/*17 Rapid Metabolizer)

Helicobacter pylori eradication: increase dose by 200% and be alert toinsufficient response.

•

Other: be extra alert to insufficient response and consider doseincrease of 200%.

•

**

Dexmethylphenidate (Focalin)

Poor Response to Dexmethylphenidate (COMT Val158Met AA Low COMT Activity)

The patient's genotype result predicts a reduced therapeutic response todexmethylphenidate. Dosage should be individualized according to the needsand response of the patient. Therapy should be initiated in small doses, withgradual weekly increments.

**

Dextroamphetamine (Dexedrine)

Poor Response to Dextroamphetamine (COMT Val158Met AA Low COMT Activity)

The patient's genotype result predicts a reduced therapeutic response toamphetamine stimulants. If prescribed, dextroamphetamine should beadministered at the lowest effective dose, and dosage should be individuallyadjusted.

**

Diazepam (Valium)

Possible Altered Sensitivity to Diazepam (CYP2C19 *1/*17 RapidMetabolizer)

CYP2C19 rapid metabolizers metabolize diazepam and nordiazepam morerapidly than normal metabolizers. However, there is insufficient data to allowcalculation of dose adjustment when diazepam is prescribed. Monitor thepatient's response and adjust the dose accordingly.

**

Dihydrocodeine (Synalgos-DC)

Possible Altered Response to Dihydrocodeine (CYP2D6 *2/*2 XN Rapid Metabolizer)

Increased conversion of dihydrocodeine to the more active metabolitedihydromorphine is expected in CYP2D6 rapid metabolizers. This may result inan exaggerated response. Adequate pain relief can be achieved by decreasingthe dose in response to pain symptoms. Other opioids not metabolized byCYP2D6 (i.e., morphine, oxymorphone, buprenorphine, fentanyl, methadone,and hydromorphone) may also be considered if signs of overdose (excessivesleepiness, confusion, or shallow breathing) are reported.

*

Dolasetron (Anzemet)

Possible Altered Response to Dolasetron (CYP2D6 *2/*2 XN RapidMetabolizer)

The reduction of dolasetron to its active metabolite hydrodolasetron ismediated by a carbonyl reductase. Hydrodolasetron is further eliminated bymultiple routes, including renal excretion and by glucuronidation orhydroxylation by CYP2D6. Compared to CYP2D6 normal metabolizers, CYP2D6rapid metabolizers may have lower hydroxydolasetron plasma concentrationsat standard dosing. However, the clinical significance of this change remainsunclear. Dolasetron can be prescribed at standard label-recommended dosageand administration. Monitor the patient for possible decreased efficacy.

**


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Donepezil (Aricept)

Possible Altered Response to Donepezil (CYP2D6 *2/*2 XN Rapid Metabolizer)

When compared to a normal metabolizer, a rapid metabolizers has a 24%increase in donepezil clearance. The clinical significance of this increase is notwell documented. Consider using a standard dosing regimen and adjustdosage in response to clinical response and tolerability.

**

Esomeprazole (Nexium)

Insufficient Response to Esomeprazole (CYP2C19 *1/*17 Rapid Metabolizer)

Helicobacter pylori eradication: increase dose by 50-100% and be alertto insufficient response.

•

Other: be extra alert to insufficient response and consider doseincrease of 50-100%.

•

**

Fluphenazine (Prolixin)

Possible Non-response to Fluphenazine (CYP2D6 *2/*2 XN Rapid Metabolizer)

Fluphenazine is metabolized by CYP2D6, CYP1A2 and other enzymes. Patients with increased CYP2D6 function will metabolizefluphenazine more rapidly which can result in sub-therapeutic drugconcentrations; these patients may require higher doses to achieveadequate plasma concentrations. There are no established dosingadjustments for patients with increased CYP2D6 function therefore, therapymust be initiated cautiously with oral or parenteral fluphenazinehydrochloride. When the pharmacological effects and an appropriate dosageare apparent, an equivalent dose of fluphenazine decanoate (IM or SC) maybe administered and subsequent dosage adjustments may be necessary.

**

Fluvoxamine (Luvox)

Possible Reduced Response to Fluvoxamine (CYP2D6 *2/*2 XN RapidMetabolizer)

There is a risk for decreased efficacy at standard dosage. If a standard doseis prescribed to a CYP2D6 rapid metabolizer, suboptimal plasmaconcentrations of the drug are likely. There is insufficient data to calculatedose adjustments and careful titration is recommended until a favorableresponse is achieved. An alternative medication not metabolized by CYP2D6can also be considered.

**

Hydrocodone (Vicodin)

Possible Altered Response to Hydrocodone (CYP2D6 *2/*2 XN RapidMetabolizer)

Increased conversion of hydrocodone to the more active metabolitehydromorphone is expected in CYP2D6 rapid metabolizers. Usually, adequatepain relief without an increase in adverse events can be achieved by usingstandard or lower hydrocodone doses. Other opioids not metabolized byCYP2D6 (e.g., morphine, oxymorphone, buprenorphine, fentanyl, methadone,and hydromorphone) may also be considered if excessive side effects arereported.

**

Lansoprazole (Prevacid)

Insufficient Response to Lansoprazole (CYP2C19 *1/*17 Rapid Metabolizer)


•


•

**

Lisdexamfetamine (Vyvanse)

Poor Response to Lisdexamfetamine (COMT Val158Met AA Low COMT Activity)

The patient's genotype result predicts a reduced therapeutic response toamphetamine stimulants. If prescribed, lisdexamfetamine should beadministered at the lowest effective dose, and dosage should be individuallyadjusted.

**


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Maprotiline (Ludiomil)

Possible Non-response to Maprotiline (CYP2D6 *2/*2 XN Rapid Metabolizer)

Like other tricyclic and tetracyclic antidepressants, maprotiline is metabolizedby CYP2D6 as well as CYP1A2. Patients with increased CYP2D6 function maymetabolize maprotiline more rapidly which can result in sub-therapeutic drugconcentrations; these patients may require higher doses to achieve adequateplasma concentrations. There are no established dosing adjustmentsfor patients with increased CYP2D6 function. Seizures have beenassociated with the use of maprotiline especially at high doses.Therefore, therapy must be initiated at a lower dose andgradually increased in small increments according to the patient'sresponse.

**

Methadone (Dolophine)

Possible Sensitivity to Methadone (CYP2B6 *1/*6 IntermediateMetabolizer)

Based on currently available evidence, S-methadone plasma concentrationsmay increase, resulting in higher risk of cardiac arrhythmias and QTcprolongation. Consider lower starting doses of methadone, and adjust dosingbased on the clinical response.

**

Methylphenidate (Ritalin)

Poor Response to Methylphenidate (COMT Val158Met AA Low COMT Activity)

The patient's genotype result predicts a reduced therapeutic response tomethylphenidate. Dosage should be individualized according to the needs andresponse of the patient. Therapy should be initiated in small doses, withgradual weekly increments.

**

Mexiletine (Mexitil)

Altered Response to Mexiletine (CYP2D6 *2/*2 XN RapidMetabolizer)

Because mexiletine plasma concentrations may be decreased, consideradjusting dose in response to mexiletine plasma concentration and ECGmonitoring, until a favorable response in achieved.

**

Morphine (MS Contin)

Altered Response to Morphine (COMT Val158Met AA Low COMT Activity)

The patient carries two COMT Val158Met mutations, which translates to areduced COMT function. The patient may require lower doses of morphine foradequate pain control. The dosing regimen needs to be individualized foreach patient, taking into account the patient's prior analgesic treatmentexperience.

**

Naltrexone (Vivitrol, Contrave)

Altered Response to Naltrexone (OPRM1 A118G AA Normal OPRM1 Function)

Treatment of alcohol dependence: the patient has the wild-type genotype forOPRM1 that is associated with a poorer outcome with naltrexone therapy.Naltrexone-treated patients not carrying the 118A> G mutation are less likelyto respond to this drug, and may have higher relapse rates than those whoare carriers of this mutation.

**

Olanzapine (Zyprexa)

Possible Non-Response to Olanzapine (CYP1A2 *1A/*1L NormalMetabolizer- Possible Inducibility)

There is little evidence regarding the impact of CYP1A2 genetic variants onolanzapine response. Smokers may be at risk for non-response at standarddoses. Careful monitoring is recommended during dosing adjustment.Smoking cessation may increase plasma drug levels, leading to adverseevents. Therefore, therapeutic drug monitoring accompanied by dosereduction may be needed in patients who have quit smoking.

**

Omeprazole (Prilosec)

Insufficient Response to Omeprazole (CYP2C19 *1/*17 Rapid Metabolizer)

Helicobacter pylori eradication: increase dose by 100-200% and bealert to insufficient response.

•

Other: be extra alert to insufficient response and consider doseincrease of 100-200%.

•

*


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Oxycodone (Percocet, Oxycontin)

Possible Altered Response to Oxycodone (CYP2D6 *2/*2 XN RapidMetabolizer)

Increased conversion of oxycodone to the more active metaboliteoxymorphone is expected in CYP2D6 rapid metabolizers. Usually, adequatepain relief without an increase in adverse events can be achieved by usingstandard or lower oxycodone doses. Other opioids not metabolized byCYP2D6 (e.g., morphine, oxymorphone, buprenorphine, fentanyl, methadone,and hydromorphone) may also be considered if excessive side effects arereported.

*

Palonosetron (Aloxi)

Possible Altered Response to Palonosetron (CYP2D6 *2/*2 XN RapidMetabolizer)

Palonosetron is eliminated by multiple routes including metabolism. WhileCYP2D6 and to a lesser extent, CYP3A4 and CYP1A2 are involved in itsmetabolism to two inactive metabolites. Compared to CYP2D6 normalmetabolizers, CYP2D6 rapid metabolizers may have lower palonosetronplasma concentrations at standard dosing. However, the clinical significanceof this change remains unclear. Palonosetron can be prescribed at standardlabel-recommended dosage and administration. Monitor the patient forpossible decreased efficacy.

**

Pantoprazole (Protonix)

Insufficient Response to Pantoprazole (CYP2C19 *1/*17 Rapid Metabolizer)


•


•

*

Perphenazine (Trilafon)

Possible Non-Response to Perphenazine (CYP2D6 *2/*2 XN Rapid Metabolizer)

Subjects with increased CYP2D6 function will metabolize perphenazine morerapidly, which can result in sub-therapeutic drug concentrations. Consider adose increase with close monitoring until a favorable response is achieved.

*

Pimozide (Orap) Possible Non-Response to Pimozide (CYP2D6 *2/*2 XN Rapid Metabolizer)

There is insufficient data to calculate dose adjustment, and if pimozide isprescribed at standard dosing, monitor response and be alert to reducedefficacy. Standard starting dose: 1 to 2 mg/day (adult) or 0.05 mg/kg/day(children). Doses may be increased to a maximum of 10 mg/day or 0.2mg/kg/day.

*

Propafenone (Rythmol)

Altered Response to Propafenone (CYP2D6 *2/*2 XN RapidMetabolizer)

There is insufficient data to allow calculation of dose adjustment. Titratecarefully and adjust the dose in response to plasma concentration and ECGmonitoring. OR consider alternative drug such as sotalol, disopyramide,quinidine, or amiodarone.

*

Sertraline (Zoloft) Possible Reduced Response to Sertraline (CYP2C19 *1/*17 Rapid Metabolizer)

Sertraline can be prescribed at standard label-recommended dosage andadministration. If patient does not respond to recommended maintenancedosing, consider an alternative medication.

**


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Tetrabenazine (Xenazine)

Unknown Sensitivity to Tetrabenazine (CYP2D6 *2/*2 XN Rapid Metabolizer)

There is insufficient data to calculate dose adjustment, and if tetrabenazine isprescribed, individualization of dose with careful weekly titration is required.The first week’s starting dose is 12.5 mg daily; second week, 25 mg (12.5 mgtwice daily); then slowly titrate at weekly intervals by 12.5 mg to atolerated dose. The maximum daily dose in CYP2D6 rapidmetabolizers is not defined. The maximum daily dose in normalmetabolizers is 100 mg with a maximum single dose of 37.5 mg. Ifserious adverse events occur, titration should be stopped and the dose oftetrabenazine should be reduced. If the adverse event(s) do not resolve,consider withdrawal of tetrabenazine.

*

Tizanidine (Zanaflex)

Possible Non-Response to Tizanidine (CYP1A2 *1A/*1L NormalMetabolizer- Possible Inducibility)

There is little evidence regarding the impact of CYP1A2 genetic variants ontizanidine response. Smokers may be at risk for non-response and mayrequire higher doses. There is an association between high tizanidine plasmaconcentrations and the risk of hypotension and excessive sedation. Therefore,careful monitoring is recommended during dosing adjustment. Smokingcessation may increase plasma drug levels, leading to excessive hypotensionand sedation. Careful monitoring accompanied by dose reduction may beneeded in patients who have quit smoking.

**

Voriconazole (Vfend)

Non-response to Voriconazole (CYP2C19 *1/*17 Rapid Metabolizer)

Voriconazole plasma concentrations may be low when standard dosage isused, increasing the risk of loss of response and effectiveness. Closelymonitor voriconazole plasma concentrations, and adjust the dose accordingly.

*


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Risk ManagementAntipsychotic-Induced Tardive Dyskinesia

Closely monitor the patient for signs of tardive dyskinesia.

Increased Risk of Antipsychotic-Induced Tardive DyskinesiaThe patient does not carry the Taq1A variant (homozygous for the A2 allele).The genotype results predict that the patient has normal dopamine receptor DRD2 density and hypodopaminergicfunctioning. The patient has increased risk for tardive dyskinesia when treated with antipsychotics.

Antipsychotic-Induced Hyperprolactinemia

Monitor the patients closely for any signs of hyperprolactinemia.

Normal Risk of Antipsychotic-Induced HyperprolactinemiaThe patient does not carry the Taq1A variant (homozygous for the A2 allele).The genotype results predict that the patient has normal dopamine receptor DRD2 density and hypodopaminergicfunctioning. The patient has normal risk of hyperprolactinemia when treated with antipsychotics.

Antipsychotic-Induced Weight Gain

Monitor the patient closely for signs weight gain.

Low Risk of Antipsychotic-Induced Weight GainThe patient does not carry the Taq1A variant (homozygous for the A2 allele).The genotype results predict that the patient has normal dopamine receptor DRD2 density and hypodopaminergicfunctioning. The patient has a normal risk for weight gain when treated with antipsychotics.

Hyperlipidemia/Atherosclerotic Cardiovascular Disease

Dietary adjustment (very low fat diet) and statin drugs are the preferred agents for lipid-lowering therapy.

Possible increased risk of hyperlipidemia/atherosclerotic vascular diseaseThe patient is positive for the APOE 388 T>C (Arg112Cys) and the 526 C>T (Cys158Arg) mutations. The patient's genotypeis ε2/ε4 (frequency: 0.73-2.9%). The APOE E2 form is associated with a slower conversion of IDL to LDL, lower plasmacholesterol, and higher triglycerides. The APOE E4 confers a limitation of HDL binding to its receptor, and is associated withincreased plasma cholesterol, LDL, and triglycerides.The ε2 allele is somehow associated with an increased risk of hyperlipidemia/atherosclerotic vascular disease, andindividuals that are heterozygous for this allele may have higher lipid levels. The APOE ε2/ε4 genotype is associated withtype III hyperlipoproteinemia in patients that are also heterozygous for familial hypercholesterolemia.


19




Hyperhomocysteinemia - Depression

Patients diagnosed with depression: as lower folate levels are associated with poorer antidepressant response, and baselinelevels of folate within the normal range predict antidepressant response, testing for homocysteine levels and serum folatelevels may be informative for this patient before prescribing methylfolate as an antidepressant-augmenting agent.

No Increased Risk of HyperhomocysteinemiaThe patient does not carry the MTHFR C677T variant. MTHFR enzyme activity is normal.Patients diagnosed with depression often have low folate levels and homocysteine is a highly sensitive marker of folatestatus. Functional folate deficiency is indicated by elevated homocysteine. With a normal MTHFR activity, this patient canprocess folate normally and is unlikely to have elevated plasma levels of homocysteine.

Thrombophilia

Unless other genetic and/or circumstantial risk factors are present (e.g., smoking or obesity…), estrogen-containingcontraceptive and hormone replacement therapy can be used by the patient.

No Increased Risk of ThrombosisThe patient does not carry the Factor V Leiden G1691A mutation or Factor II G20210A mutation (wild-type).The patient's risk of thrombosis is not increased (average risk of clotting is about 1 in 1000 for anyone in a year). However,because this test cannot find all of the inherited reasons for abnormal clotting, other factors may affect this risk assessment.

Hyperhomocysteinemia - Thrombosis

MTHFR enzyme activity is normal.

No Increased Risk of HyperhomocysteinemiaThe patient does not carry the MTHFR C677T or MTHFR A1298C mutation (wild-type). MTHFR enzyme activity is normal.With a normal MTHFR activity, this patient is unlikely to have elevated plasma levels of homocysteine, which is a known riskfactor for cardiovascular diseases and thrombosis. Unless other risk factors are present, the patient is not expected to havean increased risk for venous thromboembolism (VTE).


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Comments: Genotyping result does not eliminate the necessity to account for non-genetic factors that can influence dose requirements for medications that are metabolizedby the CYP450 enzymes. CYP450 2C9, 2C19, 2D6, 3A4, 3A5, and VKORC activity is dependent upon hepatic and renal function status. Consider the results oftesting and dose adjustments in the context of renal and hepatic function. CYP450 2C9, 2C19, 2D6, 3A4, 3A5, and VKORC activity can be altered by co-administered inhibitors or inducers. It is important to interpret the testing result in the context of other co administered drugs. Consult drug label for dosingguidance. DNA testing does not replace the need for clinical and therapeutic drug monitoring. Technical Specifications: Laboratory specimens were analyzed by isolating DNA with magnetic bead method and then real time PCR technology to recognize specific gene alleles (with thehelp of genotype and allele information file program) for CYP450 2C9, 2C19, 2D6, 3A4, 3A5, and VKORC. Laboratory specimens were analyzed by isolating DNA with magnetic bead method and then real time PCR technology to recognize specific gene alleles for FactorII, Factor V Leiden, and Methylenetetrahydrofolate reductase (MTHFR).Other known variants not listed are not detected.The performance characteristics of this test were determined in conjunction with manufacturer data as required by CLIA. This test is used for clinical purpose.Disclaimer: This test was developed and its performance characteristics were determined by VANTARI Genetics Laboratory. It has not been cleared or approved by the U.S.Food and Drug Administration (FDA); however, the FDA has determined that such clearance or approval is currently not necessary for clinical use of this test. VANTARI Genetics Laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA -88) as qualified to perform high complexityclinical laboratory testing.The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions. The information presented on this report isprovided as general educational health information. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Only aphysician, pharmacist or other healthcare professional should advise a patient on the use of the medications prescribed.Laboratory Certification: CLIA # 05D2111917

ANKK1/DRD2 DRD2:Taq1A; Apolipoprotein E ε2, ε4, (ε3 is reference); COMT Val158Met; CYP1A2 *1C, *1D, *1E, *1F, *1J, *1L, *1V, *1W; CYP2B6 *6,*9, *11; CYP2C19 *2, *3, *4, *4B, *5, *6, *7, *8, *9, *17; CYP2C9 *2, *3, *4, *5, *6; CYP2D6 *5 (gene deletion), XN (gene duplication), *2, *3, *4, *4M,*6, *7, *8, *9, *10, *12, *14A, *14B, *17, *29, *35, *41, *5 (gene deletion), XN (gene duplication); CYP3A4 *1B, *2, *3, *12, *17, *22; CYP3A5 *1D, *2, *3,*3C, *6, *7, *8, *9; DPYD *2A, *13; Factor II 20210G>A; Factor V Leiden 1691G>A; GRIK4 83-10039T>C; MTHFR 1298A>C, 677C>T; OPRM1 A118G;SLCO1B1 521T>C, 388A>G, -11187G>A; UGT2B15 *2; VKORC1 -1639G>A

Tested Alleles:


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Patient Reference Card

Please provide a printed copy of this summary genetic report page to your patient so this information can be

shared with other healthcare providers.

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For a complete report contact Vantari Genetics

VKORC1 -1639G>A G/G Low Warfarin SensitivityMTHFR 1298A>C AA

677C>T CCNo Increased Risk of

HyperhomocysteinemiaMTHFR 677C>T CC Normal MTHFR Activity

Factor IIFactor V Leiden

20210G>A GG1691G>A GG

No Increased Risk of Thrombosis

CYP2C19 *1/*17 Rapid MetabolizerCYP2C9 *1/*1 Normal MetabolizerCYP2D6 *2/*2 XN Rapid MetabolizerCYP3A4 *1B/*1B Intermediate MetabolizerCYP3A5 *7/*7 Poor Metabolizer

Patient Name: Patient NA17104NA17104

DNA Test Summary For Pharmacogenetic Genes

Accession #:Date of Birth: 1/1/1900

949.783.5300Laboratory Phone: www.vantari.com


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