Gene:

CYP3A4

cytochrome P450, family 3, subfamily A, polypeptide 4

The FDA recommends, but does not require, genetic testing prior to initiating or reinitiating treatment with Ticagrelor.

Excerpts from the Ticagrelor (Brilinta) drug label:

"Ticagrelor is metabolized by CYP3A4/5. Avoid use with strong CYP3A inhibitors, such as atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin and voriconazole.

...Avoid use with potent CYP3A inducers, such as rifampin, dexamethasone, phenytoin, carbamazepine, and phenobarbital.

...BRILINTA will result in higher serum concentrations of simvastatin and lovastatin because these drugs are metabolized by CYP3A4. Avoid simvastatin and lovastatin doses greater than 40 mg.

...Digoxin: Because of inhibition of the P-glycoprotein transporter, monitor digoxin levels with initiation of or any change in BRILINTA therapy."

For the complete drug label text with sections containing pharmacogenetic information highlighted, see the Ticagrelor drug label PDF.

The FDA recommends, but does not require, genetic testing prior to initiating or reinitiating treatment with Fluvoxamine.

PGx information can be found in the Drug Interactions label section.

Excerpts from the fluvoxamine label:

Based on a finding of substantial interactions of fluvoxamine with certain of these drugs (see later parts of this section and also WARNINGS for details) and limited in vitro data for the 3A4 isozyme, it appears that fluvoxamine inhibits the following isozymes
that are known to be involved in the metabolism of the listed drugs:
1A2, 2C9, 3A4, 2C19, Warfarin, Alprazolam, Omeprazole, Theophylline, Propranolol, Tizanidine. In vitro data suggest that fluvoxamine is a relatively weak inhibitor of the 2D6 isozyme.

For the complete drug label text with sections containing pharmacogenetic information highlighted, see the fluvoxamine drug label.