Gene:
CYP2D6
cytochrome P450, family 2, subfamily D, polypeptide 6

Available Guidelines

  1. CPIC Guideline for amitriptyline and CYP2C19,CYP2D6
  2. CPIC Guideline for clomipramine and CYP2C19,CYP2D6
  3. CPIC Guideline for codeine and CYP2D6
  4. CPIC Guideline for desipramine and CYP2D6
  5. CPIC Guideline for doxepin and CYP2C19,CYP2D6
  6. CPIC Guideline for fluvoxamine and CYP2D6
  7. CPIC Guideline for imipramine and CYP2C19,CYP2D6
  8. CPIC Guideline for nortriptyline and CYP2D6
  9. CPIC Guideline for paroxetine and CYP2D6
  10. CPIC Guideline for trimipramine and CYP2C19,CYP2D6
  11. PRO Guideline for codeine and CYP2D6
  12. DPWG Guideline for amitriptyline and CYP2D6
  13. DPWG Guideline for aripiprazole and CYP2D6
  14. DPWG Guideline for atomoxetine and CYP2D6
  15. DPWG Guideline for carvedilol and CYP2D6
  16. DPWG Guideline for clomipramine and CYP2D6
  17. DPWG Guideline for clozapine and CYP2D6
  18. DPWG Guideline for codeine and CYP2D6
  19. DPWG Guideline for doxepin and CYP2D6
  20. DPWG Guideline for duloxetine and CYP2D6
  21. DPWG Guideline for flecainide and CYP2D6
  22. DPWG Guideline for flupenthixol and CYP2D6
  23. DPWG Guideline for haloperidol and CYP2D6
  24. DPWG Guideline for imipramine and CYP2D6
  25. DPWG Guideline for metoprolol and CYP2D6
  26. DPWG Guideline for mirtazapine and CYP2D6
  27. DPWG Guideline for nortriptyline and CYP2D6
  28. DPWG Guideline for olanzapine and CYP2D6
  29. DPWG Guideline for oxycodone and CYP2D6
  30. DPWG Guideline for paroxetine and CYP2D6
  31. DPWG Guideline for propafenone and CYP2D6
  32. DPWG Guideline for risperidone and CYP2D6
  33. DPWG Guideline for tamoxifen and CYP2D6
  34. DPWG Guideline for tramadol and CYP2D6
  35. DPWG Guideline for venlafaxine and CYP2D6
  36. DPWG Guideline for zuclopenthixol and CYP2D6

last updated 02/07/2014

1. CPIC Guideline for amitriptyline and CYP2C19,CYP2D6

Summary

The CPIC Dosing Guideline for amitriptyline recommends an alternative drug for CYP2D6 or CYP2C19 ultrarapid metabolizers and for CYP2D6 poor metabolizers. Consider a 50% dose reduction for CYP2C19 poor metabolizers and a 25% dose reduction for CYP2D6 intermediate metabolizers.

There's more of this guideline. Read more.


last updated 02/07/2014

2. CPIC Guideline for clomipramine and CYP2C19,CYP2D6

Summary

Tricyclic antidepressants have comparable pharmacokinetic properties, it may be reasonable to apply the CPIC Dosing Guideline for amitriptyline and CYP2C19, CYP2D6 to other tricyclics including clomipramine. In the guideline for amitriptyline, an alternative drug is recommended for CYP2D6 or CYP2C19 ultrarapid metabolizers and for CYP2D6 poor metabolizers. Consider a 50% dose reduction for CYP2C19 poor metabolizers and a 25% dose reduction for CYP2D6 intermediate metabolizers.

There's more of this guideline. Read more.


last updated 05/05/2016

3. CPIC Guideline for codeine and CYP2D6

Summary

Alternate analgesics are recommended for CYP2D6 ultrarapid and poor metabolizers. A label recommended age- or weight-specific codeine dose is warranted for CYP2D6 extensive and intermediate metabolizers.

There's more of this guideline. Read more.


last updated 02/07/2014

4. CPIC Guideline for desipramine and CYP2D6

Summary

Tricyclic antidepressants have comparable pharmacokinetic properties, it may be reasonable to apply the CPIC Dosing Guideline for amitriptyline/nortriptyline and CYP2C19, CYP2D6 to other tricyclics including desipramine. In the guideline for nortriptyline, an alternative drug is recommended for CYP2D6 ultrarapid metabolizers or poor metabolizers. For intermediate metabolizers, a 25% dose reduction may be considered.

There's more of this guideline. Read more.


last updated 02/07/2014

5. CPIC Guideline for doxepin and CYP2C19,CYP2D6

Summary

Tricyclic antidepressants have comparable pharmacokinetic properties, it may be reasonable to apply the CPIC Dosing Guideline for amitriptyline and CYP2C19, CYP2D6 to other tricyclics including doxepin. In the guideline for amitriptyline, an alternative drug is recommended for CYP2D6 or CYP2C19 ultrarapid metabolizers and for CYP2D6 poor metabolizers. Consider a 50% dose reduction for CYP2C19 poor metabolizers and a 25% dose reduction for CYP2D6 intermediate metabolizers.

There's more of this guideline. Read more.


last updated 05/11/2015

6. CPIC Guideline for fluvoxamine and CYP2D6

Summary

The CPIC Dosing Guideline for the selective serotonin reuptake inhibitor fluvoxamine recommends to consider a 25-50% reduction of recommended starting dose and titrate to response or use an alternative drug not metabolized by CYP2D6 for CYP2D6 poor metabolizers.

There's more of this guideline. Read more.


last updated 02/07/2014

7. CPIC Guideline for imipramine and CYP2C19,CYP2D6

Summary

Tricyclic antidepressants have comparable pharmacokinetic properties, it may be reasonable to apply the CPIC Dosing Guideline for amitriptyline and CYP2C19, CYP2D6 to other tricyclics including imipramine. In the guideline for amitriptyline, an alternative drug is recommended for CYP2D6 or CYP2C19 ultrarapid metabolizers and for CYP2D6 poor metabolizers. Consider a 50% dose reduction for CYP2C19 poor metabolizers and a 25% dose reduction for CYP2D6 intermediate metabolizers.

There's more of this guideline. Read more.


last updated 02/07/2014

8. CPIC Guideline for nortriptyline and CYP2D6

Summary

The CPIC Dosing Guideline for nortriptyline recommends a 25% dose reduction for CYP2D6 intermediate metabolizers. For CYP2D6 ultrarapid or poor metabolizers, an alternative drug may be considered.

There's more of this guideline. Read more.


last updated 05/11/2015

9. CPIC Guideline for paroxetine and CYP2D6

Summary

The CPIC Dosing Guideline for the selective serotonin reuptake inhibitor paroxetine recommends an alternative drug not predominantly metabolized by CYP2D6 for CYP2D6 ultrarapid metabolizers and for CYP2D6 poor metabolizers. For CYP2D6 poor metabolizers, if paroxetine use is warranted, consider a 50% reduction of recommended starting dose and titrate to response.

There's more of this guideline. Read more.


last updated 02/07/2014

10. CPIC Guideline for trimipramine and CYP2C19,CYP2D6

Summary

Tricyclic antidepressants have comparable pharmacokinetic properties, it may be reasonable to apply the CPIC Dosing Guideline for amitriptyline and CYP2C19, CYP2D6 to other tricyclics including trimipramine. In the guideline for amitriptyline, an alternative drug is recommended for CYP2D6 or CYP2C19 ultrarapid metabolizers and for CYP2D6 poor metabolizers. Consider a 50% dose reduction for CYP2C19 poor metabolizers and a 25% dose reduction for CYP2D6 intermediate metabolizers.

There's more of this guideline. Read more.


last updated 07/28/2014

11. PRO Guideline for codeine and CYP2D6

Summary

The Canadian Pharmacogenomics Network for Drug Safety (CPNDS) clinical recommendation group has published guidelines for the use of CYP2D6 genotype when prescribing codeine. They recommend that poor metabolizers of CYP2D6 should not receive codeine for pain relief, and ultrametabolizers of CYP2D6 should avoid codeine for pain relief.

There's more of this guideline. Read more.


last updated 02/07/2014

12. DPWG Guideline for amitriptyline and CYP2D6

Summary

The Dutch Pharmacogenetics Working Group Guideline for amitriptyline recommends to select an alternative drug or monitor amitriptyline and nortriptyline plasma concentration for patients who are CYP2D6 poor or ultrarapid metabolizers. Reduce the initial dose for patients who are intermediate metabolizers or select an alternative drug.

There's more of this guideline. Read more.


last updated 02/07/2014

13. DPWG Guideline for aripiprazole and CYP2D6

Summary

The Royal Dutch Pharmacists Association - Pharmacogenetics Working Group (DPWG) recommends reducing maximum dose of aripiprazole for patients carrying poor metabolizer alleles of CYP2D6.

There's more of this guideline. Read more.


last updated 02/07/2014

14. DPWG Guideline for atomoxetine and CYP2D6

Summary

For CYP2D6 ultrarapid metabolizers, be alert to reduced efficacy of atomoxetine or select an alternative drug. Be alert to ADEs in CYP2D6 poor metabolizers.

There's more of this guideline. Read more.



last updated 02/07/2014

16. DPWG Guideline for clomipramine and CYP2D6

Summary

The Dutch Pharmacogenetics Working Group Guideline for clomipramine recommends to reduce the dose by 50% for CYP2D6 poor metabolizers, and select an alternative drug for ultrarapid metabolizers. Monitor (desmethyl)clomipramine plasma concentration.

There's more of this guideline. Read more.



last updated 02/07/2014

18. DPWG Guideline for codeine and CYP2D6

Summary

Select alternative analgesics for patients who are CYP2D6 poor metabolizers, intermediate metabolizers, or ultrarapid metabolizers.

There's more of this guideline. Read more.


last updated 02/07/2014

19. DPWG Guideline for doxepin and CYP2D6

Summary

The Dutch Pharmacogenetics Working Group Guideline for doxepin recommends to reduce the dose by 60% for CYP2D6 poor metabolizers and by 20% for intermediate metabolizers. Select an alternative drug for CYP2D6 ultrarapid metabolizers.

There's more of this guideline. Read more.






last updated 02/07/2014

24. DPWG Guideline for imipramine and CYP2D6

Summary

The Dutch Pharmacogenetics Working Group Guideline for imipramine recommends to reduce the dose for CYP2D6 poor and intermediate metabolizer patients, and monitor imipramine and desipramine plasma concentrations. Select an alternative drug for CYP2D6 ultrarapid metabolizers.

There's more of this guideline. Read more.


last updated 02/07/2014

25. DPWG Guideline for metoprolol and CYP2D6

Summary

Select another drug or reduce dose of metoprolol for CYP2D6 poor and intermediate metabolizer patients. Use a dose titration of metoprolol for CYP2D6 ultra metabolizers or select an alternative drug.

There's more of this guideline. Read more.



last updated 02/07/2014

27. DPWG Guideline for nortriptyline and CYP2D6

Summary

The Dutch Pharmacogenetics Working Group Guideline for nortriptyline recommends to reduce the dose for CYP2D6 poor or intermediate metabolizer patients. For CYP2D6 ultrarapid metabolizers, select an alternative drug or increase the dose by 60%. Monitoring of nortriptyline and 10-hydroxynortriptyline plasma concentrations is recommended.

There's more of this guideline. Read more.



last updated 02/07/2014

29. DPWG Guideline for oxycodone and CYP2D6

Summary

Use an alternate drug rather than oxycodone (not codeine or tramadol) for CYP2D6 poor and intermediate metabolizer patients, or be alert to insufficient pain relief. For CYP2D6 ultra metabolizer patients, use an alternate drug rather than oxycodone (not codeine or tramadol), or be alert to adverse drug events.

There's more of this guideline. Read more.



last updated 02/07/2014

31. DPWG Guideline for propafenone and CYP2D6

Summary

Reduce the dose of propafenone by 70% for CYP2D6 poor metabolizers, and adjust propafenone dose according to plasma concentrations or use an alternative drug for CYP2D6 intermediate and ultrarapid metabolizers.

There's more of this guideline. Read more.


last updated 02/07/2014

32. DPWG Guideline for risperidone and CYP2D6

Summary

Select an alternative drug or be extra alert to adverse drug events (ADR) for patients who are CYP2D6 poor metabolizers, intermediate metabolizers, or ultrarapid metabolizers with risperidone. Adjust risperidone dose to clinical response.

There's more of this guideline. Read more.


last updated 02/07/2014

33. DPWG Guideline for tamoxifen and CYP2D6

Summary

For CYP2D6 poor and intermediate metabolizers, consider using aromatase inhibitors for postmenopausal women due to increased risk for relapse of breast cancer with tamoxifen. For intermediate metabolizers, avoid concomitant CYP2D6 inhibitor use.

There's more of this guideline. Read more.


last updated 02/07/2014

34. DPWG Guideline for tramadol and CYP2D6

Summary

For CYP2D6 poor metabolizers (PM), select an alternative to tramadol (not oxycodone or codeine) and be alert for symptoms of insufficient pain relief. For CYP2D6 intermediate metabolizers (IM), be alert for symptoms of insufficient pain relief, and consider dose increase or select an alternative to tramadol (not oxycodone or codeine). For CYP2D6 ultrarapid metabolizers, use a 30% decreased dose and be alert for ADEs, or use an alternative to tramadol (not oxycodone or codeine).

There's more of this guideline. Read more.


last updated 02/07/2014

35. DPWG Guideline for venlafaxine and CYP2D6

Summary

For CYP2D6 poor (PM) and intermediate metabolizers (IM), select an alternative to venlafaxine or adjust dose to clinical response and monitor patient's plasma metabolite level. For CYP2D6 ultrarapid metabolizers(UM), titrate dose to a maximum of 150% of the normal dose or select an alternative to venlafaxine.

There's more of this guideline. Read more.


last updated 02/07/2014

36. DPWG Guideline for zuclopenthixol and CYP2D6

Summary

For CYP2D6 poor and intermediate metabolizers, reduce zuclopenthixol dose or select an alternative drug. For ultrarapid metabolizers, be alert to low zuclopenthixol plasma concentrations or select an alternative drug.

There's more of this guideline. Read more.


PharmGKB annotates drug labels containing pharmacogenetic information approved by the US Food and Drug Administration (FDA), European Medicines Agency (EMA), the Pharmaceuticals and Medical Devices Agency, Japan (PMDA), and Health Canada (Santé Canada) (HCSC). PharmGKB annotations provide a brief summary of the PGx in the label, an excerpt from the label and a downloadable highlighted label PDF file. A list of genes and phenotypes found within the label is mapped to label section headers and listed at the end of each annotation. PharmGKB also attempts to interpret the level of action implied in each label with the "PGx Level" tag.

See the legend for more information about drug label sources and PGx Levels.

We welcome any information regarding drug labels containing PGx information approved by the FDA, EMA, PMDA, HCSC or other Medicine Agencies around the world - please contact feedback.


Annotated Labels

  1. FDA Label for amitriptyline and CYP2D6
  2. FDA Label for arformoterol and CYP2D6,UGT1A1
  3. FDA Label for aripiprazole and CYP2D6
  4. FDA Label for atomoxetine and CYP2D6
  5. FDA Label for carvedilol and CYP2D6
  6. FDA Label for cevimeline and CYP2D6
  7. FDA Label for citalopram and CYP2C19,CYP2D6
  8. FDA Label for clomipramine and CYP2D6
  9. FDA Label for clozapine and CYP2D6
  10. FDA Label for codeine and CYP2D6
  11. FDA Label for darifenacin and CYP2D6
  12. FDA Label for desipramine and CYP2D6
  13. FDA Label for doxepin and CYP2C19,CYP2D6
  14. FDA Label for eliglustat and CYP2D6
  15. FDA Label for fesoterodine and CYP2D6
  16. FDA Label for flibanserin and CYP2C19,CYP2C9,CYP2D6
  17. FDA Label for fluoxetine and CYP2D6
  18. FDA Label for fluvoxamine and CYP2D6
  19. FDA Label for galantamine and CYP2D6
  20. FDA Label for iloperidone and CYP2D6
  21. FDA Label for imipramine and CYP2D6
  22. FDA Label for metoprolol and CYP2D6
  23. FDA Label for modafinil and CYP2D6
  24. FDA Label for nefazodone and CYP2D6
  25. FDA Label for nortriptyline and CYP2D6
  26. FDA Label for paroxetine and CYP2D6
  27. FDA Label for perphenazine and CYP2D6
  28. FDA Label for pimozide and CYP2D6
  29. FDA Label for propafenone and CYP2D6
  30. FDA Label for propranolol and CYP2D6
  31. FDA Label for protriptyline and CYP2D6
  32. FDA Label for quinidine and CYP2D6
  33. FDA Label for quinine and CYP2D6,G6PD
  34. FDA Label for risperidone and CYP2D6
  35. FDA Label for terbinafine and CYP2D6
  36. FDA Label for tetrabenazine and CYP2D6
  37. FDA Label for thioridazine and CYP2D6
  38. FDA Label for timolol and CYP2D6
  39. FDA Label for tiotropium and CYP2D6
  40. FDA Label for tolterodine and CYP2D6
  41. FDA Label for tramadol and CYP2D6
  42. FDA Label for trimipramine and CYP2D6
  43. FDA Label for venlafaxine and CYP2D6
  44. FDA Label for vortioxetine and CYP2D6
  45. FDA Label for dextromethorphan,quinidine and CYP2D6
  46. FDA Label for fluoxetine,olanzapine and CYP2D6
  47. EMA Label for aripiprazole and CYP2D6,CYP3A4
  48. EMA Label for darifenacin and CYP2D6
  49. EMA Label for dronedarone and CYP2D6,CYP3A4
  50. EMA Label for eliglustat and CYP2D6
  51. EMA Label for fesoterodine and CYP2D6
  52. EMA Label for gefitinib and CYP2D6,CYP3A4,EGFR
  53. EMA Label for olanzapine and CYP1A2,CYP2D6
  54. EMA Label for propranolol and CYP2D6
  55. EMA Label for ranolazine and CYP2D6
  56. EMA Label for ritonavir and CYP2D6,CYP3A4
  57. EMA Label for timolol and CYP2D6
  58. EMA Label for vortioxetine and CYP2D6
  59. EMA Label for dextromethorphan,quinidine and CYP2D6
  60. PMDA Label for atomoxetine and CYP2D6
  61. PMDA Label for tolterodine and CYP2D6
  62. HCSC Label for aripiprazole and CYP2D6
  63. HCSC Label for atomoxetine and CYP2D6
  64. HCSC Label for carvedilol and CYP2D6
  65. HCSC Label for codeine and CYP2D6
  66. HCSC Label for darifenacin and CYP2D6
  67. HCSC Label for fesoterodine and CYP2D6
  68. HCSC Label for galantamine and CYP2D6
  69. HCSC Label for metoprolol and CYP2D6
  70. HCSC Label for nortriptyline and CYP2D6
  71. HCSC Label for propafenone and CYP2D6
  72. HCSC Label for risperidone and CYP2D6
  73. HCSC Label for tamoxifen and CYP2D6,ESR1,ESR2
  74. HCSC Label for tetrabenazine and CYP2D6
  75. HCSC Label for tolterodine and CYP2D6
  76. HCSC Label for vortioxetine and CYP2D6
  77. HCSC Label for acetaminophen,tramadol and CYP2D6

last updated 12/16/2013

1. FDA Label for amitriptyline and CYP2D6

Actionable PGx

Summary

The FDA-approved drug label for amitriptyline contains information regarding the metabolism of tricyclic antidepressants by CYP2D6: CYP2D6 poor metabolizers may have higher plasma concentrations of tricyclic antidepressants, and the label suggests monitoring of plasma levels if this drug is co-administrered with a CYP2D6 inhibitor.

There's more of this label. Read more.


last updated 05/29/2015

2. FDA Label for arformoterol and CYP2D6,UGT1A1

Informative PGx

Summary

The FDA-approved label for arformoterol (BROVANA) states those with reduced CYP2D6 and/or UGT1A1 activity do not show changes in their systemic exposure to the drug compared to those with normal CYP2D6 and/or UGT1A1 enzymatic activities.

There's more of this label. Read more.


last updated 10/25/2013

3. FDA Label for aripiprazole and CYP2D6

Actionable PGx

Summary

Elimination of aripiprazole is mainly via metabolism by CYP2D6 and CYP3A4 - the FDA-approved drug label contains information regarding dose adjustment in patients who are CYP2D6 poor metabolizers, or in patients taking concomittant drugs that may inhibit or induce CYP2D6 or CYP3A4.

There's more of this label. Read more.


last updated 10/25/2013

4. FDA Label for atomoxetine and CYP2D6

Actionable PGx

Summary

Dose adjustments of atomoxetine (Strattera) may be necessary in CYP2D6 poor metabolizers (PMs) or if CYP2D6 inhibitors are used concomitantly. Laboratory tests are available to identify CYP2D6 poor metabolizers.

There's more of this label. Read more.


last updated 10/25/2013

5. FDA Label for carvedilol and CYP2D6

Actionable PGx

Summary

Carvedilol is metabolized by CYP2D6 and CYP2C9. The drug label states that carvedilol is affected by the poor metabolizers of debrisoquin (a marker for cytochrome P450 2D6) resulting in higher plasma concentrations of R( + )-carvedilol. Additionally, retrospective analysis of side effects in clinical trials showed that poor CYP2D6 metabolizers had a higher rate of dizziness during up-titration, presumably resulting from vasodilating effects of the higher concentrations of the a-blocking R(+) enantiomer.

There's more of this label. Read more.


last updated 10/25/2013

6. FDA Label for cevimeline and CYP2D6

Actionable PGx

Summary

CYP2D6 and CYP3A3/4 are responsible for the metabolism of cevimeline, therefore the drug label states that drugs which inhibit CYP2D6 and CYP3A3/4 also inhibit the metabolism of cevimeline. Additionally, cevimeline should be used with caution in individuals known or suspected to be CYP2D6 poor metabolizers, based on previous experience, as they may be at a higher risk of adverse events.

There's more of this label. Read more.


last updated 10/25/2013

7. FDA Label for citalopram and CYP2C19,CYP2D6

Actionable PGx

Summary

The FDA-approved drug label recommends a maximum dose of 20 mg/day of citalopram (Celexa) in patients who are CYP2C19 poor metabolizers, due to an increase in citalopram exposure. This increased exposure leads to a greater risk for QT prolongation, a potentially fatal abnormality in the heart's electrical activity.

There's more of this label. Read more.


last updated 10/25/2013

8. FDA Label for clomipramine and CYP2D6

Actionable PGx

Summary

The drug label for clomipramine (Anafranil) notes that CYP2D6 poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs), such as clomipramine, when given typical doses. Additionally, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers. It is therefore desirable to monitor TCA plasma levels whenever a TCA is going to be co-administered with another drug known to be a CYP2D6 inhibitor.

There's more of this label. Read more.


last updated 10/25/2013

9. FDA Label for clozapine and CYP2D6

Actionable PGx

Summary

Clozapine is a substrate of CYP1A2, CYP3A4, and CYP2D6. The drug label notes to use caution when administering it concomitantly with drugs that are inducers or inhibitors of these enzymes. Additionally, it may be necessary to reduce the clozapine dose in patients with significant renal or hepatic impairment, or in CYP2D6 poor metabolizers.

There's more of this label. Read more.


last updated 10/25/2013

10. FDA Label for codeine and CYP2D6

Actionable PGx

Summary

CYP2D6 ultra-rapid metabolizers may experience overdose symptoms such as extreme sleepiness, confusion, or shallow breathing at normal dosing regimens. Mothers who are ultra-rapid metabolizers and breast-feeding have higher-than-expected levels of morphine in breast milk and potentially dangerously high serum morphine levels in their breastfed infants, potentially leading to serious adverse reactions, including death, in nursing infants. A black box warning on the label states "Respiratory depression and death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to a CYP2D6 polymorphism." However, no recommendations for testing for CYP2D6 metabolizer status are provided on the label.

There's more of this label. Read more.


last updated 08/08/2014

11. FDA Label for darifenacin and CYP2D6

Actionable PGx

Summary

The FDA-approved drug label for darifenacin (Enablex) notes that CYP2D6 poor metabolizers may have increased maximum plasma concentrations of darifenacin, as compared to CYP2D6 extensive metabolizers. However, the label does not comment on the clinical significance of these increased concentrations.

There's more of this label. Read more.


last updated 10/25/2013

12. FDA Label for desipramine and CYP2D6

Actionable PGx

Summary

The FDA-approved drug label for desipramine (NORPRAMIN) notes that CYP2D6 poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs), such as desipramine, when given typical doses. Additionally, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers. It is therefore desirable to monitor TCA plasma levels whenever a TCA is going to be co-administered with another drug known to be a CYP2D6 inhibitor.

There's more of this label. Read more.


last updated 10/25/2013

13. FDA Label for doxepin and CYP2C19,CYP2D6

Actionable PGx

Summary

Doxepin is primarily metabolized by hepatic cytochrome P450 isozymes CYP2C19 and CYP2D6. The drug label notes that CYP2D6 and CYP2C19 poor metabolizers have higher than expected plasma concentrations of doxepin when given typical doses. Additionally, inhibitors of these CYP isozymes may increase the exposure of doxepin.

There's more of this label. Read more.


last updated 09/17/2015

14. FDA Label for eliglustat and CYP2D6

Genetic testing required

Summary

The FDA-approved drug label for eliglustat (CERDELGA) states that it is indicated for patients with Gaucher disease type 1. CYP2D6 intermediate and extensive metabolizers have a recommended dose of 84 mg twice daily, while poor metabolizers have a recommended dose of 84 mg once daily. The label notes that CYP2D6 ultra-rapid metabolizers may not achieve adequate concentrations of eliglustat to achieve a therapeutic effect.

There's more of this label. Read more.


last updated 08/08/2014

15. FDA Label for fesoterodine and CYP2D6

Actionable PGx

Summary

The FDA-approved drug label for fesoterodine (Toviaz) notes that CYP2D6 poor metabolizers may have increased maximum plasma concentrations of the active metabolite of fesoterodine, as compared to CYP2D6 extensive metabolizers. However, the label does not comment on the clinical significance of these increased concentrations.

There's more of this label. Read more.



last updated 10/25/2013

17. FDA Label for fluoxetine and CYP2D6

Informative PGx

Summary

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Fluoxetine is indicated for the treatment of major depressive disorder, obsessive compulsive disorder, bulimia nervosa, and panic disorder. Fluoxetine is metabolized by several cytochrome P450 enzymes with CYP2D6 being a major contributor. At the same time, fluoxetine is an inhibitor of CYP2D6 mediated reactions.

There's more of this label. Read more.


last updated 10/25/2013

18. FDA Label for fluvoxamine and CYP2D6

Informative PGx

Summary

Fluvoxamine appears to inhibit several cytochrome P450 isoenzymes as it exhibits substantial interactions with drugs metabolized by the same isoenzymes. Caution should be used in treating patients with low CYP2D6 activity and those receiving other medication known to inhibit CYP2D6.

There's more of this label. Read more.



last updated 10/25/2013

20. FDA Label for iloperidone and CYP2D6

Actionable PGx

Summary

Co-administration of FANAPT with known strong inhibitors of CYP2D6 like fluoxetine results in a 2.3 fold increase in iloperidone plasma exposure, and therefore one-half of the FANAPT dose should be administered. Similarly, PMs of CYP2D6 have higher exposure to iloperidone compared with EMs and PMs should have their dose reduced by one half.

There's more of this label. Read more.


last updated 10/25/2013

21. FDA Label for imipramine and CYP2D6

Actionable PGx

Summary

Poor metabolizers have higher than expected plasma concentrations of TCAs when given usual doses. Concomitant use of TCAs with drugs that can inhibit cytochrome P450 2D6 may require lower doses than usually prescribed for either the tricyclic antidepressant or the other drug; monitor TCA plasma levels.

There's more of this label. Read more.


last updated 10/25/2013

22. FDA Label for metoprolol and CYP2D6

Informative PGx

Summary

Metoprolol is metabolized by the cytochrome P450 enzymes in the liver with a major contribution of CYP2D6. Poor metabolizers and extensive metabolizers who concomitantly use CYP2D6 inhibiting drugs will have increased (several-fold) metoprolol blood levels, decreasing metoprolol's cardioselectivity.

There's more of this label. Read more.


last updated 10/25/2013

23. FDA Label for modafinil and CYP2D6

Actionable PGx

Summary

Modafinil, used to improve wakefulness, is metabolized by many cytochrome P450s. Patients that are poor metabolizers for CYP2D6 may need dose modifications for medications that have ancillary metabolism via CYP2C19, such as tricyclic antidepressants (TCAs).

There's more of this label. Read more.



last updated 10/25/2013

25. FDA Label for nortriptyline and CYP2D6

Actionable PGx

Summary

Poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs) when given usual doses. In addition, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers; co-administration with these inhibitors' can make the patient abruptly toxic.

It is desirable to monitor TCA plasma levels whenever a TCA is going to be co-administered with another drug known to be an inhibitor.

There's more of this label. Read more.


last updated 10/25/2013

26. FDA Label for paroxetine and CYP2D6

Informative PGx

Summary

The metabolism of paroxetine is accomplished in part by cytochrome CYP2D6. Coadministration of paroxetine with other drugs that are metabolized by this isozyme should be approached with caution. Due to the risk of serious ventricular arrhythmias and sudden death potentially associated with elevated plasma levels of thioridazine, paroxetine and thioridazine should not be coadministered.

There's more of this label. Read more.


last updated 10/25/2013

27. FDA Label for perphenazine and CYP2D6

Actionable PGx

Summary

CYP2D6 is involved in the pharmacokinetics of perphenazine. Poor metabolizers demonstrate higher plasma concentrations of antipsychotic drugs at usual doses, which may correlate with emergence of side effects. Prospective phenotyping of elderly patients prior to antipsychotic treatment may identify those at risk for adverse events.

There's more of this label. Read more.


last updated 10/25/2013

28. FDA Label for pimozide and CYP2D6

Genetic testing required

Summary

CYP2D6 genotyping should be performed at doses above 0.05mg/kg/day in children or above 4 mg/day in adults. In poor CYP2D6 metabolizers, pimozide doses should not exceed 0.05mg/kg/day in children or 4 mg/day in adults and doses should not be increased earlier than 14 days.

There's more of this label. Read more.


last updated 10/25/2013

29. FDA Label for propafenone and CYP2D6

Actionable PGx

Summary

Propafenone is metabolized by CYP2D6,CYP3A4,and CYP1A2 isoenzymes. Inhibitors of CYP2D6, 1A2, and 3A4 may increase propafenone levels which may lead to cardiac arrhythmias. Simultaneous use with both a CYP3A4 and CYP2D6 inhibitor (or in a patient with CYP2D6 deficiency) should be avoided.

There's more of this label. Read more.


last updated 10/25/2013

30. FDA Label for propranolol and CYP2D6

Informative PGx

Summary

Propranolol is metabolized primarily by CYP2D6. CYP1A2 and CYP2C19 may also play a role in propranolol metabolism. The drug label states that proranolol should be used with caution when co-administered with drugs that have an affect on CYP2D6, 1A2, or 2C19 metabolic pathways. Co-administration of such drugs with propranolol may lead to clinically relevant drug interactions and changes on its efficacy and/or toxicity.

There's more of this label. Read more.


last updated 10/25/2013

31. FDA Label for protriptyline and CYP2D6

Actionable PGx

Summary

Protriptyline hydrochloride is an antidepressant agent and belongs to the class of tricyclic antidepressants. CYP2D6 poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs) when given usual doses.

There's more of this label. Read more.


last updated 10/25/2013

32. FDA Label for quinidine and CYP2D6

Informative PGx

Summary

Quinidine inhibits the action of cytochrome P450IID6, effectively converting CYP2D extensive metabolizers into poor metabolizers. The drug label advises caution whenever quinidine is prescribed together with drugs metabolized by CYP2D6.

There's more of this label. Read more.


last updated 12/20/2013

33. FDA Label for quinine and CYP2D6,G6PD

Actionable PGx

Summary

The FDA-approved drug label for quinine (QUALAQUIN) states that it is contraindicated in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency due to the risk for hemolysis. G6PD deficiency is a condition caused by variants in the G6PD gene which can be determined by enzymatic or genetic tests, however the drug label does not specifically mention testing.

There's more of this label. Read more.


last updated 10/25/2013

34. FDA Label for risperidone and CYP2D6

Informative PGx

Summary

Risperidone is metabolized to 9-hydroxyrisperidone by CYP2D6. Co-administration of drugs that are inhibitors or inducers of CYP2D6 along with risperidone may alter the plasma concentration of risperidone.

There's more of this label. Read more.


last updated 10/25/2013

35. FDA Label for terbinafine and CYP2D6

Informative PGx

Summary

Terbinafine is an antifungal drug. It is an inhibitor of CYP450 2D6 and has an effect on metabolism of desipramine, cimetidine, fluconazole, cyclosporine, rifampin, and caffeine. Coadministration of terbinafine with drugs dependent on CYP2D6 for metabolism should be done with careful monitoring and may require a reduction in dose of the 2D6-metabolized drug.

There's more of this label. Read more.


last updated 10/25/2013

36. FDA Label for tetrabenazine and CYP2D6

Genetic testing required

Summary

Tetrabenazine is used to treat Huntington's Disease chorea. Its primary metabolites are metabolized mainly by CYP2D6. Patients requiring doses above 50 mg per day should be genotyped for the drug metabolizing enzyme CYP2D6 to determine if the patient is a poor metabolizer (PM) or an extensive metabolizer (EM). People with CYP2D6 poor metabolizer genotypes should be treated with lower doses.

There's more of this label. Read more.


last updated 10/25/2013

37. FDA Label for thioridazine and CYP2D6

Actionable PGx

Summary

Thioridazine is used to treat schizophrenia, but has been associated with Torsades de pointes and sudden death. Due to the potentially fatal side effects, it is typically reserved for patients who do not respond well to other anti-psychotics. This drug is contraindicated in patients with reduced CYP2D6 activity.

There's more of this label. Read more.


last updated 10/25/2013

38. FDA Label for timolol and CYP2D6

Summary

Timolol is a non-selective beta adrenergic agonist applied to the eye to reduce intraocular pressure. This drug-biomarker pair was previously in the FDA's "Table of Pharmacogenomic Biomarkers in Drug Labels" but has subsequently been removed.

There's more of this label. Read more.


last updated 10/25/2013

39. FDA Label for tiotropium and CYP2D6

Informative PGx

Summary

Tiotropium is an inhalation powder used daily for the treatment of bronchospasms associated with chronic obstructive pulmonary disease (COPD), and believed to be in small part metabolized by CYP2D6 and CYP3A4. This drug-biomarker pair was previously in the FDA's "Table of Pharmacogenomic Biomarkers in Drug Labels" but has subsequently been removed.

There's more of this label. Read more.


last updated 10/25/2013

40. FDA Label for tolterodine and CYP2D6

Actionable PGx

Summary

Tolterodine is used for the treatment of overactive bladder and is primarily metabolized by CYP2D6. Poor metabolizers may have greater plasma concentrations of the drug which could possibly have an effect QT interval. However, no recommendations for testing for CYP2D6 metabolizer status are provided on the label.

There's more of this label. Read more.


last updated 05/19/2016

41. FDA Label for tramadol and CYP2D6

Actionable PGx

Summary

The FDA-approved label contains information regarding metabolism of Tramadol by CYP2D6: CYP2D6 poor metabolizers may have higher tramadol concentrations, and concomitant use of CYP2D6 or CYP3A4 inhibitors may reduce clearance of tramadol and increase a patient's risk for adverse events.

There's more of this label. Read more.


last updated 10/25/2013

42. FDA Label for trimipramine and CYP2D6

Actionable PGx

Summary

Trimipramine (Surmontil) is a tricyclic antidepressant used to treat depression. Like many antidepressants, it has a black box warning for increased risk of suicidal thoughts and behavior. Trimipramine is metabolized by CYP2D6 and poor metabolizers my experience higher plasma concentrations of the drug at typical doses.

There's more of this label. Read more.


last updated 10/25/2013

43. FDA Label for venlafaxine and CYP2D6

Informative PGx

Summary

Venlafaxine (Effexor) is an inhibitor of neuronal serotonin and norepinephrine reuptake and weak inhibitor of dopamine reuptake used in the treatment of depression. It is metabolized by CYP2D6, and to a lesser extent, CYP3A4 (shown in vitro).

There's more of this label. Read more.


last updated 07/16/2014

44. FDA Label for vortioxetine and CYP2D6

Actionable PGx

Summary

Vortioxetine (BRINTELLIX) is indicated as a treatment for major depressive disorder. The FDA-approved drug label for vortioxetine notes that the maximum recommended dose in patients who are known CYP2D6 poor metabolizers is 10 mg/day.

There's more of this label. Read more.


last updated 10/25/2013

45. FDA Label for dextromethorphan,quinidine and CYP2D6

Genetic testing recommended

Summary

The quinidine component of NUEDEXTA is a CYP2D6 inhibitor used to increase the plasma availability of dextromethorphan, which is metabolized by CYP2D6. Therefore, CYP2D6 poor metabolizers may be at risk of experiencing toxicity.

The label states, "The quinidine component of NUEDEXTRA is not expected to contribute to the effectiveness of NUEDEXTA in PMs [CYP2D6 poor metabolizers], but adverse events of the quinidine are still possible. In those patients who may be at risk of significant toxicity due to quinidine, genotyping to determine if they are PMs should be considered prior to making the decision to treat with NUEDEXTA."

There's more of this label. Read more.


last updated 12/17/2013

46. FDA Label for fluoxetine,olanzapine and CYP2D6

Informative PGx

Summary

Symbyax, a drug mixture of fluoxetine and olanzapine, is used for the treatment of bipolar disorder and treatment resistant depression and, due to its potent CYP2D6 inhibition as a result of fluoxetine, exhibits drug interactions with other medications also metabolized by CYP2D6. Coadministration with other drugs that are metabolized by CYP2D6 should be approached with caution.

There's more of this label. Read more.


last updated 10/25/2013

47. EMA Label for aripiprazole and CYP2D6,CYP3A4

Actionable PGx

Summary

The EMA European Public Assessment Report (EPAR) recommends dose adjustments when aripiprazole is taken with CYP3A4 inhibitors in CYP2D6 poor metabolizers, or concomitant use of CYP3A4 or CYP2D6 inhibitors, or CYP3A4 inducers.

There's more of this label. Read more.


last updated 08/07/2014

48. EMA Label for darifenacin and CYP2D6

Actionable PGx

Summary

The EMA European Public Assessment Report (EPAR) for darifenacin (Emselex) contains information regarding differences in exposure to drug in patients who are CYP2D6 poor metabolizers compared to extensive metabolizers. Darifenacin is primarily metabolized by CYP3A4 in CYP2D6 poor metabolizers, therefore exposure to darifenacin may be greater in CYP2D6 poor metabolizers when CYP3A4 inhibitors are taken concomitantly.

There's more of this label. Read more.


last updated 09/16/2014

49. EMA Label for dronedarone and CYP2D6,CYP3A4

Informative PGx

Summary

The EMA European Public Assessment Report (EPAR) for dronedarone (MULTAQ) states that it is a mild inhibitor of CYP2D6, and that the effect on metoprolol and propranol exposure is much below the difference seen between poor and extensive CYP2D6 metabolisers. It also contains information regarding metabolism of by dronedarone CYP3A4, and that concomitant drugs that are potent CYP3A4 inhibitors are contraindicated and potent CYP3A4 inducers are not recommended.

There's more of this label. Read more.


last updated 09/17/2015

50. EMA Label for eliglustat and CYP2D6

Genetic testing required

Summary

The EMA European Public Assessment Report (EPAR) for eliglustat (Cerdelga) states that it is indicated for adults with Gaucher disease type 1. CYP2D6 intermediate and extensive metabolizers have a recommended dose of 84 mg twice daily, while poor metabolizers have a recommended dose of 84 mg once daily. The label notes that eliglustat should not be used in patients who are CYP2D6 ultra-rapid metabolizers or indeterminate metabolizers.

There's more of this label. Read more.


last updated 08/07/2014

51. EMA Label for fesoterodine and CYP2D6

Actionable PGx

Summary

The EMA European Public Assessment Report (EPAR) for fesoterodine (Toviaz) contains information regarding differences in exposure to drug in patients who are CYP2D6 poor metabolizers compared to extensive metabolizers. Exposure to fesoterodine may be greater in CYP2D6 poor metabolizers, particularly when CYP3A4 inhibitors are taken concomitantly.

There's more of this label. Read more.


last updated 10/25/2013

52. EMA Label for gefitinib and CYP2D6,CYP3A4,EGFR

Genetic testing required

Summary

The EMA European Public Assessment Report (EPAR) contains biomarker information regarding the indication of gefitinib (Iressa) in patients with tumors that have activating EGFR mutations, due to its mechanism of action.

There's more of this label. Read more.


last updated 10/27/2013

53. EMA Label for olanzapine and CYP1A2,CYP2D6

Informative PGx

Summary

The EMA European Public Assessment Report (EPAR) for olanzapine (Zalasta) contains information regarding the metabolism of the drug by the enzymes CYP1A2 and CYP2D6: factors that induce or inhibit CYP1A2 may alter the concentration of olanzapine and thus may require dosage monitoring. The EPAR does not mention pharmacogenetics or testing of genetic variants in these genes.

There's more of this label. Read more.


last updated 06/26/2014

54. EMA Label for propranolol and CYP2D6

Informative PGx

Summary

The EMA European Public Assessment Report (EPAR) for propranolol hydrochloride (Hemangiol) gives information regarding the metabolism of the drug by three different routes which varies between individuals, but that no difference in oral clearance or elimination is observed between CYP2D6 extensive and poor metabolizers.

There's more of this label. Read more.


last updated 08/06/2014

55. EMA Label for ranolazine and CYP2D6

Actionable PGx

Summary

The EMA European Public Assessment Report (EPAR) for ranolazine (Ranexa) lists subgroups of patients in which caution should be taken when prescribing or uptitrating the drug. These precuations are based on the risk in CYP2D6 poor metabolizer patients (who are at risk of increased exposure to the drug leading to adverse events), and the EPAR states that there is a lower need for precautions in patients who are CYP2D6 extensive metabolizers.

There's more of this label. Read more.


last updated 09/15/2014

56. EMA Label for ritonavir and CYP2D6,CYP3A4

Informative PGx

Summary

The EMA European Public Assessment Report (EPAR) for ritonavir (Norvir) does not contain pharmacogenetic information. It contains information regarding use of ritonavir as a pharmacokinetic enhancer for certain drugs to prolong their therapeutic effects. It is a potent inhibitor of CYP3A and CYP2D6-mediated biotransformation, and the EPAR provides a list of drugs contraindicated for concomitant use with ritonavir.

There's more of this label. Read more.


last updated 01/22/2014

57. EMA Label for timolol and CYP2D6

Informative PGx

Summary

The EMA EPAR for timolol contains information regarding potentiated beta-blockade when treatment is combined with CYP2D6 inhibitors. No pharmacogenetic information was found in the label.

There's more of this label. Read more.


last updated 09/15/2014

58. EMA Label for vortioxetine and CYP2D6

Actionable PGx

Summary

The EMA European Public Assessment Report (EPAR) for vortioxetine (Brintellix) contains information regarding CYP2D6 poor metabolizers, who may have higher exposure to vortioxetine when coadministered a CYP3A4 or CYP2C9 inhibitor. The EPAR recommends considering dose adjustments depending on individual patient response.

There's more of this label. Read more.


last updated 05/02/2014

59. EMA Label for dextromethorphan,quinidine and CYP2D6

Actionable PGx

Summary

The EMA European Public Assessment Report (EPAR) for dextromethorphan and quinidine (Nuedexta) does not require dose adjustment based on CYP2D6 genotype. Efficacy is not expected to be affected in CYP2D6 poor metabolizers, however adverse reactions to quinidine are possible. Dextromethorphan is rapidly metabolized in CYP2D6 ultrametabolizers, and may result in subtherapeutic concentrations.

There's more of this label. Read more.


last updated 01/26/2015

60. PMDA Label for atomoxetine and CYP2D6

Actionable PGx

Summary

The PMDA package insert for atomoxetine states that individuals who are CYP2D6 poor metabolizers (PMs) and administered atomoxetine may have higher exposure to the drug and be at a greater risk of experiencing adverse events. The insert recommends dosing these patients with discretion.

There's more of this label. Read more.


last updated 01/26/2015

61. PMDA Label for tolterodine and CYP2D6

Informative PGx

Summary

Tolterodine is metabolized by CYP2D6 into the pharmacologically active and equipotent 5-hydroxymethyl metabolite. The PMDA package insert for tolterodine notes that CYP2D6 poor metabolizers have negligible concentrations of the 5-hydroxymethyl metabolite and significantly increased concentrations of tolterodine, as compared to extensive metabolizers.

There's more of this label. Read more.


last updated 06/08/2015

62. HCSC Label for aripiprazole and CYP2D6

Actionable PGx

Summary

The product monograph for aripiprazole (ABILIFY) notes that CYP2D6 poor metabolizers have approximately an 80% increase in aripiprazole exposure and approximately a 30% decrease in exposure to the active metabolite compared to CYP2D6 extensive metabolizers.

There's more of this label. Read more.


last updated 06/08/2015

63. HCSC Label for atomoxetine and CYP2D6

Actionable PGx

Summary

The product monograph for atomoxetine notes that CYP2D6 poor metabolizers (PMs) have a 10-fold higher area under the curve (AUC) and a 5-fold higher peak concentration of the drug as compared to extensive metabolizers (EM); this leads to a higher rate of some adverse events for PMs compared to EMs.

There's more of this label. Read more.


last updated 06/08/2015

64. HCSC Label for carvedilol and CYP2D6

Actionable PGx

Summary

The product monograph for carvedilol notes that CYP2D6 poor metabolizers exhibit 2- to 3-fold higher plasma concentrations of R( + )-carvedilol compared to extensive metabolizers. Plasma levels of S( - )-carvedilol are increased only about 20 - 25% in poor metabolizers.

There's more of this label. Read more.


last updated 06/08/2015

65. HCSC Label for codeine and CYP2D6

Actionable PGx

Summary

CYP2D6 ultra-rapid metabolizers may experience overdose symptoms such as extreme sleepiness, confusion, or shallow breathing at normal dosing regimens of codeine. Mothers who are ultra-rapid metabolizers and breast-feeding have higher-than-expected levels of morphine in breast milk and potentially dangerously high serum morphine levels in their breastfed infants.

There's more of this label. Read more.


last updated 06/08/2015

66. HCSC Label for darifenacin and CYP2D6

Actionable PGx

Summary

The product monograph for darifenacin notes that CYP2D6 poor metabolizers may have higher levels of the drug as compared to extensive metabolizers. However, it also notes that there are no special dosing requirements for poor metabolizers.

There's more of this label. Read more.


last updated 06/08/2015

67. HCSC Label for fesoterodine and CYP2D6

Actionable PGx

Summary

The product monograph for fesoterodine (TOVIAZ) states that CYP2D6 poor metabolizers have increased levels of the active metabolite of the drug as compared to extensive metabolizers. However, it makes no statements regarding genetic testing of CYP2D6.

There's more of this label. Read more.


last updated 06/08/2015

68. HCSC Label for galantamine and CYP2D6

Informative PGx

Summary

The product monograph for galantamine notes that CYP2D6 poor metabolizers have decreased clearance and increased AUC of galantamine as compared to extensive metabolizers. However, it also states that dosage adjustment based on CYP2D6 genotype is not necessary since the drug is individually titrated to tolerability.

There's more of this label. Read more.


last updated 06/08/2015

69. HCSC Label for metoprolol and CYP2D6

Actionable PGx

Summary

The product monograph for metoprolol notes that CYP2D6 poor metabolizers exhibit higher plasma concentrations of the drug as compared to extensive metabolizers, however these differences in plasma concentrations seem to have little to no effect on safety or tolerability.

There's more of this label. Read more.


last updated 06/08/2015

70. HCSC Label for nortriptyline and CYP2D6

Actionable PGx

Summary

The product monograph for nortriptyline notes that individuals who are CYP2D6 poor metabolizers may have higher than expected levels of tricyclic antidepressants (of which nortriptyline is a member) when given usual doses.

There's more of this label. Read more.


last updated 06/08/2015

71. HCSC Label for propafenone and CYP2D6

Actionable PGx

Summary

The product monograph for propafenone notes that individuals with reduced CYP2D6 activity may have higher plasma concentrations of the drug as compared to those who do not have reduced CYP2D6 activity.

There's more of this label. Read more.


last updated 06/08/2015

72. HCSC Label for risperidone and CYP2D6

Informative PGx

Summary

The product monograph for risperidone notes that since CYP2D6 is responsible for the metabolism of risperidone to 9-hydroxyrisperidone, the levels of each differ between CYP2D6 poor and extensive metabolizers. However, the concentration of risperidone and 9-hydroxyrisperidone combined does not differ substantially between poor and extensive metabolizers.

There's more of this label. Read more.


last updated 06/08/2015

73. HCSC Label for tamoxifen and CYP2D6,ESR1,ESR2

Genetic testing required

Summary

The product monograph for tamoxifen states that it is indicated for treatment of early breast cancer in women with estrogen receptor positive tumors. It also notes that individuals with low CYP2D6 activity (or using CYP2D6 inhibitors) may have reductions in plasma concentrations of the active metabolite of tamoxifen.

There's more of this label. Read more.


last updated 06/08/2015

74. HCSC Label for tetrabenazine and CYP2D6

Actionable PGx

Summary

The product monograph for tetrabenazine notes that the tetrabenazine active metabolite HTBZ is likely increased in CYP2D6 poor metabolizers as compared to extensive metabolizers, and that caution in dosing should be exercised.

There's more of this label. Read more.


last updated 06/08/2015

75. HCSC Label for tolterodine and CYP2D6

Informative PGx

Summary

The product monograph for tolterodine notes that CYP2D6 is responsible for the metabolism of tolterodine to its active metabolite DD 01. However, since tolterodine and DD 01 have similar pharmacological effects, the net activity of tolterodine is expected to be similar regardless of CYP2D6 metabolizer status.

There's more of this label. Read more.


last updated 06/08/2015

76. HCSC Label for vortioxetine and CYP2D6

Actionable PGx

Summary

The product monograph for vortioxetine (TRINTELLIX) states that the concentration of the drug is approximately 2 times higher in CYP2D6 poor metabolizers as compared to extensive metabolizers.

There's more of this label. Read more.


last updated 06/08/2015

77. HCSC Label for acetaminophen,tramadol and CYP2D6

Actionable PGx

Summary

The product monographs for tramadol and acetaminophen (APO-TRAMADOL/ACET) and tramadol (APO-TRAMADOL) note that patients who are CYP2D6 poor metabolizers may have increased tramadol concentrations as compared to those who are CYP2D6 extensive metabolizers.

There's more of this label. Read more.


Clinical Variants that meet the highest level of criteria, manually curated by PharmGKB, are shown below. Please follow the link in the "Position" column for more information about a particular variant. Each link in the "Position" column leads to the corresponding PharmGKB Variant Page. The Variant Page contains summary data, including PharmGKB manually curated information about variant-drug pairs based on individual PubMed publications. The PMIDs for these PubMed publications can be found on the Variant Page.

To see more Clinical Variants with lower levels of criteria, click the button at the bottom of the table.

Disclaimer: The PharmGKB's clinical annotations reflect expert consensus based on clinical evidence and peer-reviewed literature available at the time they are written and are intended only to assist clinicians in decision-making and to identify questions for further research. New evidence may have emerged since the time an annotation was submitted to the PharmGKB. The annotations are limited in scope and are not applicable to interventions or diseases that are not specifically identified.

The annotations do not account for individual variations among patients, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It remains the responsibility of the health-care provider to determine the best course of treatment for a patient. Adherence to any guideline is voluntary, with the ultimate determination regarding its application to be made solely by the clinician and the patient. PharmGKB assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the PharmGKB clinical annotations, or for any errors or omissions.

? = Mouse-over for quick help

The table below contains information about pharmacogenomic variants on PharmGKB. Please follow the link in the "Variant" column for more information about a particular variant. Each link in the "Variant" column leads to the corresponding PharmGKB Variant Page. The Variant Page contains summary data, including PharmGKB manually curated information about variant-drug pairs based on individual PubMed publications. The PMIDs for these PubMed publications can be found on the Variant Page.

The tags in the first column of the table indicate what type of information can be found on the corresponding Variant Page on the appropriate tab.

Links in the "Drugs" column lead to PharmGKB Drug Pages.

List of all variant annotations for CYP2D6

Variant?
(147)
Alternate Names ? Chemicals ? Alleles ?
(+ chr strand)
Function ? Amino Acid?
Translation
No VIP available CA VA *1 N/A N/A N/A
No VIP available No VIP available VA *1A N/A N/A N/A
No VIP available CA VA *1xN N/A N/A N/A
No VIP available CA VA *2 N/A N/A N/A
No VIP available No VIP available VA *2A N/A N/A N/A
No VIP available CA VA *2xN N/A N/A N/A
No VIP available CA VA *3 N/A N/A N/A
No VIP available CA VA *4 N/A N/A N/A
No VIP available No VIP available VA *4A N/A N/A N/A
No VIP available No VIP available VA *4D N/A N/A N/A
No VIP available CA VA *4xN N/A N/A N/A
No VIP available CA VA *5 N/A N/A N/A
No VIP available CA VA *6 N/A N/A N/A
No VIP available No VIP available VA *6B N/A N/A N/A
No VIP available CA VA *7 N/A N/A N/A
No VIP available CA VA *8 N/A N/A N/A
No VIP available CA VA *9 N/A N/A N/A
No VIP available CA VA *10 N/A N/A N/A
No VIP available No VIP available VA *10A N/A N/A N/A
No VIP available No VIP available VA *10B N/A N/A N/A
No VIP available CA VA *11 N/A N/A N/A
No VIP available CA VA *12 N/A N/A N/A
No VIP available CA VA *13 N/A N/A N/A
No VIP available CA VA *14 N/A N/A N/A
No VIP available No VIP available VA *14A N/A N/A N/A
No VIP available No VIP available VA *14B N/A N/A N/A
No VIP available CA VA *15 N/A N/A N/A
No VIP available CA VA *17 N/A N/A N/A
No VIP available CA VA *18 N/A N/A N/A
No VIP available No VIP available VA *19 N/A N/A N/A
No VIP available CA VA *100 N/A N/A N/A
No VIP available CA VA *101 N/A N/A N/A
No VIP available No VIP available VA *10x2 N/A N/A N/A
No VIP available CA VA *20 N/A N/A N/A
No VIP available CA VA *21 N/A N/A N/A
No VIP available No VIP available VA *24 N/A N/A N/A
No VIP available No VIP available VA *26 N/A N/A N/A
No VIP available No VIP available VA *27 N/A N/A N/A
No VIP available No VIP available VA *28 N/A N/A N/A
No VIP available CA VA *29 N/A N/A N/A
No VIP available No VIP available VA *30 N/A N/A N/A
No VIP available CA VA *31 N/A N/A N/A
No VIP available No VIP available VA *32 N/A N/A N/A
No VIP available No VIP available VA *35 N/A N/A N/A
No VIP available No VIP available VA *35xN N/A N/A N/A
No VIP available CA VA *36 N/A N/A N/A
No VIP available No VIP available VA *36xN N/A N/A N/A
No VIP available No VIP available VA *37 N/A N/A N/A
No VIP available CA VA *38 N/A N/A N/A
No VIP available No VIP available VA *39 N/A N/A N/A
No VIP available CA VA *40 N/A N/A N/A
No VIP available CA VA *41 N/A N/A N/A
No VIP available CA VA *42 N/A N/A N/A
No VIP available No VIP available VA *43 N/A N/A N/A
No VIP available CA VA *44 N/A N/A N/A
No VIP available No VIP available VA *45 N/A N/A N/A
No VIP available No VIP available VA *46 N/A N/A N/A
No VIP available CA VA *47 N/A N/A N/A
No VIP available No VIP available VA *48 N/A N/A N/A
No VIP available CA VA *49 N/A N/A N/A
No VIP available CA VA *50 N/A N/A N/A
No VIP available CA VA *51 N/A N/A N/A
No VIP available No VIP available VA *52 N/A N/A N/A
No VIP available No VIP available VA *53 N/A N/A N/A
No VIP available CA VA *54 N/A N/A N/A
No VIP available CA VA *55 N/A N/A N/A
No VIP available CA VA *56 N/A N/A N/A
No VIP available CA VA *57 N/A N/A N/A
No VIP available CA VA *59 N/A N/A N/A
No VIP available No VIP available VA *61 N/A N/A N/A
No VIP available CA VA *62 N/A N/A N/A
No VIP available No VIP available VA *63 N/A N/A N/A
No VIP available No VIP available VA *64 N/A N/A N/A
No VIP available No VIP available VA *65 N/A N/A N/A
No VIP available CA VA *69 N/A N/A N/A
No VIP available No VIP available VA *70 N/A N/A N/A
No VIP available No VIP available VA *71 N/A N/A N/A
No VIP available CA VA *72 N/A N/A N/A
No VIP available No VIP available VA *75 N/A N/A N/A
No VIP available No VIP available VA *81 N/A N/A N/A
No VIP available No VIP available VA *87 N/A N/A N/A
No VIP available No VIP available VA *88 N/A N/A N/A
No VIP available CA VA *89 N/A N/A N/A
No VIP available No VIP available VA *90 N/A N/A N/A
No VIP available No VIP available VA *91 N/A N/A N/A
No VIP available CA VA *92 N/A N/A N/A
No VIP available CA VA *93 N/A N/A N/A
No VIP available No VIP available VA *94 N/A N/A N/A
No VIP available No VIP available VA *95 N/A N/A N/A
No VIP available CA VA *96 N/A N/A N/A
No VIP available No VIP available VA *97 N/A N/A N/A
No VIP available No VIP available VA *98 N/A N/A N/A
No VIP available No Clinical Annotations available VA
CYP2D6 poor metabolizer genotype N/A N/A N/A
No VIP available No Clinical Annotations available VA
CYP2D6 poor metabolizers N/A N/A N/A
No VIP available No Clinical Annotations available VA
CYP2D6 extensive metabolizer phenotype N/A N/A N/A
No VIP available No Clinical Annotations available VA
CYP2D6 poor metabolizer phenotype N/A N/A N/A
No VIP available No Clinical Annotations available VA
CYP2D6 ultra-metabolizer genotype N/A N/A N/A
No VIP available No Clinical Annotations available VA
CYP2D6 extensive metabolizer genotype N/A N/A N/A
No VIP available No Clinical Annotations available VA
CYP2D6 extensive metabolizer N/A N/A N/A
No VIP available No Clinical Annotations available VA
CYP2D6 poor metabolizer N/A N/A N/A
No VIP available No Clinical Annotations available VA
CYP2D6 intermediate metabolizer N/A N/A N/A
No VIP available No Clinical Annotations available VA
CYP2D6 ultra-metabolizer phenotype N/A N/A N/A
No VIP available No Clinical Annotations available CYP2D6 intermediate metabolizers
CYP2D6 intermediate metabolizers N/A N/A N/A
No VIP available No Clinical Annotations available CYP2D6 extensive metabolizers
CYP2D6 extensive metabolizers N/A N/A N/A
No VIP available No Clinical Annotations available CYP2D6 poor metabolizers and intermediate metabolizers
CYP2D6 poor metabolizers and intermediate metabolizers N/A N/A N/A
No VIP available No Clinical Annotations available CYP2D6 ultrarapid metabolizer phenotype
CYP2D6 ultrarapid metabolizer phenotype N/A N/A N/A
No VIP available No Clinical Annotations available CYP2D6 ultrarapid metabolizer genotype
CYP2D6 ultrarapid metabolizer genotype N/A N/A N/A
No VIP available No Clinical Annotations available CYP2D6 intermediate metabolizer phenotype
CYP2D6 intermediate metabolizer phenotype N/A N/A N/A
rs1065852 -1114C>T, -1454C>T, -1462G>A, -1751G>A, 100C>T, 100T=, 100T>C, 1257C>T, 16258A=, 16258A>G, 328+4G>A, 37+605C>T, 42+469G>A, 42130692G>A, 42526694G>A, 4300C>T, 53019A=, 53019A>G, 53033G>A, CYP2D6:100C>T, Pro34Ser, Ser34=, Ser34Pro, part of CYP2D6*4 and CYP2D6*10
G > A
5' Flanking
Pro34Ser
No VIP available No Clinical Annotations available VA
rs1080983 -1045-725A>G, -1213T>C, -1228A>G, -1233A>G, -1770A>G, -1773A>G, -618A>G, 122C=, 122C>T, 18129C=, 18129C>T, 2431G=, 2431G>A, 40+371T>C, 42+2343T>C, 42132561C=, 42132561C>T, 42528568T>C, 54891C=, 54891C>T, 54907T>C, 836T>C, CYP2D6(-1775)A>G
C > T
5' Flanking
No VIP available CA VA
rs1080985 -1042C>G, -1042G>C, -1045-539C>G, -1045-539G>C, -1047C>G, -1047G>C, -1399C>G, -1399G>C, -1584C>G, -1584G>C, -1587C>G, -1587G>C, -432C>G, -432G>C, -65C>G, -65G>C, 17943G=, 17943G>C, 2617C=, 2617C>G, 40+185C>G, 40+185G>C, 42+2157C>G, 42+2157G>C, 42132375G=, 42132375G>C, 42528382C=, 42528382C>G, 54705G=, 54705G>C, 54721C=, 54721C>G, 650C>G, 650G>C
G > C
5' Flanking
No VIP available No Clinical Annotations available VA
rs1080989 -1000G>A, -1986C>T, -363C>T, -458G>A, -652C>T, 158G>A, 17357T=, 17357T>C, 3201G>A, 329-263C>T, 42+1568C>T, 42131791C>T, 42527793C>T, 54118T=, 54118T>C, 54132C>T, CYP2D6(-1000)A>G
C > T
5' Flanking
No VIP available No Clinical Annotations available VA
rs1135840 1157C=, 1157C>G, 12177G=, 12177G>C, 1241C=, 1241C>G, 1299+5C>G, 1299+5G>C, 1304G=, 1304G>C, 1308+5C>G, 1308+5G>C, 1313C=, 1313C>G, 1313G=, 1313G>C, 1452+5C>G, 1452+5G>C, 1457G=, 1457G>C, 1460C>G, 2472C=, 2472C>G, 42126611C=, 42126611C>G, 42522613G=, 42522613G>C, 48938G=, 48938G>C, 48952G=, 48952G>C, 8381G=, 8381G>C, CYP2D6: S486T, CYP2D6:4180G>C, Ser435=, Ser435Thr, Ser438=, Ser438Thr, Ser486=, Ser486Thr, Thr386=, Thr386Ser, Thr414=, Thr414Ser, Thr438=, Thr438Ser, Thr487Ser, part of CYP2D6*2A an extensive metabolizer haplotype.
C > G
Missense
Ser435Thr
Ser435Ser
No VIP available CA VA
rs138417770 21917289C>T, 42526720C>T, 5164G>A, 74G>A, Arg25Gln
G > T
G > C
Missense
Arg25Gln
rs16947 -1930A>G, -2094A>G, 13507G=, 13507G>A, 2000+233T>C, 42127941G=, 42127941G>A, 42523943A>G, 50268G=, 50268G>A, 50282A>G, 586C=, 586C>T, 670T>C, 7051C=, 7051C>T, 733C=, 733C>T, 742C=, 742C>T, 742T>C, 843+233T>C, 886C=, 886C>T, 889C=, 889C>T, Arg196=, Arg196Cys, Arg245=, Arg245Cys, Arg248=, Arg248Cys, Arg296=, Arg296Cys, Arg297=, Arg297Cys, CYP2D6:2850C>T, Cys224Arg, Cys248Arg
G > A
Missense
Arg196Cys
No VIP available CA VA
rs28360521 21919545C>T, 2908G>A, 42528976C>T
C > T
Not Available
No VIP available No Clinical Annotations available VA
rs28371703 -216G>T, -241C>A, -52G>T, -581C>A, 128C>A, 1428C>A, 15385G>T, 271C>A, 42129819G>T, 42525821G>T, 5173C>A, 52146G>T, 52160G>T, Ala43Asp, Leu91Met
G > T
5' Flanking
Leu91Met
Leu91Asp
No VIP available No Clinical Annotations available VA
rs28371704 -226T>C, -231A>G, -571A>G, -62T>C, 138A>G, 1438A>G, 15375T>C, 281A>G, 42129809T>C, 42525811T>C, 5183A>G, 52136T>C, 52150T>C, His94Arg, Pro46=
T > C
5' Flanking
His94Arg
His94Pro
rs28371706 -101G>A, -101G>T, -192C>A, -192C>T, -265G>A, -265G>T, -532C>A, -532C>T, 1477C>A, 1477C>T, 15336G>A, 15336G>T, 177C>A, 177C>T, 320C>A, 320C>T, 42129770G>A, 42129770G>T, 42525772G>A, 42525772G>T, 52097G>A, 52097G>T, 52111G>A, 52111G>T, 5222C>A, 5222C>T, CYP2D6:1023 C>T, His59=, His59Gln, Thr107Asn, Thr107Ile
G > A
G > T
5' Flanking
Thr107Asn
Thr107Ile
Thr107His
Thr107Gln
rs28371725 13369C>T, 2001-169G>A, 42127803C>T, 42523805C>T, 50130C>T, 50144C>T, 685+39G>A, 7189G>A, 724G>A, 769+39G>A, 832+39G>A, 841+39G>A, 844-169G>A, 985+39G>A, 988+39G>A, CYP2D6*41, CYP2D6:2988G>A, Glu242Lys, part of CYP2D6*41
C > T
Missense
Glu242Lys
VIP No Clinical Annotations available No Variant Annotations available
rs35742686 -1629delT, -1793delT, 13808delT, 1932delA, 42128242delT, 42524244delT, 475delA, 50569delT, 50583delT, 559delA, 622delA, 631delA, 6750delA, 775delA, 778delA, Arg159Glyfs, Arg187Glyfs, Arg208Glyfs, Arg211Glyfs, Arg259Glyfs, Arg260Glyfs
T > -
Frameshift
Arg159Gly
No VIP available CA VA
rs367543000 -1659G>A, -1659G>C, -1659G>T, -1823G>A, -1823G>C, -1823G>T, 13778G>A, 13778G>C, 13778G>T, 1962C>A, 1962C>G, 1962C>T, 42128212G>A, 42128212G>C, 42128212G>T, 42524214G>A, 42524214G>C, 42524214G>T, 50539G>A, 50539G>C, 50539G>T, 50553G>A, 505C>A, 505C>G, 505C>T, 589C>A, 589C>G, 589C>T, 652C>A, 652C>G, 652C>T, 661C>A, 661C>G, 661C>T, 6780C>A, 6780C>G, 6780C>T, 805C>A, 805C>G, 805C>T, 808C>A, 808C>G, 808C>T, Arg169=, Arg169Gly, Arg169Ter, Arg197=, Arg197Gly, Arg197Ter, Arg218=, Arg218Gly, Arg218Ter, Arg221=, Arg221Gly, Arg221Ter, Arg269=, Arg269Gly, Arg269Ter, Arg270=, Arg270Gly, Arg270Ter
G > A
G > T
G > C
Stop Codon
Arg169Arg
Arg169null
Arg169Gly
No VIP available CA VA
rs371793722 -1077A>G, -1241A>G, 14360A>G, 1813T>C, 356T>C, 42128794A>G, 42524796A>G, 440T>C, 503T>C, 51121A>G, 51135A>G, 512T>C, 6198T>C, 656T>C, Phe119Ser, Phe147Ser, Phe168Ser, Phe171Ser, Phe219Ser
A > G
Missense
Phe219Ser
rs3892097 -1090C>T, -926C>T, 14511C>T, 1663-1G>A, 207-2G>A, 290-1G>A, 353-1G>A, 363-2G>A, 42128945C>T, 42524947C>T, 506-1G>A, 510-2G>A, 51272T=, 51272T>C, 51286C>T, 6047G>A, CYP2D6*4, CYP2D6:1846G>A, part of CYP2D6*4
C > T
Acceptor
rs5030655 -787delA, -951delA, 14650delA, 155delT, 1611delT, 238delT, 311delT, 353-140delT, 363-141delT, 42129084delA, 42525086delA, 454delT, 51411delA, 51425delA, 5908delT, CYP2D6*6, CYP2D6:1707 del T, Trp152Glyfs, Trp80Glyfs, Val104Glyfs, Val52Glyfs, part of CYP2D6*6
A > -
Frameshift
Val52Gly
VIP No Clinical Annotations available No Variant Annotations available
rs5030656 -1697_-1695delCTT, -1861_-1859delCTT, 13740_13742delCTT, 1998_2000delAAG, 42128174_42128176delCTT, 42524176_42524178delCTT, 50501_50503delCTT, 50515_50517delCTT, 541_543delAAG, 625_627delAAG, 6816_6818delAAG, 688_690delAAG, 697_699delAAG, 841_843delAAG, 844_846delAAG, Lys181del, Lys209del, Lys230del, Lys233del, Lys281del, Lys282del
CTT > -
CTT > TTC
Non-synonymous
No VIP available No Clinical Annotations available VA
rs5030865 -1002C>A, -1002C>T, -838C>A, -838C>T, 14599C>A, 14599C>T, 1662G>A, 1662G>T, 206G>A, 206G>T, 289G>A, 289G>T, 353-89G>A, 353-89G>T, 362G>A, 362G>T, 363-90G>A, 363-90G>T, 42129033C>A, 42129033C>T, 42525035C>A, 42525035C>T, 505G>A, 505G>T, 51360C>A, 51360C>T, 51374C>A, 51374C>T, 5959G>A, 5959G>T, Arg121Gln, Arg121Leu, Arg69Gln, Arg69Leu, Gly169Arg, Gly169Cys, Gly169Ser, Gly169Ter, Gly97Arg, Gly97Ter
C > T
C > A
Missense
Arg69Arg
Arg69null
Arg69Gln
Arg69Leu
No VIP available CA VA
rs567606867 -1064C>T, -1228C>T, 14373C>T, 1800G>A, 343G>A, 42128807C>T, 42524809C>T, 427G>A, 490G>A, 499G>A, 51134C>T, 51148C>T, 6185G>A, 643G>A, Glu115Lys, Glu143Lys, Glu164Lys, Glu167Lys, Glu215Lys
C > T
Missense
Glu215Lys
VIP No Clinical Annotations available No Variant Annotations available
rs59421388 *118G>A, 1012G>A, 1015G>A, 13174C>T, 2027G>A, 3271G>A, 42127608C>T, 42523610C>T, 49935C>T, 49949C>T, 712G>A, 7384G>A, 796G>A, 859G>A, 868G>A, 870G>A, CYP2D6: 3183G>A, Thr290=, Val238Met, Val266Met, Val287Met, Val290Met, Val338Met, Val339Met
C > T
3' UTR
Val287Thr
Val287Met
VIP No Clinical Annotations available No Variant Annotations available
rs61736512 -739C>T, -903C>T, 107G>A, 14698C>T, 1563G>A, 1747G>A, 190G>A, 263G>A, 353-188G>A, 363-189G>A, 406G>A, 42129132C>T, 42525134C>T, 51459C>T, 51473C>T, 5860G>A, Arg36His, Arg88His, CYP2D6: 1659G>A, Val136Ile, Val136Met, Val64Ile
C > T
Missense
Arg36His
Arg36Ile
Arg36Met
No VIP available CA VA
rs745746329 *112G>A, 1006G>A, 13180C>T, 2021G>A, 42127614C>T, 42523616C>T, 49941C>T, 49955C>T, 706G>A, 7378G>A, 790G>A, 853G>A, 862G>A, 864G>A, Asp236Asn, Asp264Asn, Asp285Asn, Asp288Asn, Asp336Asn, Ser288=
C > T
Missense
Ser288Asn
No VIP available No Clinical Annotations available VA
rs74966855 -498C>A, 21917860G>T, 42527291G>T, 4593C>A
G > T
5' Flanking
No VIP available CA VA
rs750996195 *130G>A, *9G>A, 1024G>A, 13162C>T, 2039G>A, 42127596C>T, 42523598C>T, 49923C>T, 49937C>T, 724G>A, 7396G>A, 808G>A, 871G>A, 880G>A, Val242Met, Val270Met, Val291Met, Val294Met, Val342Met
C > T
Missense
Val294Met
No VIP available CA VA
rs76088846 1031G>A, 21914160C>T, 42523591C>T, 8293G>A, 878G>A, Arg293Gln, Arg344Gln
G > T
G > C
Missense
Arg293Gln
No VIP available CA VA
rs777560972 1018C>T, 1102C>T, 1165C>T, 1174C>T, 12316G>A, 1318C>T, 2333C>T, 42126750G>A, 42522752G>A, 49077G>A, 49091G>A, 8242C>T, Arg340Cys, Arg368Cys, Arg389Cys, Arg392Cys, Arg440Cys
G > A
Missense
Arg392Cys
Alleles, Functions, and Amino Acid Translations are all sourced from dbSNP 147

Overview

Alternate Names:  CYP2D7AP; CYP2D7BP; CYP2D7P2; CYP2D8P2; CYP2DL1
Alternate Symbols:  CPD6; CYP2D; P450-DB1; P450C2D
PharmGKB Accession Id: PA128

Details

Cytogenetic Location: chr22 : q13.1 - q13.2
GP mRNA Boundary: chr22 : 42522501 - 42526883
GP Gene Boundary: chr22 : 42519501 - 42536883
Strand: minus

Visualization

UCSC has a Genome Browser that you can use to view PharmGKB annotations for this gene in context with many other sources of information.

View on UCSC Browser
The mRNA boundaries are calculated using the gene's default feature set from NCBI, mapped onto the UCSC Golden Path. PharmGKB sets gene boundaries by expanding the mRNA boundaries by no less than 10,000 bases upstream (5') and 3,000 bases downstream (3') to allow for potential regulatory regions.

Introduction
The cytochrome P450 2D6 (CYP2D6) is an enzyme of great historical importance for pharmacogenetics and is now thought to be involved in the metabolism of up to 25% of the drugs that are in common use in the clinic [Article:18001838]. Several years before the gene was cloned, researchers observed that Caucasian subjects responded in a bimodal pattern to certain drugs such as debrisoquine and sparteine [Articles:71400, 499318], with most patients exhibiting "normal" pharmacokinetics, whereas others seemed to have great difficulty in metabolizing debrisoquine or sparteine. Debrisoquine and sparteine became examples of so-called probe drugs, and were used to phenotype patients [Article:6644761]. This finding led researchers to conclude that there were common polymorphisms in an as yet unidentified metabolic gene that contributed to the variable pharmacokinetics of these drugs. The protein responsible for the altered metabolism was later purified from human liver microsomes by Distlerath et al. [Article:4019462]. The gene encoding this protein was initially localized to chromosome 22 by Eichelbaum et al. [Article:3472585]. The cDNA was cloned by Gonzalez et al. [Articles:3123997, 3410476] from human liver cDNA libraries using an antibody against the rat ortholog. The deduced human protein revealed 73% sequence similarity with the rat protein and by use of human-rodent somatic cell hybrids the gene was localized to human chromosome 22 [Article:3410476], confirming the earlier study [Article:3472585]. This gene came to be called CYP2D6, and is part of the cytochrome P450 gene family - a group of enzymes that is responsible for Phase I metabolism and elimination of numerous endogenous substrates and a diverse array of drugs. Among the drug-metabolizing CYPs, CYP2D6 is the only non-inducible enzyme, which results in a large contribution of genetic variation to the interindividual variation in enzyme activity [Article:18001838]. CYP2D6 is highly polymorphic, with over 90 known allelic variants [Article:8807658]. A selection of these variants and haplotypes is described in this summary, and the full list of all named alleles can be found at: http://www.cypalleles.ki.se/cyp2d6.htm.

CYP2D6 metabolizer classes
CYP2D6 became an object of intense research following its identification as the gene responsible for the altered activity observed with debrisoquine and other drugs. It soon became apparent that there were many different polymorphisms in all parts of the world that impacted CYP2D6 activity [Article:17301689]. There were alleles that led to a complete loss of CYP2D6 activity, which were common in the initially studied Caucasian populations [Article:12959412]; however, studies in populations of other ethnic origins revealed reduced function and even hyperfunctional CYP2D6 alleles [Articles:7903454, 3410476]. A system of assigned patients into four categories based on their ability to metabolize CYP2D6 substrates began to emerge. They are, listed in order of highest functioning to lowest: ultrarapid metabolizers (UM), extensive metabolizers (EM), intermediate metabolizers (IM), and poor metabolizers (PM) [Articles:16968950, 14618296]. An individual's highest functioning CYP2D6 allele predicts his/her phenotypic activity [Articles:16968950, 14618296] (e.g. EM allele and PM allele results in an EM phenotype, UM allele and EM allele results in UM phenotype, IM allele and PM allele results in IM phenotype, etc.). EMs possess at least one fully functional CYP2D6 allele, and are thought of as phenotypically normal. IMs (two reduced function or one reduced and one non-functional allele) and PMs (two non-functional alleles) are not able to metabolize CYP2D6 substrates as well as their EM counterparts, and may be at increased risk for adverse effects resulting from higher plasma levels of the parent drug, or lack of efficacy resulting from an inability to form an active metabolite [Article:16968950]. UMs, or ultrarapid metabolizers, possess multiple functional copies of a single CYP2D6 gene [Article:12571261]. The CYP2D6 copy number has been found to be from 2-13 [Article:12571261]. Each functional copy of CYP2D6 that is present increases the rate of metabolism of CYP2D6 substrates significantly [Article:12571261]. CYP2D6 allele distributions exhibit significant interethnic differences. According to a review by Ingelman-Sundberg et al. [Article:18001838], PMs are mainly found in Europe, and UMs are mainly found in North Africa and Oceania. Due to the high Asian prevalence of the CYP2D6*10 allele, IMs are located to a great extent in Asia [Articles:18001838, 15492763].

CYP2D6 substrates and therapeutic implications
CYP2D6 polymorphisms have implications across many different therapeutic areas, as a diverse array of clinically used drugs are metabolized by CYP2D6 [Article:16968950] (see Drugs/Substrates section for references). Examples of CYP2D6 substrates can be found in antidepressants (amitriptyline, citalopram, clomipramine, desipramine, doxepin, fluvoxamine, imipramine, maprotiline, mianserin, nortriptyline, fluoxetine, paroxetine), antipsychotics (chlorpromazine, clozapine, haloperidol, perphenazine, risperidone, thioridazine, zuclopenthixol), antiarrhythmics (flecainide, mexiletine, propafenone), beta-blockers (carvedilol, metoprolol, yohimbine, timolol), opioid analgesics (codeine, dihydrocodeine, morphine, tramadol), anticancer agents (debrisoquine, gefitinib, sparteine, tamoxifen), and assorted other drugs (atomoxetine, dextromethorphan, perhexilline, tolterodine). The impact that a CYP2D6 polymorphism has on therapy with any of the aforementioned drugs is related to the resulting metabolizer status that the polymorphism(s) cause in the individual receiving therapy, as well as whether the parent drug is active or if it requires CYP2D6 to metabolize it into an active metabolite. If the parent drug is active, then UMs may suffer from a lack of efficacy whereas IMs and PMs may suffer from complications resulting from higher than desired plasma concentrations of the drug [Article:12571261]. If the parent drug must be converted to an active metabolite in order to relieve symptoms, then IMs and PMs may be deficient in the formation of the metabolite, and therefore not receive symptomatic relief [Article:12571261].

Phenocopying and Autophenocopying
Therapy with CYP2D6 substrates can be complex, not only due to genetic variation, but also due to drug-drug interactions. Many drugs are CYP2D6 inhibitors (such as the statins [Article:8737761]), and taking an inhibitory drug along with a CYP2D6 substrate can alter the apparent phenotype of the patient. This phenomenon is known as phenocopying [Articles:16968950, 12870705]. When this situation occurs, an EM can appear to be a IM or a PM because most of the available enzyme is being inhibited by a confounding drug. A related phenotype that can occur with chronic dosing of a CYP2D6 drug is called autophenocopying, in which a CYP2D6 substrate can inhibit its own metabolism over time as the concentration of the drug approaches steady state [Article:16968950]. The pharmacokinetic profile of a single dose and of repeated dosing for drugs that exhibit phenocopying can therefore differ markedly [Article:16968950].

CYP2D6 SNPs and Haplotypes
Traditionally, allele frequency is reported with respect to an individual SNP, and haplotypes are constructed from a collection of those polymorphic sites. However, in the CYP2D6 literature, allele frequencies are usually reported in terms of haplotypes. We have therefore included the CYP2D6 allele frequency table in the haplotype section of this summary. CYP2D6 genotyping has traditionally been done according to an algorithm that appears in Gaedigk et al. [Article:10634130] in which several SNPs are tested for, and if none are found, then the algorithm defaults to either CYP2D6*1 or CYP2D6*2. We have classified the SNPs that are used to differentiate the haplotypes that we have summarized, and indicated whether that SNP has any role in the altered function when possible. Since most of the CYP2D6 literature is focused on determining an individual's metabolic status, we have chosen the haplotypes that most commonly result in altered CYP2D6 function, although many more exist. The CYP2D6 variant page should therefore serve mainly as a guide to determining the CYP2D6 haplotype, which should in turn serve as a guide to determining the metabolizer status and allele frequency.

CYP2D6 Ultrarapid Metabolizer (UM) phenotype
For the purposes of this summary, we are using CYP2D6UM as a generic term to indicate multiple CYP2D6 copies (which can range from 2-13) [Article:12571261] that cause the ultrarapid metabolizer phenotype. Gene duplications have been seen to occur with many different CYP2D6 haplotypes, including CYP2D6*1, CYP2D6*2, CYP2D6*4, CYP2D6*10, and CYP2D6*41 [Article:17301689]. For the purposes of this summary, we are only referring to CYP2D6*1xN and CYP2D6*2xN. These gene copies can cause a lack of efficacy by quickly metabolizing a parent drug [Article:15492763]. The speed of metabolism is well correlated with number of functional CYP2D6 copies that the patient possesses [Article:12571261]. Even though it is somewhat counterintuitive, UMs can suffer from similar problems as PMs, despite having opposite phenotypes. For instance, both can experience a lack of efficacy, but in the case of UMs it would be from quickly metabolizing a parent drug, whereas in the case of PMs it would be the inability to form an active metabolite PMID; 15492763. Similarly, both can experience toxicities, but the UMs would experience toxicities resulting from a high level of metabolite, whereas the PMs would experience toxicities resulting from a high level of parent drug [Article:16968950]. In the allele frequency table at the CYP2D6*1, CYP2D6*2 haplotype page descriptions, we have listed the combined allele frequency of multiple copies of CYP2D6*1 and CYP2D6*2 under the generic heading of CYP2D6UM.

Note: The CYP2D6 gene is found on the minus chromosomal strand. Please note that for standardization, the PharmGKB presents all allele base pairs on the positive chromosomal strand, therefore the alleles within our variant annotations will differ (in a complementary manner) from those in this VIP summary that are given on the minus strand as reported in the literature.

Citation Cytochrome P450 2D6. Pharmacogenetics and genomics. 2009. Owen Ryan P, Sangkuhl Katrin, Klein Teri E, Altman Russ B. PubMed
History

Submitted by Ryan Owen, Katrin Sangkuhl

Variant Summaries rs1065852, rs16947, rs28371706, rs28371725, rs35742686, rs3892097, rs5030655, rs5030656, rs59421388, rs61736512
Haplotype Summaries CYP2D6*1, CYP2D6*2, CYP2D6*3, CYP2D6*4, CYP2D6*5 CYP2D6*6, CYP2D6*10, CYP2D6*17, CYP2D6*41, CYP2D6*9, CYP2D6*29
Drugs

Haplotype Overview

The Translational Pharmacogenetics Project (TPP) is a PGRN-led initiative with the goal to operationalize the work of CPIC by translating widely accepted actionable pharmacogenetics discoveries into real-world clinical practice. The group has published on integrating pharmacogenomics into the electronic medical record: A Clinician-Driven Automated System for Integration of Pharmacogenetic Interpretations Into an Electronic Medical Record. Download the TPP file for CYP2D6 here: CYP2D6 lookup table

Haplotypes are derived from the Human Cytochrome P450 (CYP) Allele Nomenclature Database. The Human Cytochrome P450 (CYP) Allele Nomenclature Database states that nucleotide changes listed below are based on NCBI Reference Sequence M33388.1. Note that the nucleotide positions from the Human Cytochrome P450 (CYP) Allele Nomenclature Database do not directly match the given NCBI reference sequence. For questions about nucleotide positions, please contact the Human Cytochrome P450 (CYP) Allele Nomenclature Database directly, as they are the authoritative source on cytochrome P450 nomenclature.

PharmGKB has added some alleles below (e.g. the rows for *1 and *2), inserted for star alleles with subgroups (e.g. A, B etc). These rows reflect SNPs mostly present for all subgroups for a given star allele.

Source: PharmGKB

CYP2D6 Cytochrome P450 Nomenclature DB Haplotype Set

All alleles in the download file are on the positive chromosomal strand. PharmGKB considers the first haplotype listed in each table as the reference haplotype for that set.

PharmGKB Curated Pathways

Pathways created internally by PharmGKB based primarily on literature evidence.

  1. Acetaminophen Pathway (therapeutic doses), Pharmacokinetics
    Stylized diagram showing acetaminophen metabolism and transport in the liver.
  1. Acetaminophen Pathway (toxic doses), Pharmacokinetics
    Stylized diagram showing acetaminophen metabolism at higher acetaminophen doses (toxic doses) in the liver
  1. Atorvastatin/Lovastatin/Simvastatin Pathway, Pharmacokinetics
    Drug-specific representation of the candidate genes involved in transport, metabolism and clearance.
  1. Citalopram Pathway, Pharmacokinetics
    Pharmacokinetics of the selective serotonin reuptake inhibitor citalopram.
  1. Clomipramine Pathway, Pharmacokinetics
    Schematic representation of clomipramine metabolism in human liver.
  1. Codeine and Morphine Pathway, Pharmacokinetics
    Representation of the candidate genes involved in metabolism of codeine and morphine.
  1. Doxepin Pathway, Pharmacokinetics
    Stylized liver cell showing candidate genes involved in the metabolism of the tricyclic doxepin.
  1. Fluoxetine Pathway, Pharmacokinetics
    Representation of the candidate genes involved in the metabolism of fluoxetine.
  1. Fluvastatin Pathway, Pharmacokinetics
    Drug-specific representation of the candidate genes involved in transport, metabolism and clearance.
  1. Gefitinib Pathway, Pharmacokinetics
    Representation of the candidate genes involved in the transportation and metabolism of gefitinib.
  1. Imipramine/Desipramine Pathway, Pharmacokinetics
    Representation of the candidate genes involved in the metabolism of the tricyclic antidepressants imipramine and desipramine.
  1. Nevirapine Pathway, Pharmacokinetics
    Representation of candidate genes involved in biotransformation of nevirapine and its mechanism of action in an infected liver cell.
  1. Paroxetine Pathway, Pharmacokinetics
    Genes involved in the metabolism of paroxetine and in the mechanism of action.
  1. Phenytoin Pathway, Pharmacokinetics
    Genes involved in the metabolism of phenytoin in the human liver cell.
  1. Statin Pathway - Generalized, Pharmacokinetics
    Representation of the superset of all genes involved in the transport, metabolism and clearance of statin class drugs.
  1. Tamoxifen Pathway, Pharmacokinetics
    Tamoxifen metabolism in the liver.
  1. Venlafaxine Pathway, Pharmacokinetics
    Stylized cells depicting the metabolism and mechanism of action of venlafaxine.

External Pathways

Links to non-PharmGKB pathways.

  1. P450 Dehydrogenation of alkanes to form alkenes - (Reactome via Pathway Interaction Database)
  2. Xenobiotics - (Reactome via Pathway Interaction Database)
No related genes are available

Curated Information ?

Evidence Drug
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
3,4-methylenedioxymethamphetamine
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
4-hydroxytamoxifen
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
4-methylthioamphetamine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
abacavir
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
abiraterone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
acamprosate
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
acarbose
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
acebutolol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
acenocoumarol
No Dosing Guideline available DL No Clinical Annotation available VA No VIP available PW
acetaminophen
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
alemtuzumab
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
alfentanil
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
almotriptan
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
alosetron
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
alprazolam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
alprenolol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
amantadine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
aminophenazone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
amiodarone
amitriptyline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
amlodipine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
amodiaquine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
amphetamine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
anastrozole
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
apomorphine
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
arformoterol
aripiprazole
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
arsenic trioxide
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
aspirin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
astemizole
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
atenolol
atomoxetine
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available PW
atorvastatin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
azathioprine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
aztreonam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
benzphetamine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
benztropine
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
bepridil
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
berberine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
betamethasone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
bevacizumab
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
bevantolol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
biperiden
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
bisoprolol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
boceprevir
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available PW
bromazepam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
bromocriptine
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
bufuralol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
buprenorphine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
bupropion
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
buspirone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
busulfan
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cabergoline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
caffeine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
capecitabine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
carbamazepine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
carisoprodol
carvedilol
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available PW
celecoxib
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
Celiprolol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cerivastatin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cetirizine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cetuximab
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cevimeline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
chloramphenicol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
chloroquine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available VIP No VIP available
chlorpheniramine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available VIP No VIP available
chlorpromazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
chlorpropamide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
chlorzoxazone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cholestyramine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cimetidine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cinacalcet
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ciprofloxacin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cisapride
citalopram
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
clarithromycin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
clemastine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
clindamycin
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
clobazam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
clofibrate
clomipramine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
clonidine
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
clopidogrel
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
clotrimazole
clozapine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cocaine
codeine
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
coptisine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
coumarin
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
crizotinib
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cyclobenzaprine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cyclophosphamide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cyclosporine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
cyproheptadine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Dabigatran
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
dapoxetine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
dapsone
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
darifenacin
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
dasatinib
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
daunorubicin
debrisoquine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
delavirdine
desipramine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
desloratadine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
desmethylcitalopram
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
dexamethasone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
dexfenfluramine
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
dexlansoprazole
dextromethorphan
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
diazepam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
diclofenac
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
dienestrol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
digoxin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
diltiazem
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
diphenhydramine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
diphenylpyraline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
docetaxel
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
dolasetron
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
donepezil
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
dopamine
doxepin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
doxorubicin
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
dronedarone
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
drospirenone
DG No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
duloxetine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
efavirenz
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
eletriptan
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
eliglustat
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
elvitegravir
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
emtricitabine
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
endoxifen
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
enflurane
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
entacapone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
epirubicin
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
erlotinib
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
erythromycin
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
escitalopram
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
esomeprazole
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
estradiol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
eszopiclone
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
ethambutol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ethanol
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ethinyl estradiol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
etodolac
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
everolimus
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
exemestane
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ezetimibe
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
felbamate
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
felodipine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
fenfluramine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
fenofibrate
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
fentanyl
No Dosing Guideline available DL No Clinical Annotation available VA No VIP available No VIP available
fesoterodine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
flavopiridol
flecainide
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
flibanserin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
flucloxacillin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
fluconazole
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
flunarizine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
flunitrazepam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
fluorouracil
fluoxetine
DG No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
flupenthixol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
fluphenazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
flurazepam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
flurbiprofen
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
fluticasone propionate
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available PW
fluvastatin
fluvoxamine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
folic acid
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
fosamprenavir
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
frovatriptan
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
fulvestrant
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
furafylline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
gabapentin
No Dosing Guideline available DL CA VA No VIP available No VIP available
galantamine
gefitinib
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
gemcitabine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
gemfibrozil
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
gemifloxacin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
gemtuzumab ozogamicin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
glibenclamide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
gliclazide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
glimepiride
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
glipizide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
glucose
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
grapefruit juice
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
GS-9350
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
halofantrine
haloperidol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
halothane
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
hydralazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
hydrocodone
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
hydromorphone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
hydroxyzine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ibandronate
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ibrutinib
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ibuprofen
No Dosing Guideline available DL CA VA No VIP available No VIP available
iloperidone
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available PW
imatinib
imipramine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
indacaterol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
indinavir
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
indomethacin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
irbesartan
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
irinotecan
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
isoflurane
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
isoniazid
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
isotretinoin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
itraconazole
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ivacaftor
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ketamine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ketoconazole
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
ketorolac
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
l-methyldopa
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
labetalol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
lamotrigine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
lansoprazole
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
lapatinib
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
lenalidomide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
letrozole
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
leuprolide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
levodopa
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
levomepromazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
lisuride
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
lithium
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
loperamide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
lopinavir
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
loratadine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
lorazepam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
losartan
No Dosing Guideline available No Drug Label available CA VA No VIP available PW
lovastatin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
loxapine
maprotiline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
maraviroc
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
medroxyprogesterone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
meloxicam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
memantine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
meperidine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
mephenytoin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
mercaptopurine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
metformin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
methadone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
methotrexate
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
methylcholanthrene
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
methylphenidate
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
metoclopramide
metoprolol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available VIP No VIP available
mexiletine
mianserin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
midazolam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
miglustat
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
minoxidil
DG No Drug Label available CA VA No VIP available No VIP available
mirtazapine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
mitiglinide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
moclobemide
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
modafinil
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
montelukast
morphine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
mycophenolate mofetil
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
n-desmethyltamoxifen
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
naltrexone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
naproxen
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
naratriptan
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
nateglinide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
nebivolol
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
nefazodone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
nelfinavir
No Dosing Guideline available No Drug Label available CA VA No VIP available PW
nevirapine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
nicardipine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
nicergoline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
nicotine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
nifedipine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
nilotinib
nortriptyline
olanzapine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
omeprazole
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
ondansetron
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
opipramol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
oxaliplatin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
oxazepam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
oxcarbazepine
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
oxprenolol
DG No Drug Label available CA VA No VIP available No VIP available
oxycodone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
paclitaxel
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pactimibe
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
paliperidone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pamidronate
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
panitumumab
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pantoprazole
paroxetine
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pazopanib
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
peginterferon alfa-2b
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
penbutolol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pentobarbital
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pentoxifylline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pergolide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available VIP No VIP available
perhexiline
perphenazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pertuzumab
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
phenacetin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
phencyclidine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
phenobarbital
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
phenprocoumon
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
phenytoin
No Dosing Guideline available DL CA VA No VIP available No VIP available
pimozide
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
pindolol
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
pioglitazone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
piroxicam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pitavastatin
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ponatinib
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pramipexole
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
prasugrel
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
pravastatin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
prednisone
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
pridopidine
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
primaquine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
probenecid
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
procainamide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
prochlorperazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
progesterone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
proguanil
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
promethazine
propafenone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
propofol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
propoxyphene
No Dosing Guideline available DL CA VA No VIP available No VIP available
propranolol
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
protriptyline
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
pyrazinamide
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
quetiapine
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
quinidine
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
quinine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
rabeprazole
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
raloxifene
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ramipril
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ranitidine
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ranolazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
rasagiline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
rasburicase
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
reboxetine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
repaglinide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
reserpine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ribavirin
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
rifampin
risperidone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ritodrine
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ritonavir
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
rituximab
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
rivastigmine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
rofecoxib
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ropinirole
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
rosiglitazone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
rosuvastatin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
salbutamol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
salmeterol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
saquinavir
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
selegiline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
sertindole
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
sertraline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
sevoflurane
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
sibutramine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
sildenafil
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available PW
simvastatin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
sirolimus
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
SN-38
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
sorafenib
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
sotalol
sparteine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
st. john's wort
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
sulfamethoxazole
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
sulfaphenazole
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
sulfasalazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
sunitinib
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tacrine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tacrolimus
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tadalafil
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
tafenoquine
tamoxifen
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tamsulosin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tegafur
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tegaserod
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
telaprevir
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
telithromycin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
telmisartan
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
temazepam
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
temsirolimus
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
terazosin
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
terbinafine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
terfenadine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
terodiline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
testosterone
No Dosing Guideline available DL No Clinical Annotation available VA No VIP available No VIP available
tetrabenazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
thalidomide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
theophylline
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
thioguanine
thioridazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
thiotepa
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
thiothixene
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ticagrelor
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ticlopidine
timolol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tinidazole
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tiotropium
No Dosing Guideline available DL No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tipranavir
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tizanidine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tolbutamide
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tolcapone
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
tolperisone
tolterodine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
toremifene
tramadol
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tranylcypromine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
trastuzumab
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
trazodone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tretinoin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
triamterene
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
trifluoperazine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
trihexyphenidyl
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
trimethadione
trimipramine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
tripelennamine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
troglitazone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
troleandomycin
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
tropisetron
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
valproic acid
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
valsartan
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
vemurafenib
venlafaxine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
verapamil
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
vincristine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
voriconazole
No Dosing Guideline available DL CA VA No VIP available No VIP available
vortioxetine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
warfarin
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available VIP No VIP available
yohimbine
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ziprasidone
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
zoledronate
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
zolmitriptan
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
zolpidem
zuclopenthixol