Genes

This page describes gene-specific information. PyPGx currently supports genotyping of a total of 61 pharmacogenes.

In order to provide the most accurate information, this page borrows heavily from the works of the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Pharmacogenomics Knowledge Base (PharmGKB). All curated contents published by CPIC and PharmGKB are available free of restriction under the CC0 1.0 Universal (CC0 1.0) Public Domain Dedication and the Creative Commons Attribution-ShareAlike 4.0 International License, repsectively.

Many of the genes are known to have structural variation (SV) including gene deletions, duplications, and hybrids. Please read the Structural variation detection page for more details.

Some genes have a genotype-phenotype table available from CPIC or PharmGKB. Please read the Phenotype prediction page for more details.

Below is a summary table:

Gene

Variants

SV

Phenotype

PharmVar

CPIC

Function

GRCh37

GRCh38

Notes

ABCB1

Disposition

chr7:87130178-87345639

chr7:87500862-87716323

ABCG2

Disposition

chr4:89008420-89082791

chr4:88087268-88161639

CACNA1S

Target

chr1:201005639-201084694

chr1:201036511-201115426

CFTR

Target

chr7:117117016-117311719

chr7:117477024-117671665

COMT

Metabolism

chr22:19917359-19962473

chr22:19929836-19974950

CYP1A1

Metabolism

chr15:75008882-75020951

chr15:74716541-74728528

CYP1A2

Metabolism

chr15:75038183-75051941

chr15:74745844-74759607

CYP1B1

Metabolism

chr2:38291745-38306323

chr2:38064602-38079181

CYP2A6

Metabolism

chr19:41339442-41396352

chr19:40833540-40890447

CYP2A6 has pseudogene (CYP2A7).

CYP2A13

Metabolism

chr19:41574355-41622100

chr19:41068450-41116195

CYP2B6

Metabolism

chr19:41427203-41534301

chr19:40921281-41028398

CYP2B6 has pseudogene (CYP2B7).

CYP2C8

Metabolism

chr10:96793528-96832254

chr10:95033771-95072497

CYP2C9

Metabolism

chr10:96695414-96752148

chr10:94935657-94993091

CYP2C19

Metabolism

chr10:96519437-96615962

chr10:94759680-94858547

CYP2D6

Metabolism

chr22:42512500-42551883

chr22:42116498-42155810

CYP2D6 has pseudogene (CYP2D7).

CYP2E1

Metabolism

chr10:135330866-135362620

chr10:133517362-133549123

CYP2F1

Metabolism

chr19:41617336-41637286

chr19:41111431-41131381

CYP2J2

Metabolism

chr1:60355979-60395470

chr1:59890307-59929773

CYP2R1

Metabolism

chr11:14896554-14916751

chr11:14875008-14895205

CYP2S1

Metabolism

chr19:41696111-41716444

chr19:41190218-41210539

CYP2W1

Metabolism

chr7:1019834-1032276

chr7:980180-992640

CYP3A4

Metabolism

chr7:99351582-99384811

chr7:99753966-99787184

CYP3A5

Metabolism

chr7:99242811-99280649

chr7:99645193-99682996

CYP3A7

Metabolism

chr7:99299659-99335823

chr7:99702035-99738196

CYP3A43

Metabolism

chr7:99422635-99466727

chr7:99825012-99869093

CYP4A11

Metabolism

chr1:47391859-47410148

chr1:46926187-46944476

CYP4A22

Metabolism

chr1:47600112-47618399

chr1:47134440-47152727

CYP4B1

Metabolism

chr1:47261669-47288021

chr1:46796045-46822413

CYP4F2

Metabolism

chr19:15973833-16023930

chr19:15863022-15913074

CYP17A1

Metabolism

chr10:104587287-104600170

chr10:102827530-102840413

CYP19A1

Metabolism

chr15:51497253-51633795

chr15:51205056-51341596

CYP26A1

Metabolism

chr10:94830646-94840641

chr10:93070892-93080885

DPYD

Excretion

chr1:97540298-98389615

chr1:97074742-97924034

F5

Other

chr1:169478188-169558719

chr1:169508950-169589481

G6PD

Disease

chrX:153756604-153778233

chrX:154528389-154550018

G6PD is located on X chromosome.

GSTM1

Metabolism

chr1:110227417-110239367

chr1:109684816-109696745

GSTP1

Metabolism

chr11:67348065-67357124

chr11:67580811-67589653

GSTT1

Metabolism

chr22:24373132-24387311

chr22_KI270879v1_alt:267307-281486

GSTT1 is located on different contigs between GRCh37 and GRCh38.

IFNL3

Other

chr19:39731245-39744165

chr19:39240552-39253525

MTHFR

Metabolism

chr1:11842779-11869021

chr1:11782722-11808964

NAT1

Metabolism

chr8:18064617-18084198

chr8:18207108-18226689

NAT2

Metabolism

chr8:18245791-18261728

chr8:18388281-18404218

NUDT15

Metabolism

chr13:48608702-48624364

chr13:48034725-48050221

POR

Disease

chr7:75541419-75619173

chr7:75912154-75989855

PTGIS

Other

chr20:48117410-48187674

chr20:49500873-49571137

RYR1

Disease

chr19:38921339-39081204

chr19:38430690-38590564

SLC15A2

Excretion

chr3:121610170-121666034

chr3:121891400-121947188

SLC22A2

Excretion

chr6:160627786-160689853

chr6:160206754-160268821

SLCO1B1

Absorption

chr12:21281127-21395730

chr12:21128193-21242796

SLCO1B3

Absorption

chr12:20960637-21072845

chr12:20807704-20919911

SLCO2B1

Absorption

chr11:74859151-74920594

chr11:75148106-75209549

SULT1A1

Metabolism

chr16:28601907-28636365

chr16:28590586-28625044

TBXAS1

Other

chr7:139525951-139723125

chr7:139826263-140023321

TPMT

Metabolism

chr6:18125541-18158400

chr6:18125310-18158169

UGT1A1

Excretion

chr2:234662918-234687945

chr2:233754269-233779300

UGT1A4

Excretion

chr2:234624437-234684945

chr2:233715735-233776300

UGT2B7

Excretion

chr4:69959191-69981705

chr4:69093473-69115987

UGT2B15

Excretion

chr4:69506314-69542494

chr4:68640596-68676652

UGT2B17

Excretion

chr4:69399901-69437245

chr4:68534183-68571527

VKORC1

Target

chr16:31099162-31109320

chr16:31087853-31097797

XPC

Other

chr3:14183646-14223172

chr3:14142146-14181672

ABCG2

Phenotype summary for ABCG2

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Normal Function

Reference/Reference

Normal/Routine/Low Risk

Decreased Function

Reference/rs2231142

Abnormal/Priority/High Risk

Poor Function

rs2231142/rs2231142

Abnormal/Priority/High Risk

Recommendations for ABCG2

  • Rosuvastatin

    “Prescribe ≤20mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines for patients who are SLCO1B1 or ABCG2 poor function phenotype. If dose >20mg needed for desired efficacy, consider combination therapy (i.e. rosuvastatin plus non-statin guideline directed medical therapy). Patients with both ABCG2 poor function and SLCO1B1 poor/decreased function should be prescribed ≤10mg as a starting dose.” (Source: PharmGKB)

CACNA1S

Phenotype summary for CACNA1S

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Uncertain Susceptibility

Reference/Reference

Normal Risk

Malignant Hyperthermia Susceptibility

Reference/c.520C>T

Abnormal/Priority/High Risk

Recommendations for CACNA1S

  • Desflurane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics uch as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Enflurane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Halothane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Isoflurane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Methoxyflurane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Sevoflurane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Succinylcholine

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

CFTR

Phenotype summary for CFTR

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Favorable Response

Reference/G551D

None

Unfavorable Response

F508del/F508del

None

Indeterminate

Reference/F508del

None

Recommendations for CFTR

  • Ivacaftor

    “Ivacaftor treatment is recommended only in cystic fibrosis (CF) patients that are either homozygous or heterozygous for certain CFTR variants. See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

CYP1A1

Resources for CYP1A1

CYP1A2

Resources for CYP1A2

CYP1B1

Resources for CYP1B1

CYP2A6

SV summary for CYP2A6

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*1/*2

Model

Profile

Profile

WGS

GeT-RM

NA10831

0.4.1

*4

WholeDel1

*1/*4

Model

Profile

Profile

WGS

GeT-RM

NA18617

0.4.1

*4

WholeDel1Hom

*4/*4

Model

Profile

Profile

WGS

GeT-RM

NA18952

0.4.1

*4

WholeDel2

*1/*4

Model

Profile

Profile

WGS

0.12.0

*4

WholeDel2Hom

*4/*4

Model

Profile

Profile

WGS

1KGP

NA21093

0.15.0

*4

WholeDel3

*4/*9

Model

Profile

Profile

WGS

1KGP

NA18488

0.12.0

*1x2

WholeDup1

*1x2/*25

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA18861

0.4.1

*1x2

WholeDup2

*1x2/*2

Model

Profile

Profile

WGS

1KGP

NA12342

0.12.0

*1x2

WholeDup3

*1x2/*17

Model

Profile

Profile

WGS

1KGP

NA19129

0.12.0

Hybrid1

Indeterminate

Model

Profile

Profile

WGS

GeT-RM

HG00436

0.4.1

*12

Hybrid2

*1/*12

Model

Profile

Profile

WGS

1KGP

NA11829

0.12.0

*12 has exons 1-2 of CYP2A7 origin and exons 3-9 of CYP2A6 origin (breakpoint in intron 2).

*12

Hybrid2Hom

*12/*12

Model

Profile

Profile

WGS

1KGP

NA19780

0.14.0

*34

Hybrid3

*1/*34

Model

Profile

Profile

WGS

1KGP

NA18516

0.12.0

*34 has exons 1-4 of CYP2A7 origin and exons 5-9 of CYP2A6 origin (breakpoint in intron 4).

Hybrid4

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA20515

0.14.0

Hybrid5

Indeterminate

Model

Profile

Profile

WGS

1KGP

HG00155

0.15.0

Hybrid6

Indeterminate

Model

Profile

Profile

WGS

1KGP

HG00141

0.15.0

Hybrid7

Indeterminate

Profile

Profile

WGS

1KGP

HG02382

0.16.0

Tandem1

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA20828

0.14.0

Tandem2

Indeterminate

Profile

Profile

WGS

1KGP

HG04214

0.16.0

ParalogWholeDel1

Indeterminate

Model

Profile

Profile

WGS

1KGP

HG00625

0.15.0

ParalogWholeDup1

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA06985

0.12.0

Unknown1

Indeterminate

Profile

Profile

WGS

1KGP

HG02081

0.16.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for CYP2A6, and corresponding copy number profiles and allele fraction profiles.

Filtered alleles for CYP2A6

Some alleles in PharmVar will not be called by PyPGx because one or more of their variants have a high false positive rate, likely due to read misalignment to the CYP2A7 pseudogene. Those alleles are listed in below table. If problematic variants are present in gnomAD, their links are provided so that you can look at filtering status, allele imbalance for heterozygotes, etc.

Problematic Variant

Star Alleles

GRCh37

GRCh38

rs143731390 (N438Y)

*35

22-42523514-C-T

22-42127512-C-T

Resources for CYP2A6

CYP2A13

Resources for CYP2A13

CYP2B6

SV summary for CYP2B6

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*1/*2

Model

Profile

Profile

WGS

GeT-RM

NA12813

0.4.1

*22x2

WholeDup1

*6/*22x2

Model

Profile

Profile

WGS

1KGP

NA19190

0.12.0

*29

Hybrid1

*6/*29

Model

Profile

Profile

WGS

GeT-RM

NA19178

0.4.1

*29 has exons 1-4 of CYP2B7 origin and exons 5-9 of CYP2A6 origin (breakpoint in intron 4).

Tandem1

Indeterminate

Model

Profile

Profile

WGS

1KGP

HG01806

0.16.0

PartialDup1

Indeterminate

Profile

Profile

WGS

1KGP

HG03784

0.16.0

PartialDup2

Indeterminate

Profile

Profile

WGS

1KGP

HG02790

0.16.0

ParalogWholeDel1

Indeterminate

Profile

Profile

WGS

1KGP

HG03235

0.16.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for CYP2B6, and corresponding copy number profiles and allele fraction profiles.

Phenotype summary for CYP2B6

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Ultrarapid Metabolizer

*4/*4

Normal/Routine/Low Risk

Rapid Metabolizer

*1/*4

Normal/Routine/Low Risk

Normal Metabolizer

*1/*2

Normal/Routine/Low Risk

Intermediate Metabolizer

*1/*29

Abnormal/Priority/High Risk

Poor Metabolizer

*6/*6

Abnormal/Priority/High Risk

Indeterminate

*1/*3

None

Recommendations for CYP2B6

  • Efavirenz

    “Consider initiating efavirenz with a decreased dose of either 400 or 200 mg/day for patients who are CYP2B6 poor metabolizers. Consider initiating efavirenz with a decreased dose of 400 mg/day for patients who are CYP2B6 intermediate metabolizers.” (Source: PharmGKB)

CYP2C8

Resources for CYP2C8

CYP2C9

Phenotype summary for CYP2C9

Activity score is used for phenotype prediction.

Phenotype

Activity Score

Example

Priority

Normal Metabolizer

2 == score

*1/*1

Normal/Routine/Low Risk

Intermediate Metabolizer

1 <= score < 2

*1/*2

Abnormal/Priority/High Risk

Poor Metabolizer

0 <= score < 1

*2/*3

Abnormal/Priority/High Risk

Indeterminate

Unknown score

*1/*7

Normal/Routine/Low Risk

Recommendations for CYP2C9

  • Celecoxib

    “The CPIC Dosing Guideline for celecoxib, flurbiprofen, ibuprofen and lornoxicam recommends initiating therapy with 25-50% of the lowest recommended starting dose for CYP2C9 poor metabolizers and initiating therapy with lowest recommended starting dose for CYP2C9 intermediate metabolizers with activity score of 1. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

  • Flurbiprofen

    “The CPIC Dosing Guideline for celecoxib, flurbiprofen, ibuprofen and lornoxicam recommends initiating therapy with 25-50% of the lowest recommended starting dose for CYP2C9 poor metabolizers and initiating therapy with lowest recommended starting dose for CYP2C9 intermediate metabolizers with activity score of 1. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

  • Fluvastatin

    “CYP2C9 IMs should avoid fluvastatin doses greater than 40mg while CYP2C9 PMs should avoid doses greater than 20mg. If higher doses are required for desired efficacy, an alternative statin should be considered. Patients with SLCO1B1 poor function should also avoid fluvastatin doses greater than 40mg and and adjust doses of fluvastatin based on disease-specific guidelines. Patients with both SLCO1B1 poor function and CYP2C9 IM/PM should be prescribed an alternative statin depending on the desired potency.” (Source: PharmGKB)

  • Ibuprofen

    “The CPIC Dosing Guideline for celecoxib, flurbiprofen, ibuprofen and lornoxicam recommends initiating therapy with 25-50% of the lowest recommended starting dose for CYP2C9 poor metabolizers and initiating therapy with lowest recommended starting dose for CYP2C9 intermediate metabolizers with activity score of 1. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

  • Lornoxicam

    “The CPIC Dosing Guideline for celecoxib, flurbiprofen, ibuprofen and lornoxicam recommends initiating therapy with 25-50% of the lowest recommended starting dose for CYP2C9 poor metabolizers and initiating therapy with lowest recommended starting dose for CYP2C9 intermediate metabolizers with activity score of 1. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

  • Meloxicam

    “The CPIC Dosing Guideline for meloxicam recommends alternative therapy for CYP2C9 poor metabolizers due to markedly prolonged half-life, and initiating therapy with 50% of the lowest recommended starting dose or choose an alternative therapy for CYP2C9 intermediate metabolizers with activity score of 1. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

  • Piroxicam

    “The CPIC Dosing Guideline for piroxicam recommends that CYP2C9 poor metabolizers and intermediate metabolizers with activity score of 1 should choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

  • Tenoxicam

    “The CPIC Dosing Guideline for tenoxicam recommends that CYP2C9 poor metabolizers and intermediate metabolizers with activity score of 1 should choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

CYP2C19

Phenotype summary for CYP2C19

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Ultrarapid Metabolizer

*17/*17

Abnormal/Priority/High Risk

Rapid Metabolizer

*1/*17

Abnormal/Priority/High Risk

Normal Metabolizer

*1/*1

Normal/Routine/Low Risk

Likely Intermediate Metabolizer

*1/*10

Abnormal/Priority/High Risk

Intermediate Metabolizer

*1/*2

Abnormal/Priority/High Risk

Likely Poor Metabolizer

*10/*22

Abnormal/Priority/High Risk

Poor Metabolizer

*2/*2

Abnormal/Priority/High Risk

Indeterminate

*1/*12

None

Recommendations for CYP2C19

  • Amitriptyline

    “The CPIC Dosing Guideline update for amitriptyline recommends an alternative drug for CYP2D6 ultrarapid or poor metabolizers and CYP2C19 ultrarapid, rapid or poor metabolizers. If amitriptyline is warranted, consider a 50% dose reduction in CYP2D6 or CYP2C19 poor metabolizers. For CYP2D6 intermediate metabolizers, a 25% dose reduction should be considered.” (Source: PharmGKB)

  • Citalopram

    “The CPIC Dosing Guideline for the selective serotonin reuptake inhibitors citalopram and escitalopram recommends an alternative drug not predominantly metabolized by CYP2C19 for CYP2C19 ultrarapid metabolizers. For CYP2C19 poor metabolizers, consider a 50% reduction of recommended starting dose and titrate to response or select alternative drug not predominantly metabolized by CYP2C19.” (Source: PharmGKB)

  • Clomipramine

    “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. The CPIC Dosing Guideline update for amitriptyline recommends an alternative drug for CYP2D6 ultrarapid or poor metabolizers and CYP2C19 ultrarapid, rapid or poor metabolizers. If amitriptyline is warranted, consider a 50% dose reduction in CYP2D6 or CYP2C19 poor metabolizers. For CYP2D6 intermediate metabolizers, a 25% dose reduction should be considered.” (Source: PharmGKB)

  • Clopidogrel

    “The CPIC Dosing Guideline for clopidogrel recommends an alternative antiplatelet therapy for CYP2C19 poor or intermediate metabolizers (cardiovascular indications: prasugrel or ticagrelor if no contraindication; neurovascular indications: alternative P2Y12 inhibitor if clinically indicated and no contraindication.)” (Source: PharmGKB)

  • Dexlansoprazole

    “The CPIC Dosing Guideline recommendations for dexlansoprazole are based on the similarity in its metabolism and lansoprazole and extrapolated from the first-generation PPIs. The guideline recommends to increase the starting daily dose and to monitor efficacy in CYP2C19 ultrarapid metabolizer. For CYP2C19 rapid and normal metabolizers in the treatment of H. pylori infection and erosive esophagitis increasing the dose might be considered after initiation with the standard starting daily dose. The recommendations for intermediate and poor metabolizers for chronic therapy (>12 weeks) and efficacy achieved is to consider 50% reduction in daily dose. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

  • Doxepin

    “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. The CPIC Dosing Guideline update for amitriptyline recommends an alternative drug for CYP2D6 ultrarapid or poor metabolizers and CYP2C19 ultrarapid, rapid or poor metabolizers. If amitriptyline is warranted, consider a 50% dose reduction in CYP2D6 or CYP2C19 poor metabolizers. For CYP2D6 intermediate metabolizers, a 25% dose reduction should be considered.” (Source: PharmGKB)

  • Escitalopram

    “The CPIC Dosing Guideline for the selective serotonin reuptake inhibitors citalopram and escitalopram recommends an alternative drug not predominantly metabolized by CYP2C19 for CYP2C19 ultrarapid metabolizers. For CYP2C19 poor metabolizers, consider a 50% reduction of recommended starting dose and titrate to response or select alternative drug not predominantly metabolized by CYP2C19.” (Source: PharmGKB)

  • Imipramine

    “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. The CPIC Dosing Guideline update for amitriptyline recommends an alternative drug for CYP2D6 ultrarapid or poor metabolizers and CYP2C19 ultrarapid, rapid or poor metabolizers. If amitriptyline is warranted, consider a 50% dose reduction in CYP2D6 or CYP2C19 poor metabolizers. For CYP2D6 intermediate metabolizers, a 25% dose reduction should be considered.” (Source: PharmGKB)

  • Lansoprazole

    “The CPIC Dosing Guideline for omeprazole, lansoprazole, pantoprazole recommends to increase the starting daily dose and to monitor efficacy in CYP2C19 ultrarapid metabolizer. For CYP2C19 rapid and normal metabolizers in the treatment of H. pylori infection and erosive esophagitis increasing the dose might be considered after initiation with the standard starting daily dose. The recommendations for intermediate and poor metabolizer for chronic therapy (>12 weeks) and efficacy achieved is to consider 50% reduction in daily dose. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

  • Omeprazole

    “The CPIC Dosing Guideline for omeprazole, lansoprazole, pantoprazole recommends to increase the starting daily dose and to monitor efficacy in CYP2C19 ultrarapid metabolizer. For CYP2C19 rapid and normal metabolizers in the treatment of H. pylori infection and erosive esophagitis increasing the dose might be considered after initiation with the standard starting daily dose. The recommendations for intermediate and poor metabolizer for chronic therapy (>12 weeks) and efficacy achieved is to consider 50% reduction in daily dose. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

  • Pantoprazole

    “The CPIC Dosing Guideline for omeprazole, lansoprazole, pantoprazole recommends to increase the starting daily dose and to monitor efficacy in CYP2C19 ultrarapid metabolizer. For CYP2C19 rapid and normal metabolizers in the treatment of H. pylori infection and erosive esophagitis increasing the dose might be considered after initiation with the standard starting daily dose. The recommendations for intermediate and poor metabolizer for chronic therapy (>12 weeks) and efficacy achieved is to consider 50% reduction in daily dose. See full guideline for further details and supporting evidence.” (Source: PharmGKB)

  • Sertraline

    “The CPIC Dosing Guideline for the selective serotonin reuptake inhibitor sertraline recommends to consider a 50% reduction of recommended starting dose and titrate to response or select alternative drug not predominantly metabolized by CYP2C19 for CYP2C19 poor metabolizers.” (Source: PharmGKB)

  • Voriconazole

    “The CPIC dosing guideline for voriconazole recommends selecting an alternative agent that is not dependent on CYP2C19 metabolism in adults who are CYP2C19 ultrarapid metabolizers, rapid metabolizers or poor metabolizers. In pediatric patients, an alternative agent should be used in patients who are ultrarapid metabolizers or poor metabolizers. In pediatric rapid metabolizers, therapy should be initiated at recommended standard case dosing, then therapeutic dosing monitoring should be used to titrate dose to therapeutic trough concentrations.” (Source: PharmGKB)

  • Trimipramine

    “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. The CPIC Dosing Guideline update for amitriptyline recommends an alternative drug for CYP2D6 ultrarapid or poor metabolizers and CYP2C19 ultrarapid, rapid or poor metabolizers. If amitriptyline is warranted, consider a 50% dose reduction in CYP2D6 or CYP2C19 poor metabolizers. For CYP2D6 intermediate metabolizers, a 25% dose reduction should be considered.” (Source: PharmGKB)

CYP2D6

SV summary for CYP2D6

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*1/*2

Model

Profile

Profile

WGS

GeT-RM

NA11839

0.4.1

*5

WholeDel1

*5/*29

Model

Profile

Profile

WGS

GeT-RM

NA18861

0.4.1

*5

WholeDel1Hom

*5/*5

Model

Profile

Profile

WGS

0.10.0

*4x2

WholeDup1

*2/*4x2

Model

Profile

Profile

WGS

GeT-RM

NA19819

0.4.1

*1x3

WholeMultip1

*1x3/*10

Model

Profile

Profile

WGS

1KGP

NA19190

0.12.0

*68+*4

Tandem1A

*139/*68+*4

Model

Profile

Profile

WGS

GeT-RM

NA11832

0.4.1

*68 has exon 1 of CYP2D6 origin and exons 2-9 of CYP2D7 origin (breakpoint in intron 1).

*68+*4

Tandem1B

*68+*4/*68+*4

Model

Profile

Profile

WGS

1KGP

NA12282

0.12.0

*36+*10

Tandem2A

*2/*36+*10

Model

Profile

Profile

WGS

GeT-RM

NA18564

0.4.1

*36 has exons 1-8 of CYP2D6 origin and exon 9 of CYP2D7 origin (breakpoint in exon 9).

*36x2+*10

Tandem2B

*1/*36x2+*10

Model

Profile

Profile

WGS

GeT-RM

NA18524

0.4.1

*36x3+*10

Tandem2C

*1/*36x3+*10

Model

Profile

Profile

WGS

0.10.0

Tandem2F

Indeterminate

Model

Profile

Profile

WGS

1KGP

HG00458

0.15.0

*13+*1

Tandem3

*1/*13+*1

Model

Profile

Profile

WGS

0.11.0

Tandem4

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA19719

0.14.0

*5, *68+*4

WholeDel1+Tandem1A

*5/*68+*4

Model

Profile

Profile

WGS

GeT-RM

HG01190

0.4.1

*2x2, *68+*4

WholeDup1+Tandem1A

*2x2/*68+*4

Model

Profile

Profile

WGS

GeT-RM

NA21781

0.4.1

ParalogPartialDel1

*2/*41

Model

Profile

Profile

WGS

1KGP

NA19316

0.13.0

WholeDel1+Tandem3

Indeterminate

Model

Profile

Profile

WGS

1KGP

HG03803

0.16.0

Unknown1

Indeterminate

Profile

Profile

WGS

1KGP

NA18555

0.12.0

Unknown2

Indeterminate

Profile

Profile

WGS

1KGP

NA19982

0.14.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for CYP2D6, and corresponding copy number profiles and allele fraction profiles.

Phenotype summary for CYP2D6

Activity score is used for phenotype prediction.

Phenotype

Activity Score

Example

Priority

Ultrarapid Metabolizer

2.5 <= score

*1/*2x2

Abnormal/Priority/High Risk

Normal Metabolizer

1.25 <= score < 2.5

*1/*1

Normal/Routine/Low Risk

Intermediate Metabolizer

0.25 <= score < 1.25

*1/*4

Abnormal/Priority/High Risk

Poor Metabolizer

0 <= score < 0.25

*4/*5

Abnormal/Priority/High Risk

Indeterminate

Unknown score

*1/*22

None

Recommendations for CYP2D6

  • Amitriptyline

    “The CPIC Dosing Guideline update for amitriptyline recommends an alternative drug for CYP2D6 ultrarapid or poor metabolizers and CYP2C19 ultrarapid, rapid or poor metabolizers. If amitriptyline is warranted, consider a 50% dose reduction in CYP2D6 or CYP2C19 poor metabolizers. For CYP2D6 intermediate metabolizers, a 25% dose reduction should be considered.” (Source: PharmGKB)

  • Atomoxetine

    “The CPIC Dosing Guideline for atomoxetine provides therapeutic recommendations for CYP2D6 ultrarapid, normal, intermediate, and poor metabolizer, which includes guidance for plasma drug concentration testing, as a means to estimate atomoxetine exposure, if no clinical response and in the absence of adverse events after 2 weeks of therapy.” (Source: PharmGKB)

  • Clomipramine

    “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. The CPIC Dosing Guideline update for amitriptyline recommends an alternative drug for CYP2D6 ultrarapid or poor metabolizers and CYP2C19 ultrarapid, rapid or poor metabolizers. If amitriptyline is warranted, consider a 50% dose reduction in CYP2D6 or CYP2C19 poor metabolizers. For CYP2D6 intermediate metabolizers, a 25% dose reduction should be considered.” (Source: PharmGKB)

  • Codeine

    “Alternate non-tramadol analgesics are recommended for CYP2D6 ultrarapid and poor metabolizers. A label recommended age- or weight-specific dose of codeine is warranted for CYP2D6 normal and intermediate metabolizers.” (Source: PharmGKB)

  • Desipramine

    “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. The CPIC Dosing Guideline update for nortriptyline recommends a 25% dose reduction for CYP2D6 intermediate metabolizers. For CYP2D6 ultrarapid or poor metabolizers, an alternative drug should be considered. If nortriptyline is warranted, consider a 50% dose reduction in CYP2D6 poor metabolizers.” (Source: PharmGKB)

  • Doxepin

    “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. The CPIC Dosing Guideline update for amitriptyline recommends an alternative drug for CYP2D6 ultrarapid or poor metabolizers and CYP2C19 ultrarapid, rapid or poor metabolizers. If amitriptyline is warranted, consider a 50% dose reduction in CYP2D6 or CYP2C19 poor metabolizers. For CYP2D6 intermediate metabolizers, a 25% dose reduction should be considered.” (Source: PharmGKB)

  • Fluvoxamine

    “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.” (Source: PharmGKB)

  • Hydrocodone

    “CYP2D6 intermediate and poor metabolizers should initiate hydrocodone therapy using the label recommended age- or weight-specific dosing. However, if there is no response to hydrocodone in these patients, an alternative analgesic should be considered.

    There is insufficient evidence to provide a dosing recommendation for hydrocodone in CYP2D6 ultrarapid metabolizers.” (Source: PharmGKB)

  • Imipramine

    “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. The CPIC Dosing Guideline update for amitriptyline recommends an alternative drug for CYP2D6 ultrarapid or poor metabolizers and CYP2C19 ultrarapid, rapid or poor metabolizers. If amitriptyline is warranted, consider a 50% dose reduction in CYP2D6 or CYP2C19 poor metabolizers. For CYP2D6 intermediate metabolizers, a 25% dose reduction should be considered.” (Source: PharmGKB)

  • Nortriptyline

    “The CPIC Dosing Guideline update for nortriptyline recommends a 25% dose reduction for CYP2D6 intermediate metabolizers. For CYP2D6 ultrarapid or poor metabolizers, an alternative drug should be considered. If nortriptyline is warranted, consider a 50% dose reduction in CYP2D6 poor metabolizers.” (Source: PharmGKB)

  • Ondansetron

    “The CPIC dosing guideline for ondansetron recommends selecting an alternate drug for CYP2D6 ultrarapid metabolizers. It is recommended that the alternate drug not be predominantly metabolized by CYP2D6 (eg. granisetron).” (Source: PharmGKB)

  • Paroxetine

    “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.” (Source: PharmGKB)

  • Tamoxifen

    “The CPIC Dosing Guideline for tamoxifen recommends the use of alternative hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women for CYP2D6 poor metabolizer, if aromatase inhibitor use is not contraindicated. For CYP2D6 intermediate metabolizers and CYP2D6 allele combinations resulting in an activity score (AS) of 1 the recommendation is to consider the recommendations stated for the CYP2D6 poor metabolizer. If aromatase inhibitor use is contraindicated, consideration should be given to use a higher but FDA approved tamoxifen dose for CYP2D6 intermediate metabolizers and CYP2D6 allele combinations resulting in an AS of 1. For poor metabolizer, higher dose tamoxifen (40 mg/day) increases but does not normalize endoxifen concentrations and can be considered if there are contraindications to aromatase inhibitor therapy.” (Source: PharmGKB)

  • Tramadol

    “Alternate non-codeine analgesics are recommended for CYP2D6 ultrarapid and poor metabolizers. A label recommended age- or weight-specific dose of tramadol is warranted for CYP2D6 normal and intermediate metabolizers.” (Source: PharmGKB)

  • Trimipramine

    “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. The CPIC Dosing Guideline update for amitriptyline recommends an alternative drug for CYP2D6 ultrarapid or poor metabolizers and CYP2C19 ultrarapid, rapid or poor metabolizers. If amitriptyline is warranted, consider a 50% dose reduction in CYP2D6 or CYP2C19 poor metabolizers. For CYP2D6 intermediate metabolizers, a 25% dose reduction should be considered.” (Source: PharmGKB)

  • Tropisetron

    “The CPIC dosing guideline for tropisetron recommends selecting an alternate drug for CYP2D6 ultrarapid metabolizers. It is recommended that the alternate drug not be predominantly metabolized by CYP2D6 (eg. granisetron).” (Source: PharmGKB)

Filtered alleles for CYP2D6

Some alleles in PharmVar will not be called by PyPGx because one or more of their variants have a high false positive rate, likely due to read misalignment to the CYP2D7 pseudogene. Those alleles are listed in below table. If problematic variants are present in gnomAD, their links are provided so that you can look at filtering status, allele imbalance for heterozygotes, etc.

Problematic Variant

Star Alleles

GRCh37

GRCh38

rs769157652 (E410K)

*27, *32

22-42522940-C-T

22-42126938-C-T

rs61745683 (V370I)

*122

22-42523514-C-T

22-42127512-C-T

rs1058172 (R365H)

*139

22-42523528-C-T

22-42127526-C-T

rs202102799 (Y355C)

*127

22-42523558-T-C

22-42127556-T-C

rs17002853 (L231P)

*131

22-42524327-A-G

22-42128325-A-G

CYP2E1

SV summary for CYP2E1

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*1/*7

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA10831

0.4.1

WholeDel1

Indeterminate

Profile

Profile

WGS

1KGP

HG03445

0.16.0

*1x2

WholeDup1

*1/*1x2

Model

Profile

Profile

WGS

0.4.1

*7x2

WholeDup1

*1/*7x2

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA19095

0.4.1

*1x2

WholeDup2

*1x2/*7

Model

Profile

Profile

WGS

1KGP

NA19225

0.12.0

*S1

PartialDup1

*1/*S1

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA19920

0.4.1

*S1 is linked to *7.

*S1

PartialDup1Hom

*S1/*S1

Model

Profile

Profile

WGS

1KGP

NA19309

0.13.0

*7x3

WholeMultip1

*7/*7x3

Model

Profile

Profile

WGS

GeT-RM

NA19908

0.4.1

WholeMultip2

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA20291

0.14.0

WholeDup1+PartialDup1

Indeterminate

Profile

Profile

WGS

1KGP

HG03401

0.16.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for CYP2E1, and corresponding copy number profiles and allele fraction profiles.

Resources for CYP2E1

CYP2F1

Resources for CYP2F1

CYP2J2

Resources for CYP2J2

CYP2R1

Resources for CYP2R1

CYP2S1

Resources for CYP2S1

CYP2W1

Resources for CYP2W1

CYP3A4

Resources for CYP3A4

CYP3A5

Phenotype summary for CYP3A5

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Normal Metabolizer

*1/*1

Abnormal/Priority/High Risk

Intermediate Metabolizer

*1/*3

Abnormal/Priority/High Risk

Possible Intermediate Metabolizer

*1/*2

Abnormal/Priority/High Risk

Poor Metabolizer

*6/*6

Normal/Routine/Low Risk

Indeterminate

*2/*2

None

Recommendations for CYP3A5

  • Tacrolimus

    “The CPIC dosing guideline for tacrolimus recommends increasing the starting dose by 1.5 to 2 times the recommended starting dose in patients who are CYP3A5 intermediate or extensive metabolizers, though total starting dose should not exceed 0.3 mg/kg/day. Therapeutic drug monitoring should also be used to guide dose adjustments.” (Source: PharmGKB)

CYP3A7

Resources for CYP3A7

CYP3A43

Resources for CYP3A43

CYP4A11

Resources for CYP4A11

CYP4A22

Resources for CYP4A22

CYP4B1

Resources for CYP4B1

CYP4F2

SV summary for CYP4F2

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*1/*3

Model

Profile

Profile

WGS

GeT-RM

HG01190

0.11.0

*DEL

WholeDel1

*1/*DEL

Model

Profile

Profile

WGS

0.11.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for CYP4F2, and corresponding copy number profiles and allele fraction profiles.

Resources for CYP4F2

CYP17A1

Resources for CYP17A1

CYP19A1

Resources for CYP19A1

CYP26A1

Resources for CYP26A1

DPYD

Phenotype summary for DPYD

Activity score is used for phenotype prediction.

Phenotype

Activity Score

Example

Priority

Normal Metabolizer

2 == score

Reference/Reference

Normal/Routine/Low Risk

Intermediate Metabolizer

1 <= score < 2

Reference/c.1905+1G>A (*2A)

Abnormal/Priority/High Risk

Poor Metabolizer

0 <= score < 1

c.295_298delTCAT (*7)/c.703C>T (*8)

Abnormal/Priority/High Risk

Recommendations for DPYD

  • Capecitabine

    “The CPIC Dosing Guideline for 5-fluorouracil and capecitabine recommends an alternative drug for patients who are DPYD poor metabolizers with an activity score of 0. In those who are poor metabolizers with an activity score of 0.5, an alternative drug is also recommended, but if this is not considered a suitable therapeutic option, 5-fluorouracil or capecitabine should be administered at a strongly reduced dose with early therapeutic drug monitoring. Patients who are intermediate metabolizers with an activity score of 1 or 1.5 should receive a dose reduction of 50%. Patients with the c.[2846A>T];[2846A>T] genotype may require a >50% dose reduction.” (Source: PharmGKB)

  • Fluorouracil

    “The CPIC Dosing Guideline for 5-fluorouracil and capecitabine recommends an alternative drug for patients who are DPYD poor metabolizers with an activity score of 0. In those who are poor metabolizers with an activity score of 0.5, an alternative drug is also recommended, but if this is not considered a suitable therapeutic option, 5-fluorouracil or capecitabine should be administered at a strongly reduced dose with early therapeutic drug monitoring. Patients who are intermediate metabolizers with an activity score of 1 or 1.5 should receive a dose reduction of 50%. Patients with the c.[2846A>T];[2846A>T] genotype may require a >50% dose reduction.” (Source: PharmGKB)

F5

Phenotype summary for F5

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Favorable Response

Reference/Reference

None

Unfavorable Response

Reference/Leiden

None

Recommendations for F5

  • Hormonal contraceptives

    “In individuals who carry the Factor V Leiden allele (rs6025 T) and have a family history of thrombotic events, estrogen-containing oral contraceptives should be avoided and alternative forms of contraception used.” (Source: PharmGKB)

G6PD

SV summary for G6PD

Since the gene is located on X chromosome, its copy number differs between females (N=2) and males (N=1). Technically speaking, this difference is not a SV event, but it is treated as such by PyPGx for genotyping purposes (i.e. sex determination).

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Female

B (reference)/B (reference)

Model

Profile

Profile

WGS

GeT-RM

HG00276

0.12.0

MALE

Male

MALE/B (reference)

Model

Profile

Profile

WGS

GeT-RM

HG00436

0.12.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for G6PD, and corresponding copy number profiles and allele fraction profiles.

Phenotype summary for G6PD

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

G6PD Normal

A/B (reference)

Normal Risk

G6PD Deficient with CNSHA

Alhambra/Bari

Abnormal/Priority/High Risk

G6PD Variable

202G>A_376A>G_1264C>G/B (reference)

Abnormal/Priority/High Risk

G6PD Deficient

202G>A_376A>G_1264C>G/A- 680T_376G

Abnormal/Priority/High Risk

G6PD Indeterminate

A- 202A_376G/Dagua

Abnormal/Priority/High Risk

GSTM1

SV summary for GSTM1

This gene is known to have an extremely high rate of gene deletion polymorphism in the population and thus requires SV analysis.

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*A/*B

Model

Profile

Profile

WGS

GeT-RM

NA06991

0.4.1

*0

WholeDel1

*0/*A

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA18855

0.4.1

*0

WholeDel1Hom

*0/*0

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA10831

0.4.1

*0

WholeDel2

*0/*A

Model

Profile

Profile

WGS

GeT-RM

NA21097

0.15.0

*Ax2

WholeDup1

*A/*Ax2

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA19908

0.4.1

*Bx2

WholeDup1

*A/*Bx2

Model

Profile

Profile

WGS

0.4.1

NoncodingDel1

*A/*B

Model

Profile

Profile

WGS

1KGP

NA19005

0.12.0

*0

WholeDel1+NoncodingDel1

*0/*A

Model

Profile

Profile

WGS

1KGP

NA06984

0.12.0

PartialDup1

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA19908

0.14.0

WholeDel1+WholeDel2

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA20506

0.14.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for GSTM1, and corresponding copy number profiles and allele fraction profiles.

GSTT1

GRCh38 data for GSTT1

GSTT1 is located on chr22 for GRCh37 but on chr22_KI270879v1_alt for GRCh38. Therefore, if you are interested in genotyping this gene with GRCh38 data, then you must have sequence reads mapped to the ALT contig. For more details, please read the GRCh37 vs. GRCh38 page.

SV summary for GSTT1

This gene is known to have an extremely high rate of gene deletion polymorphism in the population and thus requires SV analysis.

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*A/*A

Model

Profile

Profile

WGS

GeT-RM

NA07055

0.4.1

*0

WholeDel1

*0/*A

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA19908

0.4.1

*0

WholeDel1Hom

*0/*0

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA11832

0.4.1

IFNL3

Phenotype summary for IFNL3

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Favorable Response

Reference/Reference

None

Unfavorable Response

Reference/rs12979860

None

Indeterminate

Reference/rs8099917

None

Recommendations for IFNL3

  • Peginterferon alfa-2a

“IFNL3 (IL28B) variation (rs12979860) is the strongest baseline predictor of response to PEG-interferon-alpha-containing regimens in HCV genotype 1 patients. Patients with the favorable response genotype (rs12979860 CC) have increased likelihood of response (higher SVR rate) to PEG-interferon-alpha- containing regimens as compared to patients with unfavorable response genotype (rs12979860 CT or TT). Consider implications before initiating PEG-IFN alpha and RBV containing regimens.” (Source: PharmGKB)

  • Peginterferon alfa-2b

“IFNL3 (IL28B) variation (rs12979860) is the strongest baseline predictor of response to PEG-interferon-alpha-containing regimens in HCV genotype 1 patients. Patients with the favorable response genotype (rs12979860 CC) have increased likelihood of response (higher SVR rate) to PEG-interferon-alpha- containing regimens as compared to patients with unfavorable response genotype (rs12979860 CT or TT). Consider implications before initiating PEG-IFN alpha and RBV containing regimens.” (Source: PharmGKB)

  • Ribavirin

“IFNL3 (IL28B) variation (rs12979860) is the strongest baseline predictor of response to PEG-interferon-alpha-containing regimens in HCV genotype 1 patients. Patients with the favorable response genotype (rs12979860 CC) have increased likelihood of response (higher SVR rate) to PEG-interferon-alpha- containing regimens as compared to patients with unfavorable response genotype (rs12979860 CT or TT). Consider implications before initiating PEG-IFN alpha and RBV containing regimens.” (Source: PharmGKB)

NUDT15

Phenotype summary for NUDT15

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Normal Metabolizer

*1/*1

Normal/Routine/Low risk

Intermediate Metabolizer

*1/*2

Abnormal/Priority/High Risk

Possible Intermediate Metabolizer

*3/*4

Abnormal/Priority/High Risk

Poor Metabolizer

*2/*3

Abnormal/Priority/High Risk

Indeterminate

*1/*4

Abnormal/Priority/High Risk

Recommendations for NUDT15

  • Azathioprine

    “Consider an alternate agent or extreme dose reduction of azathioprine for patients who are TPMT or NUDT15 poor metabolizers. Start at 30-80% of target dose for patients who are TPMT or NUDT15 intermediate metabolizers.” (Source: PharmGKB)

  • Mercaptopurine

    “Consider an alternate agent or extreme dose reduction of mercaptopurine for patients who are TPMT or NUDT15 poor metabolizers. Start at 30-80% of target dose for patients who are TPMT or NUDT15 intermediate metabolizers.” (Source: PharmGKB)

  • Thioguanine

    “Consider an alternate agent or extreme dose reduction of thioguanine for patients who are TPMT or NUDT15 poor metabolizers. Start at 50-80% of target dose for patients who are TPMT or NUDT15 intermediate metabolizers.” (Source: PharmGKB)

POR

Resources for POR

PTGIS

Resources for PTGIS

RYR1

Phenotype summary for RYR1

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Uncertain Susceptibility

Reference/Reference

Normal Risk

Malignant Hyperthermia Susceptibility

Reference/c.103T>C

Abnormal/Priority/High Risk

Recommendations for RYR1

  • Desflurane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics uch as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Enflurane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Halothane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Isoflurane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Methoxyflurane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Sevoflurane

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

  • Succinylcholine

    “The CPIC Dosing Guideline recommends that halogenated volatile anesthetics such as desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane and the depolarizing muscle relaxants succinylcholine are relatively contraindicated in persons with malignant hyperthermia susceptibility (MHS). See full guideline for disclaimers, further details and supporting evidence.” (Source: PharmGKB)

SLC22A2

SV summary for SLC22A2

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*1/*3

Model

Profile

Profile

WGS

GeT-RM

HG01190

0.4.1

*S1

NoncodingDel1

*1/*S1

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA18855

0.4.1

*S1

NoncodingDel1Hom

*S1/*S1

Model

Profile

Profile

WGS

1KGP

HG02337

0.16.0

*S2

PartialDel1

*1/*S2

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA19819

0.4.1

*S1, *S2

NoncodingDel1+PartialDel1

*S1/*S2

Model

Profile

Profile

WGS

1KGP

NA19030

0.13.0

PartialDup1

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA20813

0.14.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for SLC22A2, and corresponding copy number profiles and allele fraction profiles.

SLCO1B1

Phenotype summary for SLCO1B1

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Increased Function

*14/*14

None

Normal Function

*1/*1

Normal/Routine/Low Risk

Possible Decreased Function

*2/*15

Abnormal/Priority/High Risk

Decreased Function

*1/*5

Abnormal/Priority/High Risk

Poor Function

*5/*5

Abnormal/Priority/High Risk

Indeterminate

*2/*38

None

Recommendations for SLCO1B1

  • Atorvastatin

    “Prescribe ≤20mg for patients with SLCO1B1 poor function phenotype and ≤40mg for patients with SLCO1B1 decreased or possible decreased phenotype as a starting dose. Adjust doses of atorvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for 40mg dose.” (Source: PharmGKB)

  • Fluvastatin

    “CYP2C9 IMs should avoid fluvastatin doses greater than 40mg while CYP2C9 PMs should avoid doses greater than 20mg. If higher doses are required for desired efficacy, an alternative statin should be considered. Patients with SLCO1B1 poor function should also avoid fluvastatin doses greater than 40mg and and adjust doses of fluvastatin based on disease-specific guidelines. Patients with both SLCO1B1 poor function and CYP2C9 IM/PM should be prescribed an alternative statin depending on the desired potency.” (Source: PharmGKB)

  • Lovastatin

    “Prescribe an alternative statin depending on the desired potency for patients with SLCO1B1 decreased function, possible decreased function or poor function phenotype. If lovastatin therapy is warranted in patients with SLCO1B1 decreased or possible decreased phenotype, limit dose to <20mg/day.” (Source: PharmGKB)

  • Pitavastatin

    “Prescribe ≤1mg as a starting dose for patients with SLCO1B1 poor function phenotype. Prescribe ≤2mg as a starting dose for patients with SLCO1B1 decreased or possible decreased phenotype. Adjust doses of pitavastatin based on disease-specific guidelines. Consider an alternative statin or combination therapy if higher doses are needed.” (Source: PharmGKB)

  • Pravastatin

    “Prescribe ≤40mg as a starting dose and adjust doses of pravastatin based on disease-specific guidelines for patients with SLCO1B1 poor function phenotype. Prescribe desired starting dose and adjust doses of pravastatin based on disease-specific guidelines for patients with SLCO1B1 decreased or possible decreased phenotype. Prescriber should be aware of possible increased risk for myopathy with pravastatin especially with doses >40mg per day.” (Source: PharmGKB)

  • Rosuvastatin

    “Prescribe ≤20mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines for patients who are SLCO1B1 or ABCG2 poor function phenotype. If dose >20mg needed for desired efficacy, consider combination therapy (i.e. rosuvastatin plus non-statin guideline directed medical therapy). Patients with both ABCG2 poor function and SLCO1B1 poor/decreased function should be prescribed ≤10mg as a starting dose.” (Source: PharmGKB)

  • Simvastatin

    “Prescribe an alternative statin depending on the desired potency for patients with SLCO1B1 decreased function, possible decreased function or poor function phenotype. If simvastatin therapy is warranted in patients with SLCO1B1 decreased or possible decreased phenotype, limit dose to <20mg/day.” (Source: PharmGKB)

SULT1A1

SV summary for SULT1A1

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*1/*2

Model

Profile

Profile

WGS

GeT-RM

NA06991

0.11.0

*DEL

WholeDel1

*1/*DEL

Model

Profile

Profile

WGS

GeT-RM

NA18942

0.11.0

*DEL

WholeDel1Hom

*DEL/*DEL

Model

Profile

Profile

WGS

1KGP

NA20874

0.14.0

*1x2

WholeDup1

*1x2/*2

Model

Profile

Profile

WGS

GeT-RM

NA18509

0.11.0

*1x3

WholeMultip1

*1x3/*2

Model

Profile

Profile

WGS

GeT-RM

NA18868

0.11.0

*1x4

WholeMultip2

*1x4/*2

Model

Profile

Profile

WGS

GeT-RM

NA18484

0.11.0

*1x3, *2x2

WholeMultip2

*1x3/*2x2

Model

Profile

Profile

WGS

GeT-RM

NA19143

0.11.0

Unknown1

Indeterminate

Model

Profile

Profile

WGS

GeT-RM

HG01085

0.15.0

Unknown2

Indeterminate

Profile

Profile

WGS

1KGP

0.16.0

Unknown3

Indeterminate

Profile

Profile

WGS

1KGP

HG03854

0.16.0

Unknown4

Indeterminate

Profile

Profile

WGS

1KGP

HG03742

0.16.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for SULT1A1, and corresponding copy number profiles and allele fraction profiles.

TBXAS1

Resources for TBXAS1

TPMT

Phenotype summary for TPMT

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Normal Metabolizer

*1/*1

Normal/Routine/Low Risk

Possible Intermediate Metabolizer

*3A/*12

Abnormal/Priority/High Risk

Intermediate Metabolizer

*1/*2

Abnormal/Priority/High Risk

Poor Metabolizer

*2/*3A

Abnormal/Priority/High Risk

Indeterminate

*1/*18

Abnormal/Priority/High Risk

Recommendations for TPMT

  • Azathioprine

    “Consider an alternate agent or extreme dose reduction of azathioprine for patients who are TPMT or NUDT15 poor metabolizers. Start at 30-80% of target dose for patients who are TPMT or NUDT15 intermediate metabolizers.” (Source: PharmGKB)

  • Mercaptopurine

    “Consider an alternate agent or extreme dose reduction of mercaptopurine for patients who are TPMT or NUDT15 poor metabolizers. Start at 30-80% of target dose for patients who are TPMT or NUDT15 intermediate metabolizers.” (Source: PharmGKB)

  • Thioguanine

    “Consider an alternate agent or extreme dose reduction of thioguanine for patients who are TPMT or NUDT15 poor metabolizers. Start at 50-80% of target dose for patients who are TPMT or NUDT15 intermediate metabolizers.” (Source: PharmGKB)

UGT1A1

Phenotype summary for UGT1A1

Diplotype-phenotype mapping is used for phenotype prediction.

Phenotype

Example

Priority

Normal Metabolizer

*1/*1

Normal/Routine/Low Risk

Intermediate Metabolizer

*1/*6

Normal/Routine/Low Risk

Poor Metabolizer

*6/*27

Abnormal/Priority/High Risk

Indeterminate

*28/*80

None

Recommendations for UGT1A1

  • Atazanavir

    “The CPIC dosing guideline recommends considering advising individuals who carry two decreased function UGT1A1 alleles about a substantial likelihood of developing jaundice, which may cause non-adherence. The dosing guideline recommends that alternative agents be considered if the risk of non-adherence due to jaundice is high. The risk of discontinuation is low and very low for individuals carrying one, or no decreased function UGT1A1 alleles, respectively.” (Source: PharmGKB)

UGT1A4

SV summary for UGT1A4

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*1/*2

Model

Profile

Profile

WGS

GeT-RM

NA11993

0.9.0

*S1

NoncodingDel1

*1/*S1

Model

Profile

Profile

WGS

GeT-RM

NA19908

0.9.0

*S1

NoncodingDel1Hom

*S1/*S1

Model

Profile

Profile

WGS

1KGP

HG03479

0.16.0

*S2

NoncodingDel2

*1/*S2

Model

Profile

Profile

WGS

0.10.0

*S3

NoncodingDup1

*1/*S3

Model

Profile

Profile

WGS

1KGP

NA18632

0.13.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for UGT1A4, and corresponding copy number profiles and allele fraction profiles.

UGT2B15

SV summary for UGT2B15

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*1/*2

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

HG00589

0.4.1

*S4

WholeDel1

*2/*S4

Model

Profile

Profile

WGS

1KGP

NA19024

0.13.0

WholeDel2

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA19786

0.14.0

WholeDup1

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA19776

0.14.0

*S1

PartialDel1

*4/*S1

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA11993

0.4.1

*S2

PartialDel2

*2/*S2

Model

Profile

Profile

WGS

1KGP

NA19160

0.12.0

*S3

PartialDel3

*1/*S3

Model

Profile

Profile

WGS

1KGP

NA19189

0.13.0

PartialDup1

Indeterminate

Model

Profile

Profile

WGS

1KGP

NA20821

0.14.0

PartialDup2

Indeterminate

Profile

Profile

WGS

1KGP

HG03082

0.16.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for UGT2B15, and corresponding copy number profiles and allele fraction profiles.

UGT2B17

SV summary for UGT2B17

This gene is known to have an extremely high rate of gene deletion polymorphism in the population and thus requires SV analysis.

Below is comprehensive summary of SV described from real NGS studies:

SV Alleles

SV Name

Genotype

Reference

Gene Model

GRCh37

GRCh38

Data Type

Source

Coriell ID

Version

Description

Normal

*1/*1

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA19178

0.4.1

*2

WholeDel1

*1/*2

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA18855

0.4.1

*2

WholeDel1Hom

*2/*2

Lee et al., 2019

Model

Profile

Profile

WGS

GeT-RM

NA18617

0.4.1

*S2

PartialDel2

*1/*S2

Profile

Profile

WGS

1KGP

HG03127

0.16.0

*S3

PartialDel3

*1/*S3

Model

Profile

Profile

WGS

1KGP

NA20886

0.14.0

*2, *S1

WholeDel1+PartialDel1

*2/*S1

Model

Profile

Profile

WGS

1KGP

NA19160

0.12.0

*2, *S2

WholeDel1+PartialDel2

*2/*S2

Model

Profile

Profile

WGS

1KGP

NA19189

0.13.0

*2, *S3

WholeDel1+PartialDel3

*2/*S3

Model

Profile

Profile

WGS

1KGP

NA21090

0.15.0

PyPGx was recently applied to the entire high-coverage WGS dataset from 1KGP (N=2,504). Click here to see individual SV calls for UGT2B17, and corresponding copy number profiles and allele fraction profiles.