Introduction
Methods
Selection of drug-gene interactions and classification of therapeutic recommendations
Source of nationwide prescription data
Frequencies of genetic predicted phenotypes
Estimating the clinical impact of PGx in primary care
ATC | Drug name | No. of first-time prescriptions |
---|---|---|
B01AA07 | ACENOCOUMAROL | 49,934 |
N06AA09 | AMITRIPTYLINE | 98,750 |
N05AX12 | ARIPIPRAZOLE | 13,869 |
N06BA09 | ATOMOXETINE | 1987 |
C10AA05 | ATORVASTATIN | 111,840 |
C10BA05 | ATORVASTATIN AND EZETIMIBE | 1909 |
L04AX01 | AZATHIOPRINE | 6943 |
N06AB04 | CITALOPRAM | 56,580 |
N06AA04 | CLOMIPRAMINE | 7079 |
B01AC04 | CLOPIDOGREL | 98,709 |
R05DA04 | CODEINE | 519,728 |
N02AJ06 | CODEINE AND PARACETAMOL | 69,300 |
N06AA12 | DOXEPIN | 270 |
N06AB10 | ESCITALOPRAM | 24,454 |
A02BC05 | ESOMEPRAZOLE | 65,370 |
B01AA04 | FENPROCOUMON | 12,621 |
N03AB02 | FENYTOINE | 828 |
C01BC04 | FLECAINIDE | 13,605 |
N05AD01 | HALOPERIDOL | 51,217 |
N06AA02 | IMIPRAMINE | 988 |
A02BC03 | LANSOPRAZOLE | 1536 |
L01BB02 | MERCAPTOPURINE | 2598 |
C07AB02 | METOPROLOL | 194,724 |
C07BB02 | METOPROLOL MET THIAZIDE | 1908 |
M01AE52 | NAPROXEN AND ESOMEPRAZOLE | 673 |
N06AA10 | NORTRIPTYLINE | 20,717 |
A02BC01 | OMEPRAZOLE | 575,353 |
N02AA05 | OXYCODONE | 464,799 |
N02AA55 | OXYCODONE AND NALOXONE | 82 |
A02BC02 | PANTOPRAZOLE | 361,741 |
A02BD04 | PANTOPRAZOLE, AMOXICILLINE, AND CLARITROMYCINE | 21,768 |
N06AB05 | PAROXETINE | 27,018 |
N05AG02 | PIMOZIDE | 1060 |
C01BC03 | PROPAFENON | 409 |
N06AB06 | SERTRALINE | 28,861 |
C10AA01 | SIMVASTATIN | 187,362 |
C10BA02 | SIMVASTATIN AND EZETIMIBE | 4888 |
L04AD02 | TACROLIMUS | 2722 |
L02BA01 | TAMOXIFEN | 10,807 |
L01BB03 | TIOGUANINE | 1883 |
N02AX02 | TRAMADOL | 357,389 |
N02AJ13 | TRAMADOL AND PARACETAMOL | 124,951 |
N06AX16 | VENLAFAXINE | 26,603 |
J02AC03 | VORICONAZOLE | 891 |
N05AF05 | ZUCLOPENTHIXOL | 1873 |
Drug | Count incident prescriptions (total) | Actionable phenotype | Count incident prescriptions | Type of therapeutic recommendation |
---|---|---|---|---|
CYP2C9
| ||||
PHENYTOIN* | 828 | EM | 518 | No action |
IM | 294 | Lower dose required at start therapy | ||
PM | 17 | Lower dose required at start therapy | ||
CYP2C19
| ||||
CITALOPRAM < 65 years* | 41,338 | EM | 29,557 | No action |
IM | 8,888 | Guard maximum daily dose | ||
PM | 1240 | Guard maximum daily dose | ||
UM | 1654 | No action | ||
CITALOPRAM ≥ 65 years* | 15,242 | EM | 10,898 | No action |
IM | 3277 | Guard maximum daily dose | ||
PM | 457 | Guard maximum daily dose | ||
UM | 610 | No action | ||
CLOPIDOGREL* | 98,709 | EM | 70,577 | No action |
IM | 21,222 | Switch to alternate drug at start therapy | ||
PM | 2961 | Switch to alternate drug at start therapy | ||
UM | 3948 | Observe status of patient carefully | ||
ESCITALOPRAM < 65 years* | 21,427 | EM | 15,320 | No action |
IM | 4607 | Guard maximum daily dose | ||
PM | 643 | Guard maximum daily dose | ||
UM | 857 | No action | ||
ESCITALOPRAM ≥ 65 years* | 3027 | EM | 2164 | No action |
IM | 651 | Guard maximum daily dose | ||
PM | 91 | Guard maximum daily dose | ||
UM | 121 | No action | ||
ESOMEPRAZOLE | 65,370 | EM | 46,740 | No action |
IM | 14,055 | No action | ||
PM | 1961 | No action | ||
UM | 2615 | Optional increase of dose | ||
ESOMEPRAZOLE AND NAPROXEN | 673 | EM | 481 | No action |
IM | 145 | No action | ||
PM | 20 | No action | ||
UM | 27 | Optional increase of dose | ||
LANSOPRAZOLE | 1536 | EM | 1098 | No action |
IM | 330 | No action | ||
PM | 46 | No action | ||
UM | 61 | Optional increase of dose | ||
OMEPRAZOLE | 575,353 | EM | 411,377 | No action |
IM | 123,701 | No action | ||
PM | 17,261 | No action | ||
UM | 23,014 | Optional increase of dose | ||
PANTOPRAZOLE | 361,741 | EM | 258,645 | No action |
IM | 77,774 | No action | ||
PM | 10,852 | No action | ||
UM | 14,470 | Optional increase of dose | ||
PANTOPAC | 21,768 | EM | 15,564 | No action |
IM | 4680 | No action | ||
PM | 653 | No action | ||
UM | 871 | Higher dose required at start therapy | ||
SERTRALINE* | 28,861 | EM | 20,636 | No action |
IM | 6205 | Guard maximum daily dose | ||
PM | 866 | Guard maximum daily dose | ||
UM | 1154 | No action | ||
VORICONAZOLE* | 891 | EM | 637 | No action |
IM | 192 | Observe status of patient carefully | ||
PM | 27 | Observe status of patient carefully | ||
UM | 36 | Higher dose required at start therapy | ||
CYP2D6
| ||||
AMITRIPTYLINE* | 98,750 | EM | 52,338 | No action |
IM | 39,994 | Switch to alternate drug at start therapy | ||
PM | 4938 | Switch to alternate drug at start therapy | ||
UM | 1481 | Switch to alternate drug at start therapy | ||
ARIPIPRAZOLE | 13,869 | EM | 7351 | No action |
IM | 5617 | No action | ||
PM | 693 | Guard maximum daily dose | ||
UM | 208 | No action | ||
ATOMOXETINE* | 1987 | EM | 1053 | No action |
IM | 805 | Optional decrease of dose | ||
PM | 99 | Optional decrease of dose | ||
UM | 30 | Observe status of patient carefully | ||
CLOMIPRAMINE* | 7079 | EM | 3752 | No action |
IM | 2867 | Lower dose required at start therapy | ||
PM | 354 | Lower dose required at start therapy | ||
UM | 106 | Switch to alternate drug at start therapy | ||
CODEINE* | 519,728 | EM | 275,456 | No action |
IM | 210,490 | No action | ||
PM | 25,986 | No action | ||
UM | 7796 | Switch to alternate drug at start therapy | ||
CODEINE AND PARACETAMOL* | 69,300 | EM | 36,729 | No action |
IM | 28,067 | Optional increase of dose | ||
PM | 3465 | Switch to alternate drug at start therapy | ||
UM | 1040 | Switch to alternate drug at start therapy | ||
DOXEPIN* | 270 | EM | 143 | No action |
IM | 109 | Lower dose required at start therapy | ||
PM | 14 | Lower dose required at start therapy | ||
UM | 4 | Switch to alternate drug at start therapy | ||
FLECAINIDE | 13,605 | EM | 7211 | No action |
IM | 5510 | Lower dose required at start therapy | ||
PM | 680 | Lower dose required at start therapy | ||
UM | 204 | Observe status of patient carefully | ||
HALOPERIDOL | 51,217 | EM | 27,145 | No action |
IM | 20,743 | No action | ||
PM | 2561 | Lower dose required at start therapy | ||
UM | 768 | Optional increase of dose | ||
IMIPRAMINE (TOTAL) | 988 | |||
IMIPRAMINE (CYP2C19 EM, IM, UM)* | 958 | EM | 508 | No action |
IM | 388 | Lower dose required at start therapy | ||
PM | 48 | Lower dose required at start therapy | ||
UM | 14 | Switch to alternate drug at start therapy | ||
IMIPRAMINE (CYP2C19 PM) * | 30 | EM | 16 | Lower dose required at start therapy |
IM | 12 | Lower dose required at start therapy | ||
PM | 2 | Lower dose required at start therapy | ||
UM | 0 | Switch to alternate drug at start therapy | ||
METOPROLOL | 194,724 | EM | 103,204 | No action |
IM | 78,863 | Optional decrease of dose | ||
PM | 9736 | Optional decrease of dose | ||
UM | 2921 | Optional increase of dose | ||
METOPROLOL AND THIAZIDE | 1908 | EM | 1011 | No action |
IM | 773 | Optional decrease of dose | ||
PM | 95 | Optional decrease of dose | ||
UM | 29 | Optional increase of dose | ||
NORTRIPTYLINE* | 20,717 | EM | 10,980 | No action |
IM | 8390 | Lower dose required at start therapy | ||
PM | 1036 | Lower dose required at start therapy | ||
UM | 311 | Switch to alternate drug at start therapy | ||
OXYCODONE | 464,799 | EM | 246,343 | No action |
IM | 188,244 | Observe status of patient carefully | ||
PM | 23,240 | Observe status of patient carefully | ||
UM | 6972 | Observe status of patient carefully | ||
OXYCODONE AND NALOXONE | 82 | EM | 43 | No action |
IM | 33 | Observe status of patient carefully | ||
PM | 4 | Observe status of patient carefully | ||
UM | 1 | Observe status of patient carefully | ||
PAROXETINE* | 27,018 | EM | 14,320 | No action |
IM | 10,942 | No action | ||
PM | 1351 | No action | ||
UM | 405 | Switch to alternate drug at start therapy | ||
PIMOZIDE | 1060 | EM | 562 | No action |
IM | 429 | Lower dose required at start therapy | ||
PM | 53 | Lower dose required at start therapy | ||
UM | 16 | No action | ||
PROPAFENON | 409 | EM | 217 | No action |
IM | 166 | Optional decrease of dose | ||
PM | 20 | Lower dose required at start therapy | ||
UM | 6 | Observe status of patient carefully | ||
TAMOXIFEN* | 10,807 | EM | 5728 | No action |
IM | 4377 | Switch to alternate drug at start therapy | ||
PM | 540 | Switch to alternate drug at start therapy | ||
UM | 162 | No action | ||
TRAMADOL* | 357,389 | EM | 189,416 | No action |
IM | 144,743 | Optional increase of dose | ||
PM | 17,869 | Optional increase of dose | ||
UM | 5361 | Lower dose required at start therapy | ||
TRAMADOL AND PARACETAMOL* | 124,951 | EM | 66,224 | No action |
IM | 50,605 | Optional increase of dose | ||
PM | 6248 | Optional increase of dose | ||
UM | 1874 | Lower dose required at start therapy | ||
VENLAFAXINE | 26,603 | EM | 14,100 | No action |
IM | 10,774 | Switch to alternate drug at start therapy | ||
PM | 1330 | Switch to alternate drug at start therapy | ||
UM | 399 | Optional increase of dose | ||
ZUCLOPENTHIXOL | 1873 | EM | 993 | No action |
IM | 759 | Lower dose required at start therapy | ||
PM | 94 | Lower dose required at start therapy | ||
UM | 28 | Optional increase of dose | ||
CYP3A5
| ||||
TACROLIMUS* | 2722 | Non-Ex | 2314 | No action |
Het-Ex | 395 | Higher dose required at start therapy | ||
Homo-Ex | 14 | Higher dose required at start therapy | ||
SLCO1B1
| ||||
ATORVASTATIN (TOTAL) | 111,840 | |||
ATORVASTATIN (WITHOUT CYP3A4 INHIBITOR) | 108,400 | NT (521TT) | 80,758 | No action |
PT (521TC) | 25,474 | Observe status of patient carefully | ||
PT (521CC) | 2168 | Observe status of patient carefully | ||
ATORVASTATIN (WITH CYP3A4 INHIBITOR) | 3440 | NT (521TT) | 2563 | No action |
PT (521TC) | 808 | Switch to alternate drug at start therapy | ||
PT (521CC) | 69 | Switch to alternate drug at start therapy | ||
ATORVASTATIN AND EZETIMIBE | 1909 | |||
ATORVASTATIN AND EZETIMIBE (WITHOUT CYP3A4 INHIBITOR) | 1739 | NT (521TT) | 1296 | No action |
PT (521TC) | 409 | Observe status of patient carefully | ||
PT (521CC) | 35 | Observe status of patient carefully | ||
ATORVASTATIN AND EZETIMIBE (WITH CYP3A4 INHIBITOR) | 170 | NT (521TT) | 127 | No action |
PT (521TC) | 40 | Switch to alternate drug at start therapy | ||
PT (521CC) | 3 | Switch to alternate drug at start therapy | ||
SIMVASTATIN* | 187,362 | NT (521TT) | 139,585 | No action |
PT (521TC) | 44,030 | Switch to alternate drug at start therapy | ||
PT (521CC) | 3747 | Switch to alternate drug at start therapy | ||
SIMVASTATIN AND EZETIMIBE* | 4888 | NT (521TT) | 3642 | No action |
PT (521TC) | 1149 | Switch to alternate drug at start therapy | ||
PT (521CC) | 98 | Switch to alternate drug at start therapy | ||
TPMT
| ||||
AZATHIOPRINE* | 6943 | EM | 5867 | No action |
IM | 1041 | Lower dose required at start therapy | ||
PM | 35 | Switch to alternate drug at start therapy | ||
MERCAPTOPURINE* | 2598 | EM | 2195 | No action |
IM | 390 | Lower dose required at start therapy | ||
PM | 13 | Switch to alternate drug at start therapy | ||
TIOGUANINE* | 1888 | EM | 1591 | No action |
IM | 282 | Lower dose required at start therapy | ||
PM | 9 | Switch to alternate drug at start therapy | ||
VKORC1
| ||||
ACENOCOUMAROL | 49,934 | NS (1173CC) | 16,478 | No action |
NS (1173CT) | 25,217 | No action | ||
HS (1173TT) | 8239 | Lower dose required at start therapy | ||
FENPROCOUMON | 12,621 | NS (1173CC) | 4165 | No action |
NS (1173CT) | 6374 | No action | ||
HS (1173TT) | 2082 | Lower dose required at start therapy |