Conditions & Medications

Cardiovascular system

Anticoagulants and antithrombotic agents: clopidogrel (in certain genotypes it is replaced with prasugrel or ticagrelor), warfarin (dose adjusted by genotype)

Beta‑blockers and antiarrhythmics: metoprolol (for patients with low CYP2D6 activity start with the minimum dose), carvedilol, nebivolol, propranolol, flecainide and propafenone (metabolism depends on CYP2D6)

Statins: simvastatin, atorvastatin, rosuvastatin, pravastatin and others – in people with certain SLCO1B1/ABCG2/CYP2C9 variants the risk of myopathy is higher, so lower doses or alternatives are chosen.

…and other cardiovascular drugs

Mental Health

SSRIs and SNRIs: citalopram, escitalopram and sertraline – doses are reduced in slow metabolizers (CYP2C19); paroxetine and fluvoxamine are better replaced in rapid metabolizers (CYP2D6); venlafaxine – avoided or reduced when CYP2D6 activity is low, and sometimes increased when it is high.

Tricyclic antidepressants: amitriptyline, nortriptyline, imipramine and others – in individuals with intermediate CYP2D6 metabolism the starting dose is reduced by 25 %, for poor metabolizers by 50 % or an alternative is chosen; adjustments are similar when CYP2C19 variants are present.

Antipsychotics: haloperidol – CYP2D6 poor metabolizers receive about 60 % of the usual dose, while ultrarapid metabolizers are given roughly one and a half times the dose or another drug; risperidone – the dose is reduced when CYP2D6 activity is low.

Mood stabilizers and antiepileptics: carbamazepine and oxcarbazepine – in the presence of HLA‑B *15:02 they are avoided due to risk of severe skin reactions; with HLA‑A *31:01 the risk of hypersensitivity is increased.

…and other psychotropic drugs

Oncology

Fluoropyrimidines: 5‑fluorouracil, capecitabine and tegafur – in patients with DPD/DPYD enzyme deficiency the dose is reduced or the drug is replaced.

Thiopurines: azathioprine, mercaptopurine, thioguanine – when two non‑functional TPMT or NUDT15 alleles are present the dose is greatly reduced; otherwise severe myelosuppression is possible.

Irinotecan: in carriers of the UGT1A1*28/*28 genotype the starting dose is reduced by about 30 % with further titration.

Hormonal and targeted therapy: tamoxifen – in low CYP2D6 activity an alternative is chosen or the dose is increased; some targeted drugs require monitoring of bilirubin or other markers.

…and other anticancer drugs

Diabetes and metabolism

Hypoglycemic agents: metformin (genetic variations in the OCT1 transporter affect dosing), sulfonylureas (the influence of CYP2C9 is still unclear), meglitinides, DPP‑4 inhibitors and SGLT2 inhibitors – dosing is personalized based on clinical effect.

Hormonal drugs: GLP‑1 agonists such as semaglutide and liraglutide – there are no standardized pharmacogenetic recommendations, but individual dose adjustment is possible.

…and other antidiabetic drugs

Pain Management

Opioids: codeine and tramadol – not given to patients with very low or very high CYP2D6 activity; oxycodone and hydrocodone also require individual dose selection.

Anti‑inflammatory drugs: ibuprofen, naproxen, diclofenac, celecoxib – in slow CYP2C9 metabolizers only minimal effective doses are used.

Anticonvulsants and sedatives: phenytoin – doses are adjusted taking into account CYP2C9 and CYP2C19; some benzodiazepines (e.g., diazepam) are given in lower doses to CYP2C19 slow metabolizers.

…and other drugs for pain relief and seizure control

Other conditions

Respiratory: theophylline – clearance depends on genetics and factors such as smoking; pharmacogenetic data for inhaled agents are still limited.

Infections: abacavir – HLA‑B *57:01 testing is mandatory; allopurinol – replaced in carriers of HLA‑B *58:01 because of the risk of severe skin reactions.

Gastrointestinal: proton pump inhibitors (omeprazole, esomeprazole, lansoprazole) – slow CYP2C19 metabolizers need dose reduction, while rapid metabolizers may require higher doses.

…and other drugs for respiratory, infectious and gastrointestinal conditions