Genes and drugs covered by the RPh Labs PGx panel

How to use this pharmacogenomic drug list

This pharmacogenomic drug list covers 263 medications on the RPh Labs PGx panel. Search the table above by generic or brand name, or filter it by gene, specialty, CPIC level or FDA label status. Every filter also works as a link, so you can bookmark or share a view such as all CYP2D6 drugs.

Each row names the gene that drives the interaction. If your report shows a non-normal result for that gene, the drug is one your prescriber may dose differently or swap for an alternative. The sections below group the list by gene, so you can read the CYP2D6 drugs, CYP2C19 drugs and CYP2C9 drugs at a glance.

This list is educational. Never start, stop or change a medication without your prescriber.

What your metabolizer type means

For each enzyme gene, a PGx report translates the genotype into a metabolizer type. That type, not the raw genotype, is what decides whether a drug on this list needs a change.

• Poor metabolizer: little or no enzyme activity. Active drugs build up and cause more side effects; prodrugs such as codeine or clopidogrel may not be activated enough to work.
• Intermediate metabolizer: reduced activity. A standard dose may be slightly too strong, or a prodrug slightly too weak.
• Normal metabolizer: the drug behaves as its label expects.
• Rapid or ultrarapid metabolizer: increased activity. Active drugs may be cleared before they work; prodrugs may be converted too quickly, which can be dangerous with codeine and tramadol.

Transporter genes such as SLCO1B1 are reported as normal, decreased or poor function, and HLA results as the presence or absence of a risk allele.

CYP2D6 drugs

CYP2D6 is the liver enzyme with the most CPIC guidance, and 69 CYP2D6 drugs are on the panel. People range from poor to ultrarapid metabolizers, and some carry extra or missing copies of the gene, so the same dose can be too strong for one patient and ineffective for the next. For prodrugs such as codeine, tramadol and tamoxifen, the effect runs the other way: poor metabolizers form less of the active drug.

• Psychiatry: Amitriptyline (Elavil), Nortriptyline (Pamelor), Imipramine (Tofranil), Desipramine (Norpramin), Doxepin (Silenor), Clomipramine (Anafranil), Trimipramine (Surmontil), Protriptyline (Vivactil), Amoxapine (Asendin), Maprotiline (Ludiomil), Paroxetine (Paxil), Fluoxetine (Prozac), Fluvoxamine (Luvox), Venlafaxine (Effexor), Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Vortioxetine (Trintellix), Mirtazapine (Remeron), Trazodone (Desyrel), Atomoxetine (Strattera), Amphetamine (Adderall), Lisdexamfetamine (Vyvanse), Aripiprazole (Abilify), Brexpiprazole (Rexulti), Risperidone (Risperdal), Paliperidone (Invega), Iloperidone (Fanapt), Ziprasidone (Geodon), Clozapine (Clozaril), Haloperidol (Haldol), Pimozide (Orap), Thioridazine (Mellaril), Perphenazine (Trilafon), Fluphenazine (Prolixin), Chlorpromazine (Thorazine).
• Neurology: Pitolisant (Wakix), Tetrabenazine (Xenazine), Deutetrabenazine (Austedo), Valbenazine (Ingrezza), Donepezil (Aricept), Galantamine (Razadyne), Dextromethorphan–quinidine (Nuedexta), Cyclobenzaprine (Flexeril).
• Cardiology: Metoprolol (Lopressor), Carvedilol (Coreg), Nebivolol (Bystolic), Propranolol (Inderal), Timolol (Blocadren), Propafenone (Rythmol), Flecainide (Tambocor), Mexiletine (Mexitil).
• Gastroenterology: Ondansetron (Zofran), Tropisetron (Navoban), Dolasetron (Anzemet), Palonosetron (Aloxi), Metoclopramide (Reglan), Loperamide (Imodium).
• Pain management: Codeine (Tylenol #3), Tramadol (Ultram), Hydrocodone (Norco), Oxycodone (OxyContin).
• Urology: Tolterodine (Detrol), Fesoterodine (Toviaz), Darifenacin (Enablex), Tamsulosin (Flomax).
• Oncology: Tamoxifen (Nolvadex).
• Dermatology: Terbinafine (Lamisil).
• Infectious disease: Artemether–lumefantrine (Coartem).
• Metabolic: Eliglustat (Cerdelga).

Strong CYP2D6 inhibitors, such as fluoxetine, paroxetine and bupropion, can make a normal metabolizer act like a poor one, so the full medication list matters as much as the genotype. Filter the table to CYP2D6 drugs →

CYP2C19 drugs

CYP2C19 activates clopidogrel and clears many antidepressants, benzodiazepines and proton pump inhibitors. There are 31 CYP2C19 drugs on the panel. Poor metabolizers activate clopidogrel poorly, which is why its label carries a boxed warning, while rapid and ultrarapid metabolizers may clear SSRIs and PPIs too quickly for a standard dose to work.

• Psychiatry: Amitriptyline (Elavil), Imipramine (Tofranil), Doxepin (Silenor), Clomipramine (Anafranil), Trimipramine (Surmontil), Citalopram (Celexa), Escitalopram (Lexapro), Sertraline (Zoloft), Vilazodone (Viibryd), Modafinil (Provigil), Diazepam (Valium), Zolpidem (Ambien).
• Gastroenterology: Omeprazole (Prilosec), Esomeprazole (Nexium), Pantoprazole (Protonix), Lansoprazole (Prevacid), Dexlansoprazole (Dexilant), Rabeprazole (Aciphex).
• Neurology: Clobazam (Onfi), Phenobarbital (Luminal), Lacosamide (Vimpat), Brivaracetam (Briviact).
• Cardiology: Clopidogrel (Plavix), Prasugrel (Effient), Ticagrelor (Brilinta), Cilostazol (Pletal).
• Infectious disease: Etravirine (Intelence), Voriconazole (Vfend).
• Pain management: Carisoprodol (Soma).
• Rheumatology: Tofacitinib (Xeljanz).
• Respiratory: Roflumilast (Daliresp).

Filter the table to CYP2C19 drugs →

CYP2C9 drugs

CYP2C9 clears warfarin, phenytoin, many NSAIDs and several diabetes and blood pressure medications, and 29 CYP2C9 drugs are on the panel. Reduced-function variants raise drug levels, which matters most for narrow-margin drugs: warfarin dosing also depends on VKORC1, and siponimod should not be used in some CYP2C9 genotypes at all.

• Pain management: Celecoxib (Celebrex), Ibuprofen (Advil), Naproxen (Naprosyn), Meloxicam (Mobic), Piroxicam (Feldene), Flurbiprofen (Ansaid), Tenoxicam (Mobiflex), Lornoxicam (Xefo), Diclofenac (Voltaren), Indomethacin (Indocin).
• Cardiology: Warfarin (Coumadin), Acenocoumarol (Sintrom), Phenprocoumon (Marcoumar), Fluvastatin (Lescol), Amiodarone (Cordarone), Losartan (Cozaar), Irbesartan (Avapro), Torsemide (Demadex), Bosentan (Tracleer).
• Endocrinology: Glipizide (Glucotrol), Glimepiride (Amaryl), Glyburide (Diabeta), Gliclazide (Diamicron), Tolbutamide (Orinase).
• Neurology: Phenytoin (Dilantin), Fosphenytoin (Cerebyx), Siponimod (Mayzent).
• Dermatology: Isotretinoin (Accutane).
• Respiratory: Zafirlukast (Accolate).

Filter the table to CYP2C9 drugs →

CYP3A4 and CYP3A5 drugs

CYP3A4 and CYP3A5 process a large share of all prescription drugs. On this panel, 19 drugs are linked to CYP3A4 and 4 to CYP3A5, where the best-established use is tacrolimus dosing after transplant.

• Psychiatry: Nefazodone (Serzone), Cariprazine (Vraylar), Quetiapine (Seroquel), Lurasidone (Latuda), Buspirone (Buspar), Alprazolam (Xanax), Clonazepam (Klonopin), Eszopiclone (Lunesta), Flurazepam (Dalmane).
• Cardiology: Ranolazine (Ranexa), Ivabradine (Corlanor).
• Pain management: Fentanyl (Duragesic), Buprenorphine (Suboxone).
• Infectious disease: Itraconazole (Sporanox), Isavuconazole (Cresemba).
• Neurology: Zonisamide (Zonegran).
• Oncology: Docetaxel (Taxotere).
• Rheumatology: Colchicine (Colcrys).
• Urology: Sildenafil (Viagra).
• Immunology: Tacrolimus (Prograf), Cyclosporine (Neoral), Sirolimus (Rapamune), Everolimus (Afinitor).

Other genes on the panel

Beyond the CYP450 enzymes, the panel covers transporters, drug targets and immune (HLA) genes. Some, such as HLA-B*57:01 with abacavir and HLA-B*15:02 with carbamazepine, flag a risk of severe reactions before the first dose. Others, such as SLCO1B1 with statins and TPMT and NUDT15 with thiopurines, guide the dose.

CPIC guidelines and levels

The Clinical Pharmacogenetics Implementation Consortium (CPIC) publishes peer-reviewed CPIC guidelines that turn a genotype into a prescribing recommendation. Each gene-drug pair is given a level that reflects how strong the evidence is and whether it should change therapy. You can read the full CPIC guidelines at cpicpgx.org.

• Level A (83 drugs on this list): genetic information should be used to change prescribing; a CPIC guideline gives the recommendation.
• Level B (32 drugs): genetic information could be used to change prescribing, because alternatives are as good or better.
• Level C and D (148 drugs): the evidence is weaker or no prescribing action is recommended yet; useful context, rarely enough to change therapy alone.

Level A drugs are the ones most likely to prompt a change after testing. Use the CPIC filter in the table to see them, or show all Level A drugs.

PGx on the FDA label

The “PGx on FDA label” column shows whether a drug’s approved labeling includes pharmacogenomic information. On this list, 98 of the 263 medications do. The labeling can range from a dosing table or a statement about poor metabolizers to a boxed warning, and it is summarized in the FDA Table of Pharmacogenomic Biomarkers in Drug Labeling.

A drug can carry label information without a CPIC guideline, and the other way round. The two columns together show how actionable a result is likely to be. Show drugs with PGx on the FDA label.

What a result can change: six examples

These are some of the best-established examples of how a result for a drug on this list changes the prescription. Each follows a published CPIC guideline.

• Clopidogrel and CYP2C19: poor and intermediate metabolizers are usually offered prasugrel or ticagrelor instead after a stent, because clopidogrel is activated less.
• Codeine and CYP2D6: ultrarapid metabolizers should avoid codeine because of the risk of toxic morphine levels; poor metabolizers get little pain relief from it.
• Citalopram and CYP2C19: poor metabolizers are started on a lower dose, and ultrarapid metabolizers may do better on a different antidepressant.
• Simvastatin and SLCO1B1: people with decreased-function results are prescribed a lower dose or another statin to reduce the risk of muscle problems.
• Thiopurines and TPMT or NUDT15: low-activity results mean a much lower starting dose of azathioprine or mercaptopurine to avoid bone-marrow suppression.
• Warfarin and CYP2C9 plus VKORC1: the genotype feeds a dosing algorithm that sets a better starting dose.

In each case the prescriber still weighs age, kidney and liver function, other medications and the reason for treatment. The genotype narrows the choice; it does not make it alone.

Psychiatric medications on the list

Psychiatry has more gene-drug pairs than any other specialty on the panel, and most run through CYP2D6 and CYP2C19. These are the 55 psychiatric medications, with the genes that affect each one:

Amitriptyline (CYP2D6, CYP2C19), Nortriptyline (CYP2D6), Imipramine (CYP2D6, CYP2C19), Desipramine (CYP2D6), Doxepin (CYP2D6, CYP2C19), Clomipramine (CYP2D6, CYP2C19), Trimipramine (CYP2D6, CYP2C19), Protriptyline (CYP2D6), Amoxapine (CYP2D6), Maprotiline (CYP2D6), Citalopram (CYP2C19), Escitalopram (CYP2C19), Sertraline (CYP2C19), Paroxetine (CYP2D6), Fluoxetine (CYP2D6), Fluvoxamine (CYP2D6), Venlafaxine (CYP2D6), Desvenlafaxine (CYP2D6), Duloxetine (CYP1A2, CYP2D6), Vortioxetine (CYP2D6), Mirtazapine (CYP2D6), Bupropion (CYP2B6), Trazodone (CYP2D6), Vilazodone (CYP2C19), Nefazodone (CYP3A4), Atomoxetine (CYP2D6), Amphetamine (CYP2D6), Lisdexamfetamine (CYP2D6), Methylphenidate (CES1), Modafinil (CYP2C19), Aripiprazole (CYP2D6), Brexpiprazole (CYP2D6), Cariprazine (CYP3A4), Risperidone (CYP2D6), Paliperidone (CYP2D6), Iloperidone (CYP2D6), Ziprasidone (CYP2D6), Quetiapine (CYP3A4), Olanzapine (CYP1A2), Clozapine (CYP1A2, CYP2D6), Lurasidone (CYP3A4), Asenapine (CYP1A2), Haloperidol (CYP2D6), Pimozide (CYP2D6), Thioridazine (CYP2D6), Perphenazine (CYP2D6), Fluphenazine (CYP2D6), Chlorpromazine (CYP2D6), Buspirone (CYP3A4), Diazepam (CYP2C19), Alprazolam (CYP3A4), Clonazepam (CYP3A4), Zolpidem (CYP2C19), Eszopiclone (CYP3A4), Flurazepam (CYP3A4).

Filter the table to psychiatry →

Heart and blood medications on the list

Cardiology is the second-largest group, covering antiplatelets, anticoagulants, statins, beta-blockers and antiarrhythmics. These are the 35 cardiology medications and their genes:

Clopidogrel (CYP2C19), Prasugrel (CYP2C19), Ticagrelor (CYP2C19), Warfarin (CYP2C9, VKORC1, CYP4F2), Acenocoumarol (CYP2C9, VKORC1), Phenprocoumon (CYP2C9, VKORC1), Dabigatran (CES1), Rivaroxaban (ABCB1), Apixaban (ABCB1), Cilostazol (CYP2C19), Simvastatin (SLCO1B1), Atorvastatin (SLCO1B1), Rosuvastatin (SLCO1B1, ABCG2), Pravastatin (SLCO1B1), Fluvastatin (CYP2C9), Lovastatin (SLCO1B1), Pitavastatin (SLCO1B1), Metoprolol (CYP2D6), Carvedilol (CYP2D6), Nebivolol (CYP2D6), Propranolol (CYP2D6), Timolol (CYP2D6), Propafenone (CYP2D6), Flecainide (CYP2D6), Mexiletine (CYP2D6), Amiodarone (CYP2C9), Digoxin (ABCB1), Losartan (CYP2C9), Irbesartan (CYP2C9), Torsemide (CYP2C9), Bosentan (CYP2C9), Hydralazine (NAT2), Isosorbide dinitrate–hydralazine (NAT2), Ranolazine (CYP3A4), Ivabradine (CYP3A4).

Filter the table to cardiology →

Infectious disease medications on the list

Infectious disease is the third-largest group, including HIV medications, antifungals, antimalarials and antibiotics where HLA, G6PD, CYP2B6 and mitochondrial genes matter. These are the 33 medications and their genes:

Abacavir (HLA-B*57:01), Nevirapine (CYP2B6, HLA-B*35:01), Efavirenz (CYP2B6), Etravirine (CYP2C19), Atazanavir (UGT1A1), Dolutegravir (UGT1A1), Raltegravir (UGT1A1), Maraviroc (CCR5), Lopinavir–ritonavir (SLCO1B1), Tenofovir (ABCC2), Zidovudine (ABCC4), Ribavirin (ITPA), Peginterferon alfa (IFNL3), Voriconazole (CYP2C19), Itraconazole (CYP3A4), Isavuconazole (CYP3A4), Isoniazid (NAT2), Rifampin (SLCO1B1), Primaquine (G6PD), Tafenoquine (G6PD), Chloroquine (G6PD), Quinine (G6PD), Sulfamethoxazole–trimethoprim (G6PD), Sulfadiazine (G6PD), Nitrofurantoin (G6PD), Pyrimethamine (G6PD), Ciprofloxacin (CYP1A2), Artemether–lumefantrine (CYP2D6), Flucloxacillin (HLA-B*57:01), Amoxicillin–clavulanate (HLA-DRB1), Gentamicin (MT-RNR1), Amikacin (MT-RNR1), Tobramycin (MT-RNR1).

Filter the table to infectious disease →

Medications by specialty

Psychiatry and cardiology account for the largest share of the pharmacogenomic drug list, but the panel reaches across medicine:

• Psychiatry: 55 medications
• Cardiology: 35 medications
• Infectious disease: 33 medications
• Neurology: 24 medications
• Oncology: 24 medications
• Pain management: 21 medications
• Gastroenterology: 14 medications
• Anaesthesia: 10 medications
• Endocrinology: 10 medications
• Respiratory: 9 medications
• Rheumatology: 8 medications
• Immunology: 6 medications
• Urology: 5 medications
• Haematology: 3 medications
• Dermatology: 3 medications
• Metabolic: 3 medications

Prescribers can order the test for patients through the provider requisition, and patients can order the at-home kit directly.

If your medication is not on the list

A medication that is missing from the table has no well-established gene-drug interaction covered by the panel. That usually means its response is driven mostly by other factors, such as kidney function, body weight or other drugs, rather than by the genes tested.

It does not mean the drug is safe or unsafe for you, and it does not mean genetics plays no part. Research moves quickly, and new gene-drug pairs are added to guidelines each year. Your pharmacist can check any medication against your report.

How we keep the list current

The list follows CPIC levels and FDA labeling as they are published. When a guideline changes, or a new drug label adds pharmacogenomic information, the table is updated, and patients who have already tested receive a reissued report at no cost.

Because your genes do not change, a single test covers every drug on the list today and the new ones added later.

Using the list with your prescriber

Bring the names of your current and planned medications to your appointment, find them in the table, and note the gene for each. After testing, your report gives each of those drugs a band: standard precautions, use with caution, or consider alternatives.

Your prescriber and pharmacist can then decide together whether a dose or a drug needs to change. Our pharmacists are available for a free consultation to walk through the report with you, and will speak to your prescriber at your request.