6725594	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725595	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725596	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725597	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725598	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725599	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725660	100429	RxNorm:343047	{"UGT1A1": "n/a"}	No recommendation	No Recommendation	{"UGT1A1": "Indeterminate"}	{"UGT1A1": "n/a"}	{}	{"UGT1A1": "Indeterminate"}	general	UGT1A1*80 is in very high linkage disequilibrium with *28 and *37. In the rare event that *80 is detected but *28 and *37 are not, there are not enough clinical data to predict metabolizer status with certainty. However, if only *80 is interrogated and the patient is heterozygous or homozygous for *80, an intermediate or poor metabolizer phenotype may be inferred, respectively.	1	f	f	f
6725600	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725601	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725602	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725603	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725604	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725605	100414	RxNorm:704	{"CYP2D6": "n/a", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Likely Intermediate Metabolizer"}	general	n/a	1	f	f	f
6725606	100414	RxNorm:704	{"CYP2D6": "n/a", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "No Result", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "No Result", "CYP2C19": "n/a"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725607	100414	RxNorm:704	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725608	100414	RxNorm:704	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725609	100414	RxNorm:704	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725610	100414	RxNorm:704	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725611	100414	RxNorm:704	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use. If amitripyline is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Moderate	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725612	100414	RxNorm:704	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use. If amitripyline is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Moderate	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725751	100423	RxNorm:2002	{"HLA-A": "Greater risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "n/a"}	If patient is carbamazepine-naïve and alternative agents are not available, consider the use of carbamazepine with increased frequency of clinical monitoring. Discontinue therapy at first evidence of a cutaneous adverse reaction.	Optional	{}	{}	{"HLA-A": "HLA-A*31:01 positive", "HLA-B": "No HLA-B Result"}	{"HLA-A": "*31:01 positive", "HLA-B": "No Result"}	CBZ-no alternatives	n/a	1	f	f	f
6725613	100414	RxNorm:704	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use. If amitripyline is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Moderate	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725614	100414	RxNorm:704	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use. If amitripyline is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Moderate	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725615	100414	RxNorm:704	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use. If amitripyline is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Moderate	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725616	100414	RxNorm:704	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725617	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725618	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6727203	100416	RxNorm:10689	{"CYP2D6": "Reduced O-desmethyltramadol (active metabolite) formation"}	Use tramadol label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine opioid.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	general	n/a	1	f	f	f
6725619	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725620	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725621	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725622	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725623	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725624	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725625	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725626	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725627	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid amitriptyline use; If amitriptyline is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725628	100414	RxNorm:704	{"CYP2D6": "n/a", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid tertiary amine use due to potential for sub-optimal response. Consider alternative drug not metabolized by CYP2C19. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. For tertiary amines, consider a 50% reduction of the recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Moderate	{"CYP2D6": "Indeterminate", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725629	100414	RxNorm:704	{"CYP2D6": "n/a", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid tertiary amine use due to potential for sub-optimal response. Consider alternative drug not metabolized by CYP2C19. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. For tertiary amines, consider a 50% reduction of the recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Moderate	{"CYP2D6": "No Result", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "No Result", "CYP2C19": "n/a"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725630	100414	RxNorm:704	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Moderate	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725631	100414	RxNorm:704	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Moderate	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725632	100414	RxNorm:704	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Moderate	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725633	100414	RxNorm:704	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Moderate	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725634	100414	RxNorm:704	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725635	100414	RxNorm:704	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725636	100414	RxNorm:704	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725637	100414	RxNorm:704	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725638	100414	RxNorm:704	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725639	100414	RxNorm:704	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725800	2405438	RxNorm:1151	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	Closer monitoring may be indicated higher-than-normal dosages, and in the setting of infection or other oxidative stress including concomitant use of multiple medium and low-to-no risk drugs	1	f	f	f
6725640	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725641	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725642	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725643	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725644	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725645	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725646	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725647	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725648	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725905	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725649	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725650	100414	RxNorm:704	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Strong	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725651	100414	RxNorm:704	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate", "CYP2C19": "No Result"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6725652	2405438	RxNorm:1191	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	<= 1g per day	aspirin ≤ 1 g/day	1	f	f	f
6725653	2405438	RxNorm:1191	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	<= 1g per day	aspirin ≤ 1 g/day. Closer monitoring may be indicated higher-than-normal dosages, and in the setting of infection or other oxidative stress including concomitant use of multiple medium and low-to-no risk drugs	1	f	f	f
6725654	2405438	RxNorm:1191	{"G6PD": "High risk of acute exacerbation of chronic hemolysis"}	Use drug cautiously; if used, close monitoring for acute exacerbation of chronic hemolysis is recommended	Optional	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	<= 1g per day	There are insufficient data in patients with the G6PD Deficient with CNSHA phenotype, but the risk of using any drug should be weighed carefully against the benefits in these rare patients due to the underlying pathophysiology that confers high risk for for acute exacerbation of chronic hemolysis.	1	f	f	f
6725655	2405438	RxNorm:1191	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	<= 1g per day	aspirin ≤ 1 g/day. Due to X-linked mosaicism, individuals with more than one X chromosome (e.g., females, individuals with Klinefelter syndrome) and heterozygous for one non-deficient (class IV) and one deficient (class I–III) allele may display a normal or a deficient phenotype.	1	f	f	f
6725656	2405438	RxNorm:1191	{"G6PD": "Unknown risk of acute hemolytic anemia"}	To ascertain G6PD status, enzyme activity must be measured. Drug use should be guided per the recommendations based on the activity-based phenotype.	Moderate	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	<= 1g per day	aspirin ≤ 1 g/day	1	f	f	f
6725657	100429	RxNorm:343047	{"UGT1A1": "Reference UGT1A1 activity; very low likelihood of bilirubin-related discontinuation of atazanavir."}	There is no need to avoid prescribing of atazanavir based on UGT1A1 genetic test result. Inform the patient that some patients stop atazanavir because of jaundice (yellow eyes and skin), but that this patient's genotype makes this unlikely (less than about a 1 in 20 chance of stopping atazanavir because of jaundice).	Strong	{"UGT1A1": "Normal Metabolizer"}	{"UGT1A1": "n/a"}	{}	{"UGT1A1": "Normal Metabolizer"}	general	All studies correlating UGT1A1 genotypes with atazanavir adverse events have involved ritonavir boosting. However, concentration-time profiles are equivalent when boosted with either cobicistat or ritonavir (PMID 23532097), and bilirubin-related adverse events including discontinuation of atazanavir occur in a similar percentage of patients prescribed atazanavir with cobicistat or ritonavir (PMID 23532097). Associations between UGT1A1 genotype, bilirubin elevations, and atazanavir/r discontinuation therefore almost certainly translate to atazanavir/cobicistat. "reference" function refers to the UGT1A1 allele to which other alleles are compared.	1	f	f	f
6725658	100429	RxNorm:343047	{"UGT1A1": "Somewhat decreased UGT1A1 activity; low likelihood of bilirubin-related discontinuation of atazanavir."}	There is no need to avoid prescribing of atazanavir based on UGT1A1 genetic test result. Inform the patient that some patients stop atazanavir because of jaundice (yellow eyes and skin), but that this patient's genotype makes this unlikely (less than about a 1 in 20 chance of stopping atazanavir because of jaundice).	Strong	{"UGT1A1": "Intermediate Metabolizer"}	{"UGT1A1": "n/a"}	{}	{"UGT1A1": "Intermediate Metabolizer"}	general	All studies correlating UGT1A1 genotypes with atazanavir adverse events have involved ritonavir boosting. However, concentration-time profiles are equivalent when boosted with either cobicistat or ritonavir (PMID 23532097), and bilirubin-related adverse events including discontinuation of atazanavir occur in a similar percentage of patients prescribed atazanavir with cobicistat or ritonavir (PMID 23532097). Associations between UGT1A1 genotype, bilirubin elevations, and atazanavir/r discontinuation therefore almost certainly translate to atazanavir/cobicistat.	1	f	f	f
6725659	100429	RxNorm:343047	{"UGT1A1": "Markedly decreased UGT1A1 activity; high likelihood of bilirubin-related discontinuation of atazanavir."}	Consider an alternative agent particularly where jaundice would be of concern to the patient. If atazanavir is to be prescribed, there is a high likelihood of developing jaundice that will result in atazanavir discontinuation (at least 20% and as high as 60%).	Strong	{"UGT1A1": "Poor Metabolizer"}	{"UGT1A1": "n/a"}	{}	{"UGT1A1": "Poor Metabolizer"}	general	All studies correlating UGT1A1 genotypes with atazanavir adverse events have involved ritonavir boosting. However, concentration-time profiles are equivalent when boosted with either cobicistat or ritonavir (PMID 23532097), and bilirubin-related adverse events including discontinuation of atazanavir occur in a similar percentage of patients prescribed atazanavir with cobicistat or ritonavir (PMID 23532097). Associations between UGT1A1 genotype, bilirubin elevations, and atazanavir/r discontinuation therefore almost certainly translate to atazanavir/cobicistat.	1	f	f	f
6725661	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725662	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725663	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725664	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725665	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 0.5 mg/kg and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If < 200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725666	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725667	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725668	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725669	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725670	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725671	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725672	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If < 200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725673	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If < 200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725674	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If < 200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725675	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If < 200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725676	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If < 200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725677	104243	RxNorm:38400	{"CYP2D6": "Possibly higher atomoxetine concentrations as compared to normal metabolizers but questionable clinical significance. Intermediate metabolizers with an activity score of 1 may be at an increased risk of discontinuation as compared to poor metabolizers."}	Initiate with a dose of 0.5 mg/kg/day and increase to 1.2 mg/kg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If < 200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725678	104243	RxNorm:38400	{"CYP2D6": "Decreased metabolism of atomoxetine and higher atomoxetine concentrations as compared to normal metabolizers. Individuals with activity score of 1.0 with CYP2D6*10 may be at an increased risk of discontinuation as compared to poor metabolizers."}	Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 2 to 4 hours after dosing. If response is inadequate and concentration is < 200 ng/mL, consider a proportional dose increase to achieve a concentration to approach 400 ng/mL. If unacceptable side effects are present at any time, consider a reduction in dose.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725679	104243	RxNorm:38400	{"CYP2D6": "Decreased metabolism of atomoxetine and higher atomoxetine concentrations as compared to normal metabolizers. Intermediate metabolizers may be at an increased risk of discontinuation as compared to poor metabolizers."}	Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 2 to 4 hours after dosing. If response is inadequate and concentration is < 200 ng/mL, consider a proportional dose increase to achieve a concentration to approach 400 ng/mL. If unacceptable side effects are present at any time, consider a reduction in dose.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725680	104243	RxNorm:38400	{"CYP2D6": "Decreased metabolism of atomoxetine and higher atomoxetine concentrations as compared to normal metabolizers. Intermediate metabolizers may be at an increased risk of discontinuation as compared to poor metabolizers."}	Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 2 to 4 hours after dosing. If response is inadequate and concentration is < 200 ng/mL, consider a proportional dose increase to achieve a concentration to approach 400 ng/mL. If unacceptable side effects are present at any time, consider a reduction in dose.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725681	104243	RxNorm:38400	{"CYP2D6": "Significantly decreased metabolism of atomoxetine may result in higher concentrations as compared to non-poor metabolizers. This may increase the occurrence of side effects, but also a greater improvement of ADHD symptoms as compared to non-poor metabolizers in those who tolerate treatment. Poor metabolizer status is associated with lower final dose requirements as compared to non-poor metabolizers."}	Initiate with a dose of 0.5 mg/kg/day and if no clinical response and in the absence of adverse events after 2 weeks, consider obtaining a plasma concentration 4 hours after dosing. If response is inadequate and concentration is < 200 ng/mL, consider a proportional dose increase to achieve a concentration to approach 400 ng/mL. If unacceptable side effects are present at any time, consider a reduction in dose.	Strong	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	pediatrics	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725682	104243	RxNorm:38400	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	pediatrics	n/a	1	f	f	f
6725683	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725684	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725685	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725686	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725687	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725688	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725689	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6727204	100416	RxNorm:10689	{"CYP2D6": "Reduced O-desmethyltramadol (active metabolite) formation"}	Use tramadol label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine opioid.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	general	n/a	1	f	f	f
6725690	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725691	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725692	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725693	104243	RxNorm:38400	{"CYP2D6": "Based on very limited data available for CYP2D6 ultrarapid metabolizers taking atomoxetine, it is unlikely ultrarapid metabolizers would achieve adequate serum concentrations for the intended effect at standard dosing."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725694	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6726467	100413	RxNorm:42355	{"CYP2D6": "Reduced metabolism of fluvoxamine to less active compounds when compared to CYP2D6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	general	n/a	1	f	f	f
6725695	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725696	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725697	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725698	104243	RxNorm:38400	{"CYP2D6": "Normal metabolizers of atomoxetine have a lower likelihood of response as compared to poor metabolizers. This is associated with increased discontinuation due to lack of efficacy as compared to poor metabolizers."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6725699	104243	RxNorm:38400	{"CYP2D6": "Possibly higher atomoxetine concentrations as compared to normal metabolizers but questionable clinical significance. Intermediate metabolizers with an activity score of 1 may be at an increased risk of discontinuation as compared to poor metabolizers."}	Initiate with a dose of 40 mg/day and increase to 80 mg/day after 3 days. If no clinical response and in the absence of adverse events after 2 weeks, consider increasing dose to 100 mg/day. If no clinical response observed after 2 weeks, consider obtaining a peak plasma concentration (1 to 2 hours after dose administered). If <200 ng/mL, consider a proportional increase in dose to approach 400 ng/mL. Dosages greater than 100 mg/day may be needed to achieve target concentrations.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL. Doses above 120 mg/day have not been evaluated.	1	f	f	f
6726489	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	No recommendation for hydrocodone therapy because of minimal evidence regarding adverse events or analgesia.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	n/a	1	f	f	f
6725700	104243	RxNorm:38400	{"CYP2D6": "Decreased metabolism of atomoxetine and higher atomoxetine concentrations as compared to normal metabolizers. Individuals with activity score of 1.0 with CYP2D6*10 may be at an increased risk of discontinuation as compared to poor metabolizers."}	Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/mL, consider a proportional dose increase to achieve a concentration to approach 400 ng/mL. If unacceptable side effects are present at any time, consider a reduction in dose.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725701	104243	RxNorm:38400	{"CYP2D6": "Decreased metabolism of atomoxetine and higher atomoxetine concentrations as compared to normal metabolizers. Intermediate metabolizers may be at an increased risk of discontinuation as compared to poor metabolizers."}	Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/mL, consider a proportional dose increase to achieve a concentration to approach 400 ng/mL. If unacceptable side effects are present at any time, consider a reduction in dose.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725702	104243	RxNorm:38400	{"CYP2D6": "Decreased metabolism of atomoxetine and higher atomoxetine concentrations as compared to normal metabolizers. Intermediate metabolizers may be at an increased risk of discontinuation as compared to poor metabolizers."}	Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks consider obtaining a plasma concentration 2-4 h after dosing. If concentration is <200 ng/mL, consider a proportional dose increase to achieve a concentration to approach 400 ng/mL. If unacceptable side effects are present at any time, consider a reduction in dose.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725703	104243	RxNorm:38400	{"CYP2D6": "Significantly decreased metabolism of atomoxetine may result in higher concentrations as compared to non-poor metabolizers. This may increase the occurrence of treatment-emergent side effects, but also a greater improvement of ADHD symptoms as compared to non-poor metabolizers in those who tolerate treatment. Poor metabolizer status is associated with lower final dose requirements as compared to non-poor metabolizers."}	Initiate with a dose of 40 mg/day and if no clinical response and in the absence of adverse events after 2 weeks increase dose to 80 mg/day. If response is inadequate after 2 weeks, consider obtaining a plasma concentration 2 to 4 hours after dosing. If concentration is <200 ng/mL, consider a proportional dose increase to achieve a concentration to approach 400 ng/mL. If unacceptable side effects are present at any time, consider a reduction in dose.	Moderate	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	adults	Therapeutic range of 200 to 1000 ng/mL has been proposed (PMID 29493375). Limited data are available regarding the relationship between atomoxetine plasma concentrations and clinical response. Available information suggests that clinical response is greater in poor metabolizers (PMs) compared to non-PMs and may be related to the higher plasma concentrations 1 to 1.5 hours after dosing in PMs compared to non-PMs administered a similar dose. Furthermore, modest improvement in response, defined as reduction in ADHD-rating scale, is observed at peak concentrations greater than 400 ng/mL.	1	f	f	f
6725704	104243	RxNorm:38400	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	adults	n/a	1	f	f	f
6725705	100426	RxNorm:83367	{"SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe desired starting dose and adjust doses based on disease-specific guidelines.	Strong	{"SLCO1B1": "Increased Function"}	{}	{}	{"SLCO1B1": "Increased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.	1	f	f	f
6725706	100426	RxNorm:83367	{"SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe desired starting dose and adjust doses based on disease-specific guidelines.	Strong	{"SLCO1B1": "Normal Function"}	{}	{}	{"SLCO1B1": "Normal Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.	1	f	f	f
6725707	100426	RxNorm:83367	{"SLCO1B1": "Increased atorvastatin exposure as compared to normal function which may translate to increased myopathy risk"}	Prescribe ≤40mg as a starting dose and adjust doses of atorvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for 40mg dose. If dose >40mg needed for desired efficacy, consider combination therapy (i.e., atorvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"SLCO1B1": "Possible Decreased Function"}	{}	{}	{"SLCO1B1": "Possible Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
6725708	100426	RxNorm:83367	{"SLCO1B1": "Increased atorvastatin exposure as compared to normal function which may translate to increased myopathy risk"}	Prescribe ≤40mg as a starting dose and adjust doses of atorvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for 40mg dose. If dose >40mg needed for desired efficacy, consider combination therapy (i.e., atorvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"SLCO1B1": "Decreased Function"}	{}	{}	{"SLCO1B1": "Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
6725709	100426	RxNorm:83367	{"SLCO1B1": "Increased atorvastatin exposure as compared to normal and decreased function which may translate to increased myopathy risk."}	Prescribe ≤20mg as a starting dose and adjust doses of atorvastatin based on disease-specific guidelines. If dose >20mg is needed for desired efficacy, consider rosuvastatin or combination therapy (i.e., atorvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"SLCO1B1": "Poor Function"}	{}	{}	{"SLCO1B1": "Poor Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
6725710	100426	RxNorm:83367	{"SLCO1B1": "n/a"}	No recommendation	No Recommendation	{"SLCO1B1": "Indeterminate"}	{}	{}	{"SLCO1B1": "Indeterminate"}	general	n/a	1	f	f	f
6725711	100428	RxNorm:1256	{"TPMT": "n/a", "NUDT15": "n/a"}	Neither TPMT or NUDT15 phenotype could be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte activity to assess TPMT phenotype. If thiopurines are required and either TPMT or NUDT15 status is unknown, monitor closely for toxicity.	Strong	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Indeterminate", "NUDT15": "Indeterminate"}	general	Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions.	1	f	f	f
6725712	100428	RxNorm:1256	{"TPMT": "n/a", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Based on NUDT15 status, start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532). TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating erythrocyte TPMT activity to assess TPMT phenotype. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity.	Strong	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions.	1	f	f	f
6725713	100428	RxNorm:1256	{"TPMT": "n/a", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Based on NUDT15, start with normal starting dose (e.g., 2-3 mg/kg/day) and adjust doses of azathioprine based on disease-specific guidelines. Allow 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506). TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating erythrocyte TPMT activity to assess TPMT phenotype. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity.	Strong	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions.	1	f	f	f
6725714	100428	RxNorm:1256	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Based on NUDT15 status, for non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10-fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment (PMID 16530578, 11302950, 15606506, 16530532, 12477776). TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating erythrocyte TPMT activity to assess TPMT phenotype. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity.	Strong	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions.	1	f	f	f
6725715	100428	RxNorm:1256	{"TPMT": "n/a", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Based on NUDT15 status, start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532). TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating erythrocyte TPMT activity to assess TPMT phenotype. If thiopurines are required and TPMT status is unknown, monitor closely for toxicity.	Strong	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers. Erythrocyte TPMT activity test results can be falsely low at diagnosis of leukemia and is unreliable in the case of recent red blood cell transfusions.	1	f	f	f
6727205	100416	RxNorm:10689	{"CYP2D6": "Expected O-desmethyltramadol (active metabolite) formation"}	Use tramadol label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	general	n/a	1	f	f	f
6725716	100428	RxNorm:1256	{"TPMT": "Moderate to high concentrations of TGN metabolites; low concentrations of MeTIMP. Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "n/a"}	Based on TPMT status, start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532). NUDT15 phenotype could not be assigned based on genotyping. If thiopurines are required and either TPMT or NUDT15 status is unknown, monitor closely for toxicity.	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725717	100428	RxNorm:1256	{"TPMT": "Moderate to high concentrations of TGN metabolites; low concentrations of MeTIMP. Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532).	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725718	100428	RxNorm:1256	{"TPMT": "Moderate to high concentrations of TGN metabolites; low concentrations of MeTIMP. Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532).	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725719	100428	RxNorm:1256	{"TPMT": "Moderate to high concentrations of TGN metabolites; low concentrations of MeTIMP. Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10-fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment (PMID 16530578, 11302950, 15606506, 16530532, 12477776).	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725720	100428	RxNorm:1256	{"TPMT": "Moderate to high concentrations of TGN metabolites; low concentrations of MeTIMP. Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532).	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725721	100428	RxNorm:1256	{"TPMT": "Moderate to high concentrations of TGN metabolites; low concentrations of MeTIMP. Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "n/a"}	Based on TPMT status, start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532). NUDT15 phenotype could not be assigned based on genotyping. If thiopurines are required and NUDT15 status is unknown, monitor closely for toxicity.	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725722	100428	RxNorm:1256	{"TPMT": "Moderate to high concentrations of TGN metabolites; low concentrations of MeTIMP. Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532).	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725723	100428	RxNorm:1256	{"TPMT": "Moderate to high concentrations of TGN metabolites; low concentrations of MeTIMP. Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532).	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725724	100428	RxNorm:1256	{"TPMT": "Moderate to high concentrations of TGN metabolites; low concentrations of MeTIMP. Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10-fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment (PMID 16530578, 11302950, 15606506, 16530532, 12477776).	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725725	100428	RxNorm:1256	{"TPMT": "Moderate to high concentrations of TGN metabolites; low concentrations of MeTIMP. Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Start with reduced starting doses (20%-50% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.4 – 1.5 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. At least 2-4 weeks will be required to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532).	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725726	100428	RxNorm:1256	{"TPMT": "Lower concentrations of TGN metabolites, higher MeTIMP, this is the 'normal' pattern. Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "n/a"}	Based on TPMT status, start with normal starting dose (e.g., 2-3 mg/kg/day) and adjust doses of azathioprine based on disease-specific guidelines. Allow 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506). NUDT15 status could not be determined based on genotyping. If thiopurines are required and NUDT15 status is unknown, monitor closely for toxicity.	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725727	100428	RxNorm:1256	{"TPMT": "Lower concentrations of TGN metabolites, higher MeTIMP, this is the 'normal' pattern. Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532).	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725728	100428	RxNorm:1256	{"TPMT": "Lower concentrations of TGN metabolites, higher MeTIMP, this is the 'normal' pattern. Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Start with normal starting dose (e.g., 2-3 mg/kg/day) and adjust doses of azathioprine based on disease-specific guidelines. Allow 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506).	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725729	100428	RxNorm:1256	{"TPMT": "Lower concentrations of TGN metabolites, higher MeTIMP, this is the 'normal' pattern. Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignant conditions, start with drastically reduced normal daily doses (reduce daily dose by 10-fold) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment (PMID 16530578, 11302950, 15606506, 16530532, 12477776).	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6726490	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	No recommendation for hydrocodone therapy because of minimal evidence regarding adverse events or analgesia.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	n/a	1	f	f	f
6725730	100428	RxNorm:1256	{"TPMT": "Lower concentrations of TGN metabolites, higher MeTIMP, this is the 'normal' pattern. Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Start with reduced starting doses (30%-80% of normal dose) if normal starting dose is 2-3 mg/kg/day (e.g., 0.6 – 2.4 mg/kg/day), and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment (PMID 20354201, 11302950, 15606506, 16530532).	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725731	100428	RxNorm:1256	{"TPMT": "Extremely high concentrations of TGN metabolites; fatal toxicity possible without dose decrease; no MeTIMP metabolites. Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "n/a"}	Based on TPMT status, for non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignancy, start with drastically reduced doses (reduce daily dose by 10-fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment (PMID 16530578, 11302950, 15606506, 16530532, 12477776). NUDT15 status could not be determined based on genotyping. If thiopurines are required and NUDT15 status is unknown, monitor closely for toxicity.	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725732	100428	RxNorm:1256	{"TPMT": "Extremely high concentrations of TGN metabolites; fatal toxicity possible without dose decrease; no MeTIMP metabolites. Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignancy, start with drastically reduced doses (reduce daily dose by 10-fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment (PMID 16530578, 11302950, 15606506, 16530532, 12477776).	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725733	100428	RxNorm:1256	{"TPMT": "Extremely high concentrations of TGN metabolites; fatal toxicity possible without dose decrease; no MeTIMP metabolites. Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignancy, start with drastically reduced doses (reduce daily dose by 10-fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment (PMID 16530578, 11302950, 15606506, 16530532, 12477776).	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725734	100428	RxNorm:1256	{"TPMT": "Extremely high concentrations of TGN metabolites; fatal toxicity possible without dose decrease; no MeTIMP metabolites. Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignancy, start with drastically reduced doses (reduce daily dose by 10-fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment (PMID 16530578, 11302950, 15606506, 16530532, 12477776).	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725735	100428	RxNorm:1256	{"TPMT": "Extremely high concentrations of TGN metabolites; fatal toxicity possible without dose decrease; no MeTIMP metabolites. Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy. For malignancy, start with drastically reduced doses (reduce daily dose by 10-fold and dose thrice weekly instead of daily) and adjust doses of azathioprine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment (PMID 16530578, 11302950, 15606506, 16530532, 12477776).	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{"TPMT": "n/a", "NUDT15": "n/a"}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	general	Normal starting doses vary by race/ethnicity and treatment regimens. If standard dose is below normal recommended dose, dose reduction might not be recommended for intermediate metabolizers.	1	f	f	f
6725779	110058	RxNorm:20890	{"CYP2C9": "Mildly reduced metabolism"}	Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	general	IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age. Further caution should be taken with ibuprofen use in individuals carrying the CYP2C9*2 allele as it is in linkage disequilibrium with CYP2C8*3 and ibuprofen is also metabolized by CYP2C8.	1	f	f	f
6725736	100423	RxNorm:2002	{"HLA-A": "Greater risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"}	If patient is carbamazepine-naïve and alternative agents are available, do not use carbamazepine.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 positive", "HLA-B": "HLA-B*15:02 negative"}	{"HLA-A": "*31:01 positive", "HLA-B": "*15:02 negative"}	CBZ naive	Other aromatic anticonvulsants have very limited evidence, if any, linking SJS/TEN, DRESS, and/or MPE with the HLA-A*31:01 allele, and thus no recommendation can be made with respect to choosing another aromatic anticonvulsant as an alternative agent. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
6725737	100423	RxNorm:2002	{"HLA-A": "n/a", "HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"}	Use carbamazepine per standard dosing guidelines.	Strong	{}	{}	{"HLA-A": "No HLA-A Result", "HLA-B": "HLA-B*15:02 negative"}	{"HLA-A": "No Result", "HLA-B": "*15:02 negative"}	CBZ naive	HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).	1	f	f	f
6725738	100423	RxNorm:2002	{"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Greater risk of carbamazepine-induced SJS/TEN"}	If patient is carbamazepine-naïve, do not use carbamazepine.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 negative", "HLA-B": "HLA-B*15:02 positive"}	{"HLA-A": "*31:01 negative", "HLA-B": "*15:02 positive"}	CBZ naive	Other aromatic anticonvulsants have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent. Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. In addition to HLA-B*15:02, risk for carbamazepine-induced SJS/TEN has been reported in association with the most common B75 serotype alleles in Southeast Asia, HLA-B*15:08, HLA-B*15:11, and HLA-B*15:21. Although not described, the possibility of carbamazepine-induced SJS/TEN in association with less frequently carried B75 serotype alleles, such as HLA-B*15:30 and HLA-B*15:31, should also be considered.	1	f	f	f
6725739	100423	RxNorm:2002	{"HLA-A": "Greater risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Greater risk of carbamazepine-induced SJS/TEN"}	If patient is carbamazepine-naïve, do not use carbamazepine.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 positive", "HLA-B": "HLA-B*15:02 positive"}	{"HLA-A": "*31:01 positive", "HLA-B": "*15:02 positive"}	CBZ naive	Other aromatic anticonvulsants have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent. Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. In addition to HLA-B*15:02, risk for carbamazepine-induced SJS/TEN has been reported in association with the most common B75 serotype alleles in Southeast Asia, HLA-B*15:08, HLA-B*15:11, and HLA-B*15:21. Although not described, the possibility of carbamazepine-induced SJS/TEN in association with less frequently carried B75 serotype alleles, such as HLA-B*15:30 and HLA-B*15:31, should also be considered.	1	f	f	f
6725740	100423	RxNorm:2002	{"HLA-A": "n/a", "HLA-B": "Greater risk of carbamazepine-induced SJS/TEN"}	If patient is carbamazepine-naïve, do not use carbamazepine.	Strong	{}	{}	{"HLA-A": "No HLA-A Result", "HLA-B": "HLA-B*15:02 positive"}	{"HLA-A": "No Result", "HLA-B": "*15:02 positive"}	CBZ naive	Other aromatic anticonvulsants have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent. Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. In addition to HLA-B*15:02, risk for carbamazepine-induced SJS/TEN has been reported in association with the most common B75 serotype alleles in Southeast Asia, HLA-B*15:08, HLA-B*15:11, and HLA-B*15:21. Although not described, the possibility of carbamazepine-induced SJS/TEN in association with less frequently carried B75 serotype alleles, such as HLA-B*15:30 and HLA-B*15:31, should also be considered.	1	f	f	f
6725741	100423	RxNorm:2002	{"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "n/a"}	Use carbamazepine per standard dosing guidelines.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 negative", "HLA-B": "No HLA-B Result"}	{"HLA-A": "*31:01 negative", "HLA-B": "No Result"}	CBZ naive	HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).	1	f	f	f
6725742	100423	RxNorm:2002	{"HLA-A": "Greater risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "n/a"}	If patient is carbamazepine-naïve and alternative agents are available, do not use carbamazepine.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 positive", "HLA-B": "No HLA-B Result"}	{"HLA-A": "*31:01 positive", "HLA-B": "No Result"}	CBZ naive	Other aromatic anticonvulsants have very limited evidence, if any, linking SJS/TEN, DRESS, and/or MPE with the HLA-A*31:01 allele, and thus no recommendation can be made with respect to choosing another aromatic anticonvulsant as an alternative agent. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
6725794	2405438	RxNorm:5521	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	\N	1	f	f	f
6725795	2405438	RxNorm:5521	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	Closer monitoring may be indicated higher-than-normal dosages, and in the setting of infection or other oxidative stress including concomitant use of multiple medium and low-to-no risk drugs	1	f	f	f
6725743	100423	RxNorm:2002	{"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"}	Use carbamazepine per standard dosing guidelines.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 negative", "HLA-B": "HLA-B*15:02 negative"}	{"HLA-A": "*31:01 negative", "HLA-B": "*15:02 negative"}	CBZ naive	HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).	1	f	f	f
6725744	100423	RxNorm:2002	{"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"}	Use carbamazepine per standard dosing guidelines.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 negative", "HLA-B": "HLA-B*15:02 negative"}	{"HLA-A": "*31:01 negative", "HLA-B": "*15:02 negative"}	CBZ-no alternatives	HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).	1	f	f	f
6725745	100423	RxNorm:2002	{"HLA-A": "Greater risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"}	If patient is carbamazepine-naïve and alternative agents are not available, consider the use of carbamazepine with increased frequency of clinical monitoring. Discontinue therapy at first evidence of a cutaneous adverse reaction.	Optional	{}	{}	{"HLA-A": "HLA-A*31:01 positive", "HLA-B": "HLA-B*15:02 negative"}	{"HLA-A": "*31:01 positive", "HLA-B": "*15:02 negative"}	CBZ-no alternatives	n/a	1	f	f	f
6725746	100423	RxNorm:2002	{"HLA-A": "n/a", "HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"}	Use carbamazepine per standard dosing guidelines.	Strong	{}	{}	{"HLA-A": "No HLA-A Result", "HLA-B": "HLA-B*15:02 negative"}	{"HLA-A": "No Result", "HLA-B": "*15:02 negative"}	CBZ-no alternatives	HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).	1	f	f	f
6725747	100423	RxNorm:2002	{"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Greater risk of carbamazepine-induced SJS/TEN"}	If patient is carbamazepine-naïve, do not use carbamazepine.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 negative", "HLA-B": "HLA-B*15:02 positive"}	{"HLA-A": "*31:01 negative", "HLA-B": "*15:02 positive"}	CBZ-no alternatives	Other aromatic anticonvulsants have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent. Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. In addition to HLA-B*15:02, risk for carbamazepine-induced SJS/TEN has been reported in association with the most common B75 serotype alleles in Southeast Asia, HLA-B*15:08, HLA-B*15:11, and HLA-B*15:21. Although not described, the possibility of carbamazepine-induced SJS/TEN in association with less frequently carried B75 serotype alleles, such as HLA-B*15:30 and HLA-B*15:31, should also be considered.	1	f	f	f
6725748	100423	RxNorm:2002	{"HLA-A": "Greater risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Greater risk of carbamazepine-induced SJS/TEN"}	If patient is carbamazepine-naïve, do not use carbamazepine.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 positive", "HLA-B": "HLA-B*15:02 positive"}	{"HLA-A": "*31:01 positive", "HLA-B": "*15:02 positive"}	CBZ-no alternatives	Other aromatic anticonvulsants have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent. Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. In addition to HLA-B*15:02, risk for carbamazepine-induced SJS/TEN has been reported in association with the most common B75 serotype alleles in Southeast Asia, HLA-B*15:08, HLA-B*15:11, and HLA-B*15:21. Although not described, the possibility of carbamazepine-induced SJS/TEN in association with less frequently carried B75 serotype alleles, such as HLA-B*15:30 and HLA-B*15:31, should also be considered.	1	f	f	f
6725749	100423	RxNorm:2002	{"HLA-A": "n/a", "HLA-B": "Greater risk of carbamazepine-induced SJS/TEN"}	If patient is carbamazepine-naïve, do not use carbamazepine.	Strong	{}	{}	{"HLA-A": "No HLA-A Result", "HLA-B": "HLA-B*15:02 positive"}	{"HLA-A": "No Result", "HLA-B": "*15:02 positive"}	CBZ-no alternatives	Other aromatic anticonvulsants have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent. Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. In addition to HLA-B*15:02, risk for carbamazepine-induced SJS/TEN has been reported in association with the most common B75 serotype alleles in Southeast Asia, HLA-B*15:08, HLA-B*15:11, and HLA-B*15:21. Although not described, the possibility of carbamazepine-induced SJS/TEN in association with less frequently carried B75 serotype alleles, such as HLA-B*15:30 and HLA-B*15:31, should also be considered.	1	f	f	f
6725750	100423	RxNorm:2002	{"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "n/a"}	Use carbamazepine per standard dosing guidelines.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 negative", "HLA-B": "No HLA-B Result"}	{"HLA-A": "*31:01 negative", "HLA-B": "No Result"}	CBZ-no alternatives	HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).	1	f	f	f
6725752	100423	RxNorm:2002	{"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"}	Use carbamazepine per standard dosing guidelines.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 negative", "HLA-B": "HLA-B*15:02 negative"}	{"HLA-A": "*31:01 negative", "HLA-B": "*15:02 negative"}	CBZ use >3mos 	HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).	1	f	f	f
6725753	100423	RxNorm:2002	{"HLA-A": "Greater risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"}	The latency period for cutaneous adverse drug reactions is variable depending on phenotype; however, all usually occur within three months of regular dosing. Therefore, if the patient has previously used carbamazepine consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of carbamazepine.	Optional	{}	{}	{"HLA-A": "HLA-A*31:01 positive", "HLA-B": "HLA-B*15:02 negative"}	{"HLA-A": "*31:01 positive", "HLA-B": "*15:02 negative"}	CBZ use >3mos 	Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital.	1	f	f	f
6725754	100423	RxNorm:2002	{"HLA-A": "n/a", "HLA-B": "Normal risk of carbamazepine-induced SJS/TEN"}	Use carbamazepine per standard dosing guidelines.	Strong	{}	{}	{"HLA-A": "No HLA-A Result", "HLA-B": "HLA-B*15:02 negative"}	{"HLA-A": "No Result", "HLA-B": "*15:02 negative"}	CBZ use >3mos 	HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).	1	f	f	f
6725755	100423	RxNorm:2002	{"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Greater risk of carbamazepine-induced SJS/TEN"}	The latency period for drug-induced SJS/TEN is short with continuous dosing and adherence to therapy (~4-28 days), and cases usually occur within three months of dosing; therefore, if the patient has previously used carbamazepine consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of carbamazepine in the future.	Optional	{}	{}	{"HLA-A": "HLA-A*31:01 negative", "HLA-B": "HLA-B*15:02 positive"}	{"HLA-A": "*31:01 negative", "HLA-B": "*15:02 positive"}	CBZ use >3mos 	Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. In addition to HLA-B*15:02, risk for carbamazepine-induced SJS/TEN has been reported in association with the most common B75 serotype alleles in Southeast Asia, HLA-B*15:08, HLA-B*15:11, and HLA-B*15:21. Although not described, the possibility of carbamazepine-induced SJS/TEN in association with less frequently carried B75 serotype alleles, such as HLA-B*15:30 and HLA-B*15:31, should also be considered.	1	f	f	f
6725756	100423	RxNorm:2002	{"HLA-A": "Greater risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "Greater risk of carbamazepine-induced SJS/TEN"}	The latency period for drug-induced SJS/TEN is short with continuous dosing and adherence to therapy (~4-28 days), and cases usually occur within three months of dosing; therefore, if the patient has previously used carbamazepine consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of carbamazepine in the future.	Optional	{}	{}	{"HLA-A": "HLA-A*31:01 positive", "HLA-B": "HLA-B*15:02 positive"}	{"HLA-A": "*31:01 positive", "HLA-B": "*15:02 positive"}	CBZ use >3mos 	Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. In addition to HLA-B*15:02, risk for carbamazepine-induced SJS/TEN has been reported in association with the most common B75 serotype alleles in Southeast Asia, HLA-B*15:08, HLA-B*15:11, and HLA-B*15:21. Although not described, the possibility of carbamazepine-induced SJS/TEN in association with less frequently carried B75 serotype alleles, such as HLA-B*15:30 and HLA-B*15:31, should also be considered.	1	f	f	f
6725757	100423	RxNorm:2002	{"HLA-A": "n/a", "HLA-B": "Greater risk of carbamazepine-induced SJS/TEN"}	The latency period for drug-induced SJS/TEN is short with continuous dosing and adherence to therapy (~4-28 days), and cases usually occur within three months of dosing; therefore, if the patient has previously used carbamazepine consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of carbamazepine in the future.	Optional	{}	{}	{"HLA-A": "No HLA-A Result", "HLA-B": "HLA-B*15:02 positive"}	{"HLA-A": "No Result", "HLA-B": "*15:02 positive"}	CBZ use >3mos 	Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital. In addition to HLA-B*15:02, risk for carbamazepine-induced SJS/TEN has been reported in association with the most common B75 serotype alleles in Southeast Asia, HLA-B*15:08, HLA-B*15:11, and HLA-B*15:21. Although not described, the possibility of carbamazepine-induced SJS/TEN in association with less frequently carried B75 serotype alleles, such as HLA-B*15:30 and HLA-B*15:31, should also be considered.	1	f	f	f
6725758	100423	RxNorm:2002	{"HLA-A": "Normal risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "n/a"}	Use carbamazepine per standard dosing guidelines.	Strong	{}	{}	{"HLA-A": "HLA-A*31:01 negative", "HLA-B": "No HLA-B Result"}	{"HLA-A": "*31:01 negative", "HLA-B": "No Result"}	CBZ use >3mos 	HLA-B*15:02 has a 100% negative predictive value for carbamazepine-induced SJS/TEN, and its use is currently recommended to guide use of carbamazepine and oxcarbazepine only. Because there is a much weaker association and less than 100% negative predictive value of HLA-B*15:02 for SJS/TEN associated with other aromatic anticonvulsants, using these drugs instead of carbamazepine or oxcarbazepine in the setting of a negative HLA-B*15:02 test in Southeast Asians will not result in prevention of anticonvulsant-associated SJS/TEN (PMID 25355835).	1	f	f	f
6727206	100416	RxNorm:10689	{"CYP2D6": "Expected O-desmethyltramadol (active metabolite) formation"}	Use tramadol label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	general	n/a	1	f	f	f
6725759	100423	RxNorm:2002	{"HLA-A": "Greater risk of carbamazepine-induced SJS/TEN, DRESS, and MPE", "HLA-B": "n/a"}	The latency period for cutaneous adverse drug reactions is variable depending on phenotype; however, all usually occur within three months of regular dosing. Therefore, if the patient has previously used carbamazepine consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of carbamazepine.	Optional	{}	{}	{"HLA-A": "HLA-A*31:01 positive", "HLA-B": "No HLA-B Result"}	{"HLA-A": "*31:01 positive", "HLA-B": "No Result"}	CBZ use >3mos 	Previous tolerance of carbamazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital.	1	f	f	f
6725760	110058	RxNorm:140587	{"CYP2C9": "Normal metabolism"}	Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.	Strong	{"CYP2C9": "Normal Metabolizer"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	general	n/a	1	f	f	f
6725761	110058	RxNorm:140587	{"CYP2C9": "Mildly reduced metabolism"}	Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	general	IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age. Further caution should be taken with ibuprofen use in individuals carrying the CYP2C9*2 allele as it is in linkage disequilibrium with CYP2C8*3 and ibuprofen is also metabolized by CYP2C8.	1	f	f	f
6725762	110058	RxNorm:140587	{"CYP2C9": "Moderately reduced metabolism; higher plasma concentrations may increase probability of toxicities"}	Initiate therapy with lowest recommended starting dose. Titrate dose upward to clinical effect or maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	general	IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age. Further caution should be taken with ibuprofen use in individuals carrying the CYP2C9*2 allele as it is in linkage disequilibrium with CYP2C8*3 and ibuprofen is also metabolized by CYP2C8.	1	f	f	f
6725763	110058	RxNorm:140587	{"CYP2C9": "Significantly reduced metabolism and prolonged half-life; higher plasma concentrations may increase probability and/or severity of toxicities"}	Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose upward to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Upward dose titration should not occur until after steady state is reached (at least 8 days for celecoxib after first dose in PMs). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo.	Moderate	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
6725764	110058	RxNorm:140587	{"CYP2C9": "Significantly reduced metabolism and prolonged half-life; higher plasma concentrations may increase probability and/or severity of toxicities"}	Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose upward to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Upward dose titration should not occur until after steady state is reached (at least 8 days for celecoxib after first dose in PMs). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo.	Moderate	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
6725765	110058	RxNorm:140587	{"CYP2C9": "n/a"}	No recommendation	No Recommendation	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	general	n/a	1	f	f	f
6725766	110058	RxNorm:4502	{"CYP2C9": "Normal metabolism"}	Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.	Strong	{"CYP2C9": "Normal Metabolizer"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	general	n/a	1	f	f	f
6725767	110058	RxNorm:4502	{"CYP2C9": "Mildly reduced metabolism"}	Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	general	IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age. Further caution should be taken with ibuprofen use in individuals carrying the CYP2C9*2 allele as it is in linkage disequilibrium with CYP2C8*3 and ibuprofen is also metabolized by CYP2C8.	1	f	f	f
6725768	110058	RxNorm:4502	{"CYP2C9": "Moderately reduced metabolism; higher plasma concentrations may increase probability of toxicities"}	Initiate therapy with lowest recommended starting dose. Titrate dose upward to clinical effect or maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	general	IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age. Further caution should be taken with ibuprofen use in individuals carrying the CYP2C9*2 allele as it is in linkage disequilibrium with CYP2C8*3 and ibuprofen is also metabolized by CYP2C8.	1	f	f	f
6725769	110058	RxNorm:4502	{"CYP2C9": "Significantly reduced metabolism and prolonged half-life; higher plasma concentrations may increase probability and/or severity of toxicities"}	Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose upward to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Upward dose titration should not occur until after steady state is reached (at least 8 days for celecoxib after first dose in PMs). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo.	Moderate	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
6725770	110058	RxNorm:4502	{"CYP2C9": "Significantly reduced metabolism and prolonged half-life; higher plasma concentrations may increase probability and/or severity of toxicities"}	Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose upward to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Upward dose titration should not occur until after steady state is reached (at least 8 days for celecoxib after first dose in PMs). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo.	Moderate	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
6725771	110058	RxNorm:4502	{"CYP2C9": "n/a"}	No recommendation	No Recommendation	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	general	n/a	1	f	f	f
6725772	110058	RxNorm:5640	{"CYP2C9": "Normal metabolism"}	Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.	Strong	{"CYP2C9": "Normal Metabolizer"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	general	n/a	1	f	f	f
6725773	110058	RxNorm:5640	{"CYP2C9": "Mildly reduced metabolism"}	Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	general	IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age. Further caution should be taken with ibuprofen use in individuals carrying the CYP2C9*2 allele as it is in linkage disequilibrium with CYP2C8*3 and ibuprofen is also metabolized by CYP2C8.	1	f	f	f
6725774	110058	RxNorm:5640	{"CYP2C9": "Moderately reduced metabolism; higher plasma concentrations may increase probability of toxicities"}	Initiate therapy with lowest recommended starting dose. Titrate dose upward to clinical effect or maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	general	IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age. Further caution should be taken with ibuprofen use in individuals carrying the CYP2C9*2 allele as it is in linkage disequilibrium with CYP2C8*3 and ibuprofen is also metabolized by CYP2C8.	1	f	f	f
6725775	110058	RxNorm:5640	{"CYP2C9": "Significantly reduced metabolism and prolonged half-life; higher plasma concentrations may increase probability and/or severity of toxicities"}	Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose upward to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Upward dose titration should not occur until after steady state is reached (at least 8 days for celecoxib after first dose in PMs). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo.	Moderate	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
6725776	110058	RxNorm:5640	{"CYP2C9": "Significantly reduced metabolism and prolonged half-life; higher plasma concentrations may increase probability and/or severity of toxicities"}	Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose upward to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Upward dose titration should not occur until after steady state is reached (at least 8 days for celecoxib after first dose in PMs). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo.	Moderate	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
6725777	110058	RxNorm:5640	{"CYP2C9": "n/a"}	No recommendation	No Recommendation	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	general	n/a	1	f	f	f
6725778	110058	RxNorm:20890	{"CYP2C9": "Normal metabolism"}	Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.	Strong	{"CYP2C9": "Normal Metabolizer"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0"}	general	n/a	1	f	f	f
6725780	110058	RxNorm:20890	{"CYP2C9": "Moderately reduced metabolism; higher plasma concentrations may increase probability of toxicities"}	Initiate therapy with lowest recommended starting dose. Titrate dose upward to clinical effect or maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Carefully monitor adverse events such as blood pressure and kidney function during course of therapy.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	general	IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age. Further caution should be taken with ibuprofen use in individuals carrying the CYP2C9*2 allele as it is in linkage disequilibrium with CYP2C8*3 and ibuprofen is also metabolized by CYP2C8.	1	f	f	f
6725781	110058	RxNorm:20890	{"CYP2C9": "Significantly reduced metabolism and prolonged half-life; higher plasma concentrations may increase probability and/or severity of toxicities"}	Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose upward to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Upward dose titration should not occur until after steady state is reached (at least 8 days for celecoxib after first dose in PMs). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo.	Moderate	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
6725782	110058	RxNorm:20890	{"CYP2C9": "Significantly reduced metabolism and prolonged half-life; higher plasma concentrations may increase probability and/or severity of toxicities"}	Initiate therapy with 25-50% of the lowest recommended starting dose. Titrate dose upward to clinical effect or 25-50% of the maximum recommended dose with caution. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals. Upward dose titration should not occur until after steady state is reached (at least 8 days for celecoxib after first dose in PMs). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider an alternate therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo.	Moderate	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
6725783	110058	RxNorm:20890	{"CYP2C9": "n/a"}	No recommendation	No Recommendation	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	general	n/a	1	f	f	f
6725784	2405438	RxNorm:2348	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	\N	1	f	f	f
6725785	2405438	RxNorm:2348	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	Closer monitoring may be indicated higher-than-normal dosages, and in the setting of infection or other oxidative stress including concomitant use of multiple medium and low-to-no risk drugs	1	f	f	f
6725786	2405438	RxNorm:2348	{"G6PD": "High risk of acute exacerbation of chronic hemolysis"}	Use drug cautiously; if used, close monitoring for acute exacerbation of chronic hemolysis is recommended	Optional	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	general	There are insufficient data in patients with the G6PD Deficient with CNSHA phenotype, but the risk of using any drug should be weighed carefully against the benefits in these rare patients due to the underlying pathophysiology that confers high risk for acute on chronic hemolysis	1	f	f	f
6725787	2405438	RxNorm:2348	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	general	Due to X-linked mosaicism, individuals with more than one X chromosome (e.g., females, individuals with Klinefelter syndrome) and heterozygous for one non-deficient (class IV) and one deficient (class I–III) allele may display a normal or a deficient phenotype.	1	f	f	f
6725788	2405438	RxNorm:2348	{"G6PD": "Unknown risk of acute hemolytic anemia"}	To ascertain G6PD status, enzyme activity must be measured. Drug use should be guided per the recommendations based on the activity-based phenotype.	Moderate	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	general	\N	1	f	f	f
6725789	2405438	RxNorm:2393	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	\N	1	f	f	f
6725790	2405438	RxNorm:2393	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	Closer monitoring may be indicated higher-than-normal dosages, and in the setting of infection or other oxidative stress including concomitant use of multiple medium and low-to-no risk drugs	1	f	f	f
6725791	2405438	RxNorm:2393	{"G6PD": "High risk of acute exacerbation of chronic hemolysis"}	Use drug cautiously; if used, close monitoring for acute exacerbation of chronic hemolysis is recommended	Optional	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	general	There are insufficient data in patients with the G6PD Deficient with CNSHA phenotype, but the risk of using any drug should be weighed carefully against the benefits in these rare patients due to the underlying pathophysiology that confers high risk for acute on chronic hemolysis	1	f	f	f
6725792	2405438	RxNorm:2393	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	general	Due to X-linked mosaicism, individuals with more than one X chromosome (e.g., females, individuals with Klinefelter syndrome) and heterozygous for one non-deficient (class IV) and one deficient (class I–III) allele may display a normal or a deficient phenotype.	1	f	f	f
6725793	2405438	RxNorm:2393	{"G6PD": "Unknown risk of acute hemolytic anemia"}	To ascertain G6PD status, enzyme activity must be measured. Drug use should be guided per the recommendations based on the activity-based phenotype.	Moderate	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	general	\N	1	f	f	f
6725801	2405438	RxNorm:1151	{"G6PD": "High risk of acute exacerbation of chronic hemolysis"}	Use drug cautiously; if used, close monitoring for acute exacerbation of chronic hemolysis is recommended	Optional	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	general	There are insufficient data in patients with the G6PD Deficient with CNSHA phenotype, but the risk of using any drug should be weighed carefully against the benefits in these rare patients due to the underlying pathophysiology that confers high risk for acute on chronic hemolysis	1	f	f	f
6725802	2405438	RxNorm:1151	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	general	Due to X-linked mosaicism, individuals with more than one X chromosome (e.g., females, individuals with Klinefelter syndrome) and heterozygous for one non-deficient (class IV) and one deficient (class I–III) allele may display a normal or a deficient phenotype.	1	f	f	f
6725803	2405438	RxNorm:1151	{"G6PD": "Unknown risk of acute hemolytic anemia"}	To ascertain G6PD status, enzyme activity must be measured. Drug use should be guided per the recommendations based on the activity-based phenotype.	Moderate	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	general	\N	1	f	f	f
6725804	2405438	RxNorm:11258	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	\N	1	f	f	f
6725805	2405438	RxNorm:11258	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	Closer monitoring may be indicated higher-than-normal dosages, and in the setting of infection or other oxidative stress including concomitant use of multiple medium and low-to-no risk drugs	1	f	f	f
6725806	2405438	RxNorm:11258	{"G6PD": "High risk of acute exacerbation of chronic hemolysis"}	Use drug cautiously; if used, close monitoring for acute exacerbation of chronic hemolysis is recommended	Optional	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	general	There are insufficient data in patients with the G6PD Deficient with CNSHA phenotype, but the risk of using any drug should be weighed carefully against the benefits in these rare patients due to the underlying pathophysiology that confers high risk for acute on chronic hemolysis	1	f	f	f
6725807	2405438	RxNorm:11258	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Moderate	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	general	Due to X-linked mosaicism, individuals with more than one X chromosome (e.g., females, individuals with Klinefelter syndrome) and heterozygous for one non-deficient (class IV) and one deficient (class I–III) allele may display a normal or a deficient phenotype.	1	f	f	f
6725808	2405438	RxNorm:11258	{"G6PD": "Unknown risk of acute hemolytic anemia"}	To ascertain G6PD status, enzyme activity must be measured. Drug use should be guided per the recommendations based on the activity-based phenotype.	Moderate	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	general	\N	1	f	f	f
6725809	100413	RxNorm:2556	{"CYP2C19": "Increased metabolism of citalopram and escitalopram to less active compounds when compared to CYP2C19 rapid and normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. If citalopram or escitalopram are clinically appropriate, and adequate efficacy is not achieved at standard maintenance dosing, consider titrating to a higher maintenance dose.	Strong	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when adjusting dose or selecting an alternative therapy.	1	f	f	f
6725810	100413	RxNorm:2556	{"CYP2C19": "Increase in metabolism of citalopram and escitalopram to less active compounds when compared to CYP2C19 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher maintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Optional	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Rapid Metabolizer"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when adjusting dose or selecting an alternative therapy.	1	f	f	f
6725811	100413	RxNorm:2556	{"CYP2C19": "Normal metabolism"}	Initiate therapy with recommended starting dose	Strong	{"CYP2C19": "Normal Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725812	100413	RxNorm:2556	{"CYP2C19": "Reduced metabolism when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.	Moderate	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when adjusting dose.	1	f	f	f
6725813	100413	RxNorm:2556	{"CYP2C19": "Reduced metabolism when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.	Moderate	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Intermediate Metabolizer"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when adjusting dose.	1	f	f	f
6725814	100413	RxNorm:2556	{"CYP2C19": "Reduced metabolism of citalopram and escitalopram to less active compounds when compared to CYP2C19 normal and intermediate metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a clinically appropriate antidepressant not predominantly metabolized by CYP2C19. If citalopram or escitalopram are clinically appropriate, consider a lower starting dose, slower titration schedule and 50% reduction of the standard maintenance dose as compared to normal metabolizers.	Strong	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	general	Per the FDA warning, citalopram 20 mg/day is the maximum recommended dose in CYP2C19 poor metabolizers due to the risk of QT prolongation. FDA product labeling additionally cautions that citalopram dose should be limited to 20 mg/day in patients with hepatic impairment, those taking a CYP2C19 inhibitor, and patients greater than 60 years of age.	1	f	f	f
6725815	100413	RxNorm:2556	{"CYP2C19": "Reduced metabolism of citalopram and escitalopram to less active compounds when compared to CYP2C19 normal and intermediate metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a clinically appropriate antidepressant not predominantly metabolized by CYP2C19. If citalopram or escitalopram are clinically appropriate, consider a lower starting dose, slower titration schedule and 50% reduction of the standard maintenance dose as compared to normal metabolizers.	Strong	{"CYP2C19": "Poor Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Poor Metabolizer"}	general	Per the FDA warning, citalopram 20 mg/day is the maximum recommended dose in CYP2C19 poor metabolizers due to the risk of QT prolongation. FDA product labeling additionally cautions that citalopram dose should be limited to 20 mg/day in patients with hepatic impairment, those taking a CYP2C19 inhibitor, and patients greater than 60 years of age.	1	f	f	f
6725816	100413	RxNorm:2556	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725817	100413	RxNorm:321988	{"CYP2C19": "Increased metabolism of citalopram and escitalopram to less active compounds when compared to CYP2C19 rapid and normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19. If citalopram or escitalopram are clinically appropriate, and adequate efficacy is not achieved at standard maintenance dosing, consider titrating to a higher maintenance dose.	Strong	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when adjusting dose or selecting an alternative therapy.	1	f	f	f
6725818	100413	RxNorm:321988	{"CYP2C19": "Increase in metabolism of citalopram and escitalopram to less active compounds when compared to CYP2C19 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher maintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Optional	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Rapid Metabolizer"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when adjusting dose or selecting an alternative therapy.	1	f	f	f
6725819	100413	RxNorm:321988	{"CYP2C19": "Normal metabolism"}	Initiate therapy with recommended starting dose	Strong	{"CYP2C19": "Normal Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725820	100413	RxNorm:321988	{"CYP2C19": "Reduced metabolism when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.	Moderate	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when adjusting dose.	1	f	f	f
6725821	100413	RxNorm:321988	{"CYP2C19": "Reduced metabolism when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.	Moderate	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Intermediate Metabolizer"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when adjusting dose.	1	f	f	f
6725822	100413	RxNorm:321988	{"CYP2C19": "Reduced metabolism of citalopram and escitalopram to less active compounds when compared to CYP2C19 normal and intermediate metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a clinically appropriate antidepressant not predominantly metabolized by CYP2C19. If citalopram or escitalopram are clinically appropriate, consider a lower starting dose, slower titration schedule and 50% reduction of the standard maintenance dose as compared to normal metabolizers.	Strong	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	general	Per the FDA warning, citalopram 20 mg/day is the maximum recommended dose in CYP2C19 poor metabolizers due to the risk of QT prolongation. FDA product labeling additionally cautions that citalopram dose should be limited to 20 mg/day in patients with hepatic impairment, those taking a CYP2C19 inhibitor, and patients greater than 60 years of age.	1	f	f	f
6725823	100413	RxNorm:321988	{"CYP2C19": "Reduced metabolism of citalopram and escitalopram to less active compounds when compared to CYP2C19 normal and intermediate metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a clinically appropriate antidepressant not predominantly metabolized by CYP2C19. If citalopram or escitalopram are clinically appropriate, consider a lower starting dose, slower titration schedule and 50% reduction of the standard maintenance dose as compared to normal metabolizers.	Strong	{"CYP2C19": "Poor Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Poor Metabolizer"}	general	Per the FDA warning, citalopram 20 mg/day is the maximum recommended dose in CYP2C19 poor metabolizers due to the risk of QT prolongation. FDA product labeling additionally cautions that citalopram dose should be limited to 20 mg/day in patients with hepatic impairment, those taking a CYP2C19 inhibitor, and patients greater than 60 years of age.	1	f	f	f
6725824	100413	RxNorm:321988	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725831	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Normal metabolism of tertiary amines"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725825	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Consider a 25% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725826	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Consider a 25% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725827	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Consider a 25% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725828	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Consider a 25% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725829	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Normal metabolism of tertiary amines"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725830	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Normal metabolism of tertiary amines"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6726491	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	No recommendation for hydrocodone therapy because of minimal evidence regarding adverse events or analgesia.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	n/a	1	f	f	f
6725832	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Normal metabolism of tertiary amines"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725833	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725834	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725835	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725836	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6726492	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	No recommendation for hydrocodone therapy because of minimal evidence regarding adverse events or analgesia.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	n/a	1	f	f	f
6725837	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725838	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725839	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725840	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725841	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725870	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Normal metabolism of tertiary amines"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725842	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725843	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725844	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725845	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Indeterminate"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725846	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Indeterminate"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725847	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Indeterminate"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6727207	100416	RxNorm:10689	{"CYP2D6": "Expected O-desmethyltramadol (active metabolite) formation"}	Use tramadol label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	general	n/a	1	f	f	f
6725848	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Indeterminate"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725849	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Consider a 25% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725850	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Consider a 25% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725851	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Consider a 25% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725852	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Consider a 25% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725858	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725853	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725854	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.5", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725855	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725856	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725857	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "0.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.25", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6726493	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	No recommendation for hydrocodone therapy because of minimal evidence regarding adverse events or analgesia.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	n/a	1	f	f	f
6725859	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "0.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.75", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725860	100414	RxNorm:2597	{"CYP2D6": "Reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Consider a 25% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "1.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.0", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725861	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725862	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725863	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725864	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725865	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725866	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Normal metabolism of tertiary amines"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725867	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Normal metabolism of tertiary amines"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725868	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Normal metabolism of tertiary amines"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725869	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Normal metabolism of tertiary amines"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725871	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use. If clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725872	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use. If clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725873	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use. If clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725874	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use. If clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725875	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use. If clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725876	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725895	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725877	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725878	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725879	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725880	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725881	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725882	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725904	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6726494	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	No recommendation for hydrocodone therapy because of minimal evidence regarding adverse events or analgesia.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	n/a	1	f	f	f
6725883	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725884	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725885	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Consider alternative drug not metabolized by CYP2C19; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725886	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	No recommendation	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725887	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	No recommendation	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725888	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	No recommendation	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725889	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	No recommendation	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725890	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	No recommendation	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725891	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725892	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725893	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725894	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725896	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use. If clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725897	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use. If clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725898	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use. If clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725899	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use. If clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725900	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use. If clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.25", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\n for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725901	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "1.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.25", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725902	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "1.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.5", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725903	100414	RxNorm:2597	{"CYP2D6": "Normal metabolism of TCAs", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "1.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "1.75", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725906	100414	RxNorm:2597	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use. If a clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725907	100414	RxNorm:2597	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use. If a clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725908	100414	RxNorm:2597	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725909	100414	RxNorm:2597	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725910	100414	RxNorm:2597	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725911	100414	RxNorm:2597	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Indeterminate"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6727208	100416	RxNorm:10689	{"CYP2D6": "Expected O-desmethyltramadol (active metabolite) formation"}	Use tramadol label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	general	n/a	1	f	f	f
6725912	100414	RxNorm:2597	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use. If a clomipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725913	100414	RxNorm:2597	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725914	100414	RxNorm:2597	{"CYP2D6": "Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider a 50% reduction of recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Poor Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "0.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "0.0", "CYP2C19": "No Result"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose. Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain.	1	f	f	f
6725915	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725916	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725917	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725918	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725919	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725920	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725921	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725922	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725923	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725924	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725925	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725926	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6726495	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	No recommendation for hydrocodone therapy because of minimal evidence regarding adverse events or analgesia.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	n/a	1	f	f	f
6725927	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725928	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725929	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725930	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725931	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725932	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725933	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725934	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725935	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725936	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Normal metabolism of tertiary amines"}	Avoid clomipramine use; If clomipramine is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustment.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6725974	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725937	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725938	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725939	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725940	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725941	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725942	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725943	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725944	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725945	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725946	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725947	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725948	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725949	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725950	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725951	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725952	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725953	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725954	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725955	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725956	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725957	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725958	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725959	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725960	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725961	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725962	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725963	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725964	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725965	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725966	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725967	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725968	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725969	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations\nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate, or poor metabolism in combination with CYP2C19 ultrarapid, intermediate, or poor metabolism is strongly recommended	1	f	f	f
6725970	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725971	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725972	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725973	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6726024	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Normal metabolism of tertiary amines"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "No Result", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "No Result", "CYP2C19": "n/a"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Normal Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6725975	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725976	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725977	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725978	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725979	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725980	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6725981	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725982	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725983	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725984	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725985	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725986	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725987	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725988	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725989	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725990	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725991	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725992	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725993	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725994	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725995	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725996	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725997	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725998	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6725999	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6726000	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6726001	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6726002	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid clomipramine use; If clomipramine is warranted, utilize therapeutic drug monitoring to guide dose adjustment. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations \nfor conditions where lower initial doses are used, such as neuropathic pain. Utilizing therapeutic drug monitoring if a tricyclic is prescribed to a patient with CYP2D6 ultrarapid, intermediate or poor metabolism in combination with CYP2C19 ultrarapid, intermediate or poor metabolism is strongly recommended.	1	f	f	f
6726003	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726074	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	n/a	1	f	f	f
6726004	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "3.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726005	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726006	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "4.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726007	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥3.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726008	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥3.25", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.25", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726009	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥3.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.5", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726010	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥4.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥4.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726011	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥3.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥3.75", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726012	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥5.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥5.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726075	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	n/a	1	f	f	f
6726013	100414	RxNorm:2597	{"CYP2D6": "Increased metabolism of TCAs to less active compounds compared to normal metabolizers; Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure", "CYP2C19": "n/a"}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a TCA is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2D6": "≥6.0", "CYP2C19": "n/a"}	{}	{"CYP2D6": "≥6.0", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726014	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	No recommendation	Optional	{"CYP2D6": "Indeterminate", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
6726015	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Normal metabolism of tertiary amines"}	No recommendation	Strong	{"CYP2D6": "Indeterminate", "CYP2C19": "Normal Metabolizer"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
6726016	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid tertiary amine use due to potential for sub-optimal response. Consider alternative drug not metabolized by CYP2C19. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. For tertiary amines, consider a 50% reduction of the recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Indeterminate", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6726017	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid tertiary amine use due to potential for sub-optimal response. Consider alternative drug not metabolized by CYP2C19. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. If a tertiary amine is warranted, utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Indeterminate", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	1	f	f	f
6726018	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid tertiary amine use due to potential for sub-optimal response. Consider alternative drug not metabolized by CYP2C19. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. If a tertiary amine is warranted, utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Indeterminate", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	1	f	f	f
6726019	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	No recommendation	Optional	{"CYP2D6": "Indeterminate", "CYP2C19": "Indeterminate"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6726020	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	No recommendation	Optional	{"CYP2D6": "Indeterminate", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Likely Intermediate Metabolizer"}	general	n/a	1	f	f	f
6726021	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid tertiary amine use due to potential for sub-optimal response. Consider alternative drug not metabolized by CYP2C19. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. For tertiary amines, consider a 50% reduction of the recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "Indeterminate", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6726022	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	No recommendation	Optional	{"CYP2D6": "Indeterminate", "CYP2C19": "No Result"}	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2D6": "n/a", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
6726023	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "No Result", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2D6": "No Result", "CYP2C19": "n/a"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6726025	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid tertiary amine use due to potential for sub-optimal response. Consider alternative drug not metabolized by CYP2C19. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. For tertiary amines, consider a 50% reduction of the recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "No Result", "CYP2C19": "Poor Metabolizer"}	{"CYP2D6": "No Result", "CYP2C19": "n/a"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6726026	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid tertiary amine use due to potential for sub-optimal response. Consider alternative drug not metabolized by CYP2C19. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. If a tertiary amine is warranted, utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "No Result", "CYP2C19": "Rapid Metabolizer"}	{"CYP2D6": "No Result", "CYP2C19": "n/a"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Rapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	1	f	f	f
6726027	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid tertiary amine use due to potential for sub-optimal response. Consider alternative drug not metabolized by CYP2C19. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. If a tertiary amine is warranted, utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "No Result", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2D6": "No Result", "CYP2C19": "n/a"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Ultrarapid Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. See other considerations for dosing recommendations for conditions where lower initial doses are used, such as neuropathic pain. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	1	f	f	f
6726028	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "n/a"}	No recommendation	Optional	{"CYP2D6": "No Result", "CYP2C19": "Indeterminate"}	{"CYP2D6": "No Result", "CYP2C19": "n/a"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
6726029	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Reduced metabolism of tertiary amines compared to normal metabolizers"}	Initiate therapy with recommended starting dose.	Optional	{"CYP2D6": "No Result", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2D6": "No Result", "CYP2C19": "n/a"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Likely Intermediate Metabolizer"}	general	Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6726030	100414	RxNorm:2597	{"CYP2D6": "n/a", "CYP2C19": "Greatly reduced metabolism of tertiary amines compared to normal metabolizers; Decreased conversion of tertiary amines to secondary amines may affect response or side effects"}	Avoid tertiary amine use due to potential for sub-optimal response. Consider alternative drug not metabolized by CYP2C19. TCAs without major CYP2C19 metabolism include the secondary amines nortriptyline and desipramine. For tertiary amines, consider a 50% reduction of the recommended starting dose. Utilize therapeutic drug monitoring to guide dose adjustments. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects.	Optional	{"CYP2D6": "No Result", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2D6": "No Result", "CYP2C19": "n/a"}	{}	{"CYP2D6": "No Result", "CYP2C19": "Likely Poor Metabolizer"}	general	Dosing recommendations only apply to higher initial doses of TCAs for treatment of conditions such as depression. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Patients may receive an initial low dose of a tricyclic, which is then increased over several days to the recommended steady-state dose. The starting dose in this guideline refers to the recommended steady-state dose.	1	f	f	f
6726031	100411	RxNorm:32968	{"CYP2C19": "Increased clopidogrel active metabolite formation; lower on-treatment platelet reactivity; no association with higher bleeding risk"}	If considering clopidogrel, use at standard dose (75 mg/day)	Strong	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	CVI ACS PCI 	For cardiovascular indications of acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI). ACS and/or PCI includes patients undergoing PCI for an ACS or non-ACS (elective) indication.	1	f	f	f
6726032	100411	RxNorm:32968	{"CYP2C19": "Normal or increased clopidogrel active metabolite formation; normal or lower on-treatment platelet reactivity; no association with higher bleeding risk"}	If considering clopidogrel, use at standard dose (75 mg/day)	Strong	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	CVI ACS PCI 	For cardiovascular indications of acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI). ACS and/or PCI includes patients undergoing PCI for an ACS or non-ACS (elective) indication.	1	f	f	f
6726033	100411	RxNorm:32968	{"CYP2C19": "Normal clopidogrel active metabolite formation; normal on-treatment platelet reactivity"}	If considering clopidogrel, use at standard dose (75 mg/day)	Strong	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	CVI ACS PCI 	For cardiovascular indications of acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI). ACS and/or PCI includes patients undergoing PCI for an ACS or non-ACS (elective) indication.	1	f	f	f
6726076	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	n/a	1	f	f	f
6726034	100411	RxNorm:32968	{"CYP2C19": "Reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	Avoid standard dose clopidogrel (75 mg) if possible. Use prasugrel or ticagrelor at standard dose if no contraindication.	Strong	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	CVI ACS PCI 	For cardiovascular indications of acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI). ACS and/or PCI includes patients undergoing PCI for an ACS or non-ACS (elective) indication. The strength of recommendation for "likely" phenotypes are the same as their respective confirmed phenotypes. "Likely" indicates the uncertainty in the phenotype assignment, but it is reasonable to apply the recommendation for the confirmed phenotype to the corresponding "likely" phenotype.	1	f	f	f
6726035	100411	RxNorm:32968	{"CYP2C19": "Reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	Avoid standard dose (75 mg) clopidogrel if possible. Use prasugrel or ticagrelor at standard dose if no contraindication.	Strong	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	CVI ACS PCI 	For cardiovascular indications of acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI). ACS and/or PCI includes patients undergoing PCI for an ACS or non-ACS (elective) indication.	1	f	f	f
6726036	100411	RxNorm:32968	{"CYP2C19": "Significantly reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	Avoid clopidogrel if possible. Use prasugrel or ticagrelor at standard dose if no contraindication.	Strong	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	CVI ACS PCI 	For cardiovascular indications of acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI). ACS and/or PCI includes patients undergoing PCI for an ACS or non-ACS (elective) indication. The strength of recommendation for "likely" phenotypes are the same as their respective confirmed phenotypes. "Likely" indicates the uncertainty in the phenotype assignment, but it is reasonable to apply the recommendation for the confirmed phenotype to the corresponding "likely" phenotype.	1	f	f	f
6726037	100411	RxNorm:32968	{"CYP2C19": "Significantly reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	Avoid clopidogrel if possible. Use prasugrel or ticagrelor at standard dose if no contraindication.	Strong	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	CVI ACS PCI 	For cardiovascular indications of acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI). ACS and/or PCI includes patients undergoing PCI for an ACS or non-ACS (elective) indication.	1	f	f	f
6726038	100411	RxNorm:32968	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	CVI ACS PCI 	n/a	1	f	f	f
6726039	100411	RxNorm:32968	{"CYP2C19": "Increased clopidogrel active metabolite formation; lower on-treatment platelet reactivity; no association with higher bleeding risk"}	No recommendation	No Recommendation	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	CVI non-ACS non-PCI	For non-acute coronary syndrome (non-ACS) and non-percutaneous coronary intervention (non-PCI) cardiovascular indications. Non-ACS, non-PCI cardiovascular indications include peripheral arterial disease and stable coronary artery disease following a recent myocardial infarction outside the setting of PCI.	1	f	f	f
6726040	100411	RxNorm:32968	{"CYP2C19": "Normal or increased clopidogrel active metabolite formation; normal or lower on-treatment platelet reactivity; no association with higher bleeding risk"}	No recommendation	No Recommendation	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	CVI non-ACS non-PCI	For non-acute coronary syndrome (non-ACS) and non-percutaneous coronary intervention (non-PCI) cardiovascular indications. Non-ACS, non-PCI cardiovascular indications include peripheral arterial disease and stable coronary artery disease following a recent myocardial infarction outside the setting of PCI.	1	f	f	f
6726041	100411	RxNorm:32968	{"CYP2C19": "Normal clopidogrel active metabolite formation; normal on-treatment platelet reactivity"}	If considering clopidogrel, use at standard dose (75 mg/day)	Strong	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	CVI non-ACS non-PCI	For non-acute coronary syndrome (non-ACS) and non-percutaneous coronary intervention (non-PCI) cardiovascular indications. Non-ACS, non-PCI cardiovascular indications include peripheral arterial disease and stable coronary artery disease following a recent myocardial infarction outside the setting of PCI.	1	f	f	f
6726042	100411	RxNorm:32968	{"CYP2C19": "Reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	No recommendation	No Recommendation	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	CVI non-ACS non-PCI	For non-acute coronary syndrome (non-ACS) and non-percutaneous coronary intervention (non-PCI) cardiovascular indications. Non-ACS, non-PCI cardiovascular indications include peripheral arterial disease and stable coronary artery disease following a recent myocardial infarction outside the setting of PCI. The strength of recommendation for "likely" phenotypes are the same as their respective confirmed phenotypes. "Likely" indicates the uncertainty in the phenotype assignment, but it is reasonable to apply the recommendation for the confirmed phenotype to the corresponding "likely" phenotype.	1	f	f	f
6726043	100411	RxNorm:32968	{"CYP2C19": "Reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	No recommendation	No Recommendation	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	CVI non-ACS non-PCI	For non-acute coronary syndrome (non-ACS) and non-percutaneous coronary intervention (non-PCI) cardiovascular indications. Non-ACS, non-PCI cardiovascular indications include peripheral arterial disease and stable coronary artery disease following a recent myocardial infarction outside the setting of PCI.	1	f	f	f
6726078	2405438	RxNorm:3108	{"G6PD": "High risk of acute hemolytic anemia"}	Avoid use	Strong	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	\N	1	f	f	f
6726079	2405438	RxNorm:3108	{"G6PD": "High risk of acute eacerbation of chronic hemolysis"}	Avoid use	Strong	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	general	Although there are not published data in individuals with the G6PD Deficient with CNSHA phenotype, there is a strong rationale to avoid these drugs based on evidence in G6PD Deficient individuals.	1	f	f	f
6726044	100411	RxNorm:32968	{"CYP2C19": "Significantly reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	Avoid clopidogrel if possible. Use prasugrel or ticagrelor at standard dose if no contraindication.	Moderate	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	CVI non-ACS non-PCI	For non-acute coronary syndrome (non-ACS) and non-percutaneous coronary intervention (non-PCI) cardiovascular indications. Non-ACS, non-PCI cardiovascular indications include peripheral arterial disease and stable coronary artery disease following a recent myocardial infarction outside the setting of PCI. The strength of recommendation for "likely" phenotypes are the same as their respective confirmed phenotypes. "Likely" indicates the uncertainty in the phenotype assignment, but it is reasonable to apply the recommendation for the confirmed phenotype to the corresponding "likely" phenotype.	1	f	f	f
6726045	100411	RxNorm:32968	{"CYP2C19": "Significantly reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	Avoid clopidogrel if possible. Use prasugrel or ticagrelor at standard dose if no contraindication.	Moderate	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	CVI non-ACS non-PCI	For non-acute coronary syndrome (non-ACS) and non-percutaneous coronary intervention (non-PCI) cardiovascular indications. Non-ACS, non-PCI cardiovascular indications include peripheral arterial disease and stable coronary artery disease following a recent myocardial infarction outside the setting of PCI.	1	f	f	f
6726046	100411	RxNorm:32968	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	CVI non-ACS non-PCI	n/a	1	f	f	f
6726047	100411	RxNorm:32968	{"CYP2C19": "Increased clopidogrel active metabolite formation; lower on-treatment platelet reactivity"}	No recommendation	No Recommendation	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	NVI	For neurovascular indications. Neurovascular disease includes acute ischemic stroke or transient ischemic attack, secondary prevention of stroke, or prevention of thromboembolic events following neurointerventional procedures such as carotid artery stenting and stent-assisted coiling of intracranial aneurysms.	1	f	f	f
6726048	100411	RxNorm:32968	{"CYP2C19": "Normal or increased clopidogrel active metabolite formation; normal or lower on-treatment platelet reactivity"}	No recommendation	No Recommendation	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	NVI	For neurovascular indications. Neurovascular disease includes acute ischemic stroke or transient ischemic attack, secondary prevention of stroke, or prevention of thromboembolic events following neurointerventional procedures such as carotid artery stenting and stent-assisted coiling of intracranial aneurysms.	1	f	f	f
6726049	100411	RxNorm:32968	{"CYP2C19": "Normal clopidogrel active metabolite formation; normal on-treatment platelet reactivity"}	If considering clopidogrel, use at standard dose (75 mg/day)	Strong	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	NVI	For neurovascular indications. Neurovascular disease includes acute ischemic stroke or transient ischemic attack, secondary prevention of stroke, or prevention of thromboembolic events following neurointerventional procedures such as carotid artery stenting and stent-assisted coiling of intracranial aneurysms.	1	f	f	f
6726050	100411	RxNorm:32968	{"CYP2C19": "Reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	Consider an alternative P2Y12 inhibitor at standard dose if clinically indicated and no contraindication.	Moderate	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	NVI	For neurovascular indications. Neurovascular disease includes acute ischemic stroke or transient ischemic attack, secondary prevention of stroke, or prevention of thromboembolic events following neurointerventional procedures such as carotid artery stenting and stent-assisted coiling of intracranial aneurysms. Alternative P2Y12 inhibitors not impacted by CYP2C19 genetic variants include ticagrelor and ticlopidine. Prasugrel is contraindicated in patients with a history of stroke or TIA. Given limited outcomes data for genotype-guided anti-platelet therapy for neurovascular indications, selection of therapy should depend on individual patient treatment goals and risks for adverse events. The strength of recommendation for "likely" phenotypes are the same as their respective confirmed phenotypes. "Likely" indicates the uncertainty in the phenotype assignment, but it is reasonable to apply the recommendation for the confirmed phenotype to the corresponding "likely" phenotype.	1	f	f	f
6726051	100411	RxNorm:32968	{"CYP2C19": "Reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	Consider an alternative P2Y12 inhibitor at standard dose if clinically indicated and no contraindication.	Moderate	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	NVI	For neurovascular indications. Neurovascular disease includes acute ischemic stroke or transient ischemic attack, secondary prevention of stroke, or prevention of thromboembolic events following neurointerventional procedures such as carotid artery stenting and stent-assisted coiling of intracranial aneurysms. Alternative P2Y12 inhibitors not impacted by CYP2C19 genetic variants include ticagrelor and ticlopidine. Prasugrel is contraindicated in patients with a history of stroke or TIA. Given limited outcomes data for genotype-guided anti-platelet therapy for neurovascular indications, selection of therapy should depend on individual patient treatment goals and risks for adverse events.	1	f	f	f
6726052	100411	RxNorm:32968	{"CYP2C19": "Significantly reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	Avoid clopidogrel if possible. Consider an alternative P2Y12 inhibitor at standard dose if clinically indicated and no contraindication.	Moderate	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	NVI	For neurovascular indications. Neurovascular disease includes acute ischemic stroke or transient ischemic attack, secondary prevention of stroke, or prevention of thromboembolic events following neurointerventional procedures such as carotid artery stenting and stent-assisted coiling of intracranial aneurysms. Alternative P2Y12 inhibitors not impacted by CYP2C19 genetic variants include ticagrelor and ticlopidine. Prasugrel is contraindicated in patients with a history of stroke or TIA. Given limited outcomes data for genotype-guided anti-platelet therapy for neurovascular indications, selection of therapy should depend on individual patient treatment goals and risks for adverse events. The strength of recommendation for "likely" phenotypes are the same as their respective confirmed phenotypes. "Likely" indicates the uncertainty in the phenotype assignment, but it is reasonable to apply the recommendation for the confirmed phenotype to the corresponding "likely" phenotype.	1	f	f	f
6726053	100411	RxNorm:32968	{"CYP2C19": "Significantly reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events"}	Avoid clopidogrel if possible. Consider an alternative P2Y12 inhibitor at standard dose if clinically indicated and no contraindication.	Moderate	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	NVI	For neurovascular indications. Neurovascular disease includes acute ischemic stroke or transient ischemic attack, secondary prevention of stroke, or prevention of thromboembolic events following neurointerventional procedures such as carotid artery stenting and stent-assisted coiling of intracranial aneurysms. Alternative P2Y12 inhibitors not impacted by CYP2C19 genetic variants include ticagrelor and ticlopidine. Prasugrel is contraindicated in patients with a history of stroke or TIA. Given limited outcomes data for genotype-guided anti-platelet therapy for neurovascular indications, selection of therapy should depend on individual patient treatment goals and risks for adverse events.	1	f	f	f
6726054	100411	RxNorm:32968	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	NVI	n/a	1	f	f	f
6726055	100416	RxNorm:2670	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
6726056	100416	RxNorm:2670	{"CYP2D6": "Reduced morphine formation"}	Use codeine label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider a non-tramadol opioid.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	general	n/a	1	f	f	f
6726057	100416	RxNorm:2670	{"CYP2D6": "Reduced morphine formation"}	Use codeine label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider a non-tramadol opioid.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	general	n/a	1	f	f	f
6726058	100416	RxNorm:2670	{"CYP2D6": "Reduced morphine formation"}	Use codeine label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider a non-tramadol opioid.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	general	n/a	1	f	f	f
6726059	100416	RxNorm:2670	{"CYP2D6": "Reduced morphine formation"}	Use codeine label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider a non-tramadol opioid.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	general	n/a	1	f	f	f
6726060	100416	RxNorm:2670	{"CYP2D6": "Expected morphine formation"}	Use codeine label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	general	n/a	1	f	f	f
6726061	100416	RxNorm:2670	{"CYP2D6": "Expected morphine formation"}	Use codeine label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	general	n/a	1	f	f	f
6726062	100416	RxNorm:2670	{"CYP2D6": "Expected morphine formation"}	Use codeine label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	general	n/a	1	f	f	f
6726063	100416	RxNorm:2670	{"CYP2D6": "Expected morphine formation"}	Use codeine label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	general	n/a	1	f	f	f
6726064	100416	RxNorm:2670	{"CYP2D6": "Expected morphine formation"}	Use codeine label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	general	n/a	1	f	f	f
6726065	100416	RxNorm:2670	{"CYP2D6": "Greatly reduced morphine formation leading to diminished analgesia."}	Avoid codeine use because of possibility of diminished analgesia. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	general	n/a	1	f	f	f
6726066	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	n/a	1	f	f	f
6726067	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	general	n/a	1	f	f	f
6726068	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	general	n/a	1	f	f	f
6726069	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	general	n/a	1	f	f	f
6726070	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	n/a	1	f	f	f
6726071	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	n/a	1	f	f	f
6726072	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	n/a	1	f	f	f
6726073	100416	RxNorm:2670	{"CYP2D6": "Increased formation of morphine leading to higher risk of toxicity"}	Avoid codeine use because of potential for serious toxicity. If opioid use is warranted, consider a non-tramadol opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	n/a	1	f	f	f
6726077	2405438	RxNorm:3108	{"G6PD": "Low risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	\N	1	f	f	f
6726080	2405438	RxNorm:3108	{"G6PD": "Variable risk of acute hemolytic anemia"}	To ascertain G6PD status, enzyme activity must be measured. Drug use should be guided per the recommendations based on the activity-based phenotype.	Moderate	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	general	Due to X-linked mosaicism, individuals with more than one X chromosome (e.g., females, individuals with Klinefelter syndrome) and heterozygous for one non-deficient (class IV) and one deficient (class I–III) allele may display a normal or a deficient phenotype; an enzyme activity test is needed to assign G6PD phenotype in such cases.	1	f	f	f
6726081	2405438	RxNorm:3108	{"G6PD": "Unknown risk of acute hemolytic anemia"}	To ascertain G6PD status, enzyme activity must be measured. Drug use should be guided per the recommendations based on the activity-based phenotype.	Moderate	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	general	\N	1	f	f	f
6726082	2405438	RxNorm:1011650	{"G6PD": "Low risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	\N	1	f	f	f
6726083	2405438	RxNorm:1011650	{"G6PD": "High risk of acute hemolytic anemia"}	Avoid use	Strong	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	\N	1	f	f	f
6726084	2405438	RxNorm:1011650	{"G6PD": "High risk of acute eacerbation of chronic hemolysis"}	Avoid use	Strong	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	general	Although there are not published data in individuals with the G6PD Deficient with CNSHA phenotype, there is a strong rationale to avoid these drugs based on evidence in G6PD Deficient individuals.	1	f	f	f
6726085	2405438	RxNorm:1011650	{"G6PD": "Variable risk of acute hemolytic anemia"}	To ascertain G6PD status, enzyme activity must be measured. Drug use should be guided per the recommendations based on the activity-based phenotype.	Moderate	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	general	Due to X-linked mosaicism, individuals with more than one X chromosome (e.g., females, individuals with Klinefelter syndrome) and heterozygous for one non-deficient (class IV) and one deficient (class I–III) allele may display a normal or a deficient phenotype; an enzyme activity test is needed to assign G6PD phenotype in such cases.	1	f	f	f
6726086	2405438	RxNorm:1011650	{"G6PD": "Unknown risk of acute hemolytic anemia"}	To ascertain G6PD status, enzyme activity must be measured. Drug use should be guided per the recommendations based on the activity-based phenotype.	Moderate	{"G6PD": "Indeterminate"}	{}	{}	{"G6PD": "Indeterminate"}	general	\N	1	f	f	f
6726087	2405438	RxNorm:283821	{"G6PD": "Low risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	\N	1	f	f	f
6726088	2405438	RxNorm:283821	{"G6PD": "High risk of acute hemolytic anemia"}	Avoid use	Strong	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	\N	1	f	f	f
6726089	2405438	RxNorm:283821	{"G6PD": "High risk of acute eacerbation of chronic hemolysis"}	Avoid use	Strong	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	general	Although there are not published data in individuals with the G6PD Deficient with CNSHA phenotype, there is a strong rationale to avoid these drugs based on evidence in G6PD Deficient individuals.	1	f	f	f
6726090	2405438	RxNorm:283821	{"G6PD": "Variable risk of acute hemolytic anemia"}	To ascertain G6PD status, enzyme activity must be measured. Drug use should be guided per the recommendations based on the activity-based phenotype.	Moderate	{"G6PD": "Variable"}	{}	{}	{"G6PD": "Variable"}	general	Due to X-linked mosaicism, individuals with more than one X chromosome (e.g., females, individuals with Klinefelter syndrome) and heterozygous for one non-deficient (class IV) and one deficient (class I–III) allele may display a normal or a deficient phenotype; an enzyme activity test is needed to assign G6PD phenotype in such cases.	1	f	f	f
