7337341	100414	RxNorm:3638	{"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
7337342	100414	RxNorm:3638	{"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
7337343	100414	RxNorm:3638	{"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
7337344	100414	RxNorm:3638	{"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
7337345	100414	RxNorm:3638	{"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
7337346	100414	RxNorm:3638	{"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
7337347	100414	RxNorm:3638	{"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
7337348	100414	RxNorm:3638	{"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
7337349	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337350	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337351	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337352	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337353	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337354	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337355	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337356	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337357	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337358	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337359	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337360	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337361	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337362	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337363	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337437	100426	RxNorm:41127	{"CYP2C9": "Normal exposure.", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines.	Strong	{"CYP2C9": "Normal Metabolizer", "SLCO1B1": "Increased Function"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "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
7337364	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337365	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337366	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337367	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337368	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337369	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337370	100414	RxNorm:3638	{"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 doxepin use; If doxepin 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
7337371	100414	RxNorm:3638	{"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
7337372	100414	RxNorm:3638	{"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
7337373	100414	RxNorm:3638	{"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
7337374	100414	RxNorm:3638	{"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
7337375	100414	RxNorm:3638	{"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
7337376	100414	RxNorm:3638	{"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
7337377	100414	RxNorm:3638	{"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
7337378	100414	RxNorm:3638	{"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
7337379	100414	RxNorm:3638	{"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
7337380	100414	RxNorm:3638	{"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
7337381	100414	RxNorm:3638	{"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
7337382	100414	RxNorm:3638	{"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
7337383	100414	RxNorm:3638	{"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
7337384	100414	RxNorm:3638	{"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
7337385	100414	RxNorm:3638	{"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
7337386	100414	RxNorm:3638	{"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
7337387	100414	RxNorm:3638	{"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
7337388	100414	RxNorm:3638	{"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
7337457	100426	RxNorm:41127	{"CYP2C9": "Normal exposure.", "SLCO1B1": "n/a"}	Based on CYP2C9 status, prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines. SLCO1B1 phenotype could not be assigned based on genotyping.	Strong	{"CYP2C9": "Normal Metabolizer", "SLCO1B1": "Indeterminate"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "SLCO1B1": "Indeterminate"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin.	1	f	f	f
7337389	100414	RxNorm:3638	{"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
7337390	100414	RxNorm:3638	{"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
7337391	100414	RxNorm:3638	{"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
7337392	100414	RxNorm:3638	{"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
7337393	100414	RxNorm:3638	{"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
7337394	100414	RxNorm:3638	{"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
7337395	100414	RxNorm:3638	{"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
7337396	100414	RxNorm:3638	{"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
7337397	100414	RxNorm:3638	{"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
7337458	100426	RxNorm:41127	{"CYP2C9": "Normal exposure.", "SLCO1B1": "n/a"}	Based on CYP2C9 status, prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines. SLCO1B1 genotype result is not available.	Strong	{"CYP2C9": "Normal Metabolizer", "SLCO1B1": "No Result"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "SLCO1B1": "No Result"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin.	1	f	f	f
7337398	100414	RxNorm:3638	{"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
7337399	104245	RxNorm:195085	{"CYP2B6": "Slightly lower dose-adjusted trough concentrations of efavirenz compared with normal metabolizers"}	Initiate efavirenz with standard dosing (600 mg/day)	Strong	{"CYP2B6": "Ultrarapid Metabolizer"}	{"CYP2B6": "n/a"}	{}	{"CYP2B6": "Ultrarapid Metabolizer"}	child >40kg_adult	n/a	1	f	f	f
7337400	104245	RxNorm:195085	{"CYP2B6": "Slightly lower dose-adjusted trough concentrations of efavirenz compared with normal metabolizers"}	Initiate efavirenz with standard dosing (600 mg/day)	Strong	{"CYP2B6": "Rapid Metabolizer"}	{"CYP2B6": "n/a"}	{}	{"CYP2B6": "Rapid Metabolizer"}	child >40kg_adult	n/a	1	f	f	f
7337401	104245	RxNorm:195085	{"CYP2B6": "Normal efavirenz metabolism"}	Initiate efavirenz with standard dosing (600 mg/day)	Strong	{"CYP2B6": "Normal Metabolizer"}	{"CYP2B6": "n/a"}	{}	{"CYP2B6": "Normal Metabolizer"}	child >40kg_adult	The ENCORE study showed that in treatment-naïve patients randomized to initiate efavirenz-based regimens (combined with tenofovir and emtricitabine), 400 mg/day was non-inferior to 600 mg/day regardless of CYP2B6 genotype (PMID 24522178).	1	f	f	f
7337402	104245	RxNorm:195085	{"CYP2B6": "Higher dose-adjusted trough concentrations of efavirenz compared with normal metabolizers; increased risk of CNS adverse events"}	Consider initiating efavirenz with decreased dose of 400 mg/day	Moderate	{"CYP2B6": "Intermediate Metabolizer"}	{"CYP2B6": "n/a"}	{}	{"CYP2B6": "Intermediate Metabolizer"}	child >40kg_adult	If therapeutic drug monitoring is available and a decreased efavirenz dose is prescribed, consider obtaining steady-state plasma efavirenz concentrations to ensure concentrations are in the suggested therapeutic range (~1 to 4 μg/mL). To prescribe efavirenz at a decreased dose of 400 mg/day or 200 mg/day in a multidrug regimen may require prescribing more than one pill once daily. If so, the provider should weigh the potential benefit of reduced dose against the potential detrimental impact of increased pill number.	1	f	f	f
7337403	104245	RxNorm:195085	{"CYP2B6": "Higher dose-adjusted trough concentrations of efavirenz compared with normal metabolizers; significantly increased risk of CNS adverse events and treatment discontinuation"}	Consider initiating efavirenz with decreased dose of 400 or 200 mg/day	Moderate	{"CYP2B6": "Poor Metabolizer"}	{"CYP2B6": "n/a"}	{}	{"CYP2B6": "Poor Metabolizer"}	child >40kg_adult	If therapeutic drug monitoring is available and a decreased efavirenz dose is prescribed, consider obtaining steady-state plasma efavirenz concentrations to ensure concentrations are in the suggested therapeutic range (~1 to 4 μg/mL). To prescribe efavirenz at a decreased dose of 400 mg/day or 200 mg/day in a multidrug regimen may require prescribing more than one pill once daily. If so, the provider should weigh the potential benefit of reduced dose against the potential detrimental impact of increased pill number.	1	f	f	f
7337404	104245	RxNorm:195085	{"CYP2B6": "n/a"}	No recommendation	No Recommendation	{"CYP2B6": "Indeterminate"}	{"CYP2B6": "n/a"}	{}	{"CYP2B6": "Indeterminate"}	child >40kg_adult	n/a	1	f	f	f
7337405	100419	RxNorm:4492	{"DPYD": "Normal DPD activity and \\"normal\\" risk for fluoropyrimidine toxicity"}	Based on genotype, there is no indication to change dose or therapy. Use label-recommended dosage and administration.	Strong	{"DPYD": "Normal Metabolizer"}	{"DPYD": "2.0"}	{}	{"DPYD": "2.0"}	general	n/a	1	f	f	f
7337406	100419	RxNorm:4492	{"DPYD": "Decreased DPD activity (leukocyte DPD activity at 30% to 70% that of the normal population) and increased risk for severe or even fatal drug toxicity when treated with fluoropyrimidine drugs"}	Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available).	Moderate	{"DPYD": "Intermediate Metabolizer"}	{"DPYD": "1.5"}	{}	{"DPYD": "1.5"}	general	Increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles to maintain efficacy; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities.	1	f	f	f
7337407	100419	RxNorm:4492	{"DPYD": "Decreased DPD activity (leukocyte DPD activity at 30% to 70% that of the normal population) and increased risk for severe or even fatal drug toxicity when treated with fluoropyrimidine drugs"}	Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available). Patients with the c.2846A>T/c.2846A>T genotype may require >50% reduction in starting dose.	Strong	{"DPYD": "Intermediate Metabolizer"}	{"DPYD": "1.0"}	{}	{"DPYD": "1.0"}	general	Increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles to maintain efficacy; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities.	1	f	f	f
7337408	100419	RxNorm:4492	{"DPYD": "Complete DPD deficiency and increased risk for severe or even fatal drug toxicity when treated with fluoropyrimidine drugs."}	Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens. In the event, based on clinical advice, alternative agents are not considered a suitable therapeutic option, 5-fluorouracil should be administered at a strongly reduced dose with early therapeutic drug monitoring.	Strong	{"DPYD": "Poor Metabolizer"}	{"DPYD": "0.5"}	{}	{"DPYD": "0.5"}	general	If available, a phenotyping test (see main text for further details) should be considered to estimate the starting dose. In absence of phenotyping data, a dose of <25% of the normal starting dose is estimated assuming additive effects of alleles on 5-FU clearance. Therapeutic drug monitoring should be done at the earliest time point possible (e.g., minimum time point in steady state) in order to immediately discontinue therapy if the drug level is too high.	1	f	f	f
7337409	100419	RxNorm:4492	{"DPYD": "Complete DPD deficiency and increased risk for severe or even fatal drug toxicity when treated with fluoropyrimidine drugs."}	Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens.	Strong	{"DPYD": "Poor Metabolizer"}	{"DPYD": "0.0"}	{}	{"DPYD": "0.0"}	general	n/a	1	f	f	f
7337412	100419	RxNorm:194000	{"DPYD": "Decreased DPD activity (leukocyte DPD activity at 30% to 70% that of the normal population) and increased risk for severe or even fatal drug toxicity when treated with fluoropyrimidine drugs"}	Reduce starting dose by 50% followed by titration of dose based on toxicity or therapeutic drug monitoring (if available). Patients with the c.2846A>T/c.2846A>T genotype may require >50% reduction in starting dose.	Strong	{"DPYD": "Intermediate Metabolizer"}	{"DPYD": "1.0"}	{}	{"DPYD": "1.0"}	general	Increase the dose in patients experiencing no or clinically tolerable toxicity in the first two cycles to maintain efficacy; decrease the dose in patients who do not tolerate the starting dose to minimize toxicities.	1	f	f	f
7337413	100419	RxNorm:194000	{"DPYD": "Complete DPD deficiency and increased risk for severe or even fatal drug toxicity when treated with fluoropyrimidine drugs."}	Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens. In the event, based on clinical advice, alternative agents are not considered a suitable therapeutic option, 5-fluorouracil should be administered at a strongly reduced dose with early therapeutic drug monitoring.	Strong	{"DPYD": "Poor Metabolizer"}	{"DPYD": "0.5"}	{}	{"DPYD": "0.5"}	general	If available, a phenotyping test (see main text for further details) should be considered to estimate the starting dose. In absence of phenotyping data, a dose of <25% of the normal starting dose is estimated assuming additive effects of alleles on 5-FU clearance. Therapeutic drug monitoring should be done at the earliest time point possible (e.g., minimum time point in steady state) in order to immediately discontinue therapy if the drug level is too high.	1	f	f	f
7337414	100419	RxNorm:194000	{"DPYD": "Complete DPD deficiency and increased risk for severe or even fatal drug toxicity when treated with fluoropyrimidine drugs."}	Avoid use of 5-fluorouracil or 5-fluorouracil prodrug-based regimens.	Strong	{"DPYD": "Poor Metabolizer"}	{"DPYD": "0.0"}	{}	{"DPYD": "0.0"}	general	n/a	1	f	f	f
7337415	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Optional	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "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
7337416	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Optional	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Decreased Function"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "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
7337417	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Optional	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "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
7337418	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Optional	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Decreased Function"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "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
7337419	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Normal Function"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "Normal 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
7337477	100413	RxNorm:42355	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	general	n/a	1	f	f	f
7337478	100413	RxNorm:42355	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	general	n/a	1	f	f	f
7337420	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Increased Function"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "Increased 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
7337421	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Normal Function"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "Normal 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
7337422	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Increased Function"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "Increased 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
7337423	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >40mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Normal Function"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "Normal 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
7337424	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >40mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Increased Function"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "Increased 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
7337425	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >40mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Normal Function"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "Normal 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
7337426	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >40mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Increased Function"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "Increased 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
7337427	100426	RxNorm:41127	{"CYP2C9": "Normal exposure.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal and decreased function; Typical myopathy risk with doses less ≤40 mg."}	Prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If patient is tolerating 40mg per day but higher potency is needed, a higher dose (>40mg) or an alternative statin or combination therapy (i.e. fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391) could be considered. Prescriber should be aware of possible increased risk for myopathy with fluvastatin especially with doses >40mg per day.	Moderate	{"CYP2C9": "Normal Metabolizer", "SLCO1B1": "Poor Function"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "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
7337428	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins).	Optional	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "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
7337429	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins).	Optional	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Decreased Function"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "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
7337430	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins).	Optional	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "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
7337431	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins).	Optional	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Decreased Function"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "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
7337432	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal and decreased function; Typical myopathy risk with doses less ≤40 mg."}	Prescribe an alternative statin depending on the desired potency (see Table 2 and Figure 1 of PMID: 35152405 for recommendations for alternative statins).	Optional	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Poor Function"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "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
7337433	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal and decreased function; Typical myopathy risk with doses less ≤40 mg."}	Prescribe an alternative statin depending on the desired potency (see Table 2 and Figure 1 of PMID: 35152405 for recommendations for alternative statins).	Optional	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Poor Function"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "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
7337434	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal and decreased function; Typical myopathy risk with doses less ≤40 mg."}	Prescribe an alternative statin depending on the desired potency. (see Table 2 and Figure 1 of PMID: 35152405 for recommendations for alternative statins).	Optional	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Poor Function"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "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
7337435	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal and decreased function; Typical myopathy risk with doses less ≤40 mg."}	Prescribe an alternative statin depending on the desired potency. (see Table 2 and Figure 1 of PMID: 35152405 for recommendations for alternative statins).	Optional	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Poor Function"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "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
7337436	100426	RxNorm:41127	{"CYP2C9": "Normal exposure.", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines.	Strong	{"CYP2C9": "Normal Metabolizer", "SLCO1B1": "Normal Function"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "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
7337438	100426	RxNorm:41127	{"CYP2C9": "Normal exposure.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >40mg per day.	Moderate	{"CYP2C9": "Normal Metabolizer", "SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "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
7337439	100426	RxNorm:41127	{"CYP2C9": "Normal exposure.", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >40mg per day.	Moderate	{"CYP2C9": "Normal Metabolizer", "SLCO1B1": "Decreased Function"}	{"CYP2C9": "2.0"}	{}	{"CYP2C9": "2.0", "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
7337440	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Based on SLCO1B1 status, prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >40mg per day. CYP2C9 phenotype could not be assigned based on genotyping.	Moderate	{"CYP2C9": "Indeterminate", "SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "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
7337441	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Based on SLCO1B1 status, prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >40mg per day. CYP2C9 phenotype could not be assigned based on genotyping.	Moderate	{"CYP2C9": "Indeterminate", "SLCO1B1": "Decreased Function"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "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
7337442	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Based on SLCO1B1 status, prescribe desired starting dose and adjust doses based on disease-specific guidelines. CYP2C9 phenotype could not be assigned based on genotyping.	Strong	{"CYP2C9": "Indeterminate", "SLCO1B1": "Increased Function"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "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
7337443	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "n/a"}	n/a	n/a	{"CYP2C9": "Indeterminate", "SLCO1B1": "Indeterminate"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "SLCO1B1": "Indeterminate"}	general	n/a	1	f	f	f
7337444	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "n/a"}	n/a	n/a	{"CYP2C9": "Indeterminate", "SLCO1B1": "No Result"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "SLCO1B1": "No Result"}	general	n/a	1	f	f	f
7337445	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Based on SLCO1B1 status, prescribe desired starting dose and adjust doses based on disease-specific guidelines. CYP2C9 phenotype could not be assigned based on genotyping.	Strong	{"CYP2C9": "Indeterminate", "SLCO1B1": "Normal Function"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "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
7337446	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "Increased fluvastatin exposure as compared to normal and decreased function; Typical myopathy risk with doses less ≤40 mg."}	Based on SLCO1B1 status, prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If patient is tolerating 40mg per day but higher potency is needed, a higher dose (>40mg) or an alternative statin (see Figure 1 of PMID: 35152405 for recommendations for alternative statins) or combination therapy (i.e. fluvastatin plus non-statin guideline directed medical therapy)(PMID: 30423391) could be considered. Prescriber should be aware of possible increased risk for myopathy with fluvastatin especially with doses >40mg per day. CYP2C9 phenotype could not be assigned based on genotyping.	Moderate	{"CYP2C9": "Indeterminate", "SLCO1B1": "Poor Function"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a", "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
7337447	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "n/a"}	Based on CYP2C9 status, prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >40mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). SLCO1B1 phenotype could not be assigned based on genotyping.	Moderate	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Indeterminate"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "Indeterminate"}	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
7337479	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": "1.0"}	{}	{"CYP2D6": "1.0"}	general	n/a	1	f	f	f
7337448	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "n/a"}	Based on CYP2C9 status, prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >40mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). SLCO1B1 phenotype could not be assigned based on genotyping.	Moderate	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "Indeterminate"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "Indeterminate"}	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
7337449	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "n/a"}	Based on CYP2C9 status, prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >40mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). SLCO1B1 genotype result is not available.	Moderate	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "No Result"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0", "SLCO1B1": "No Result"}	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
7337450	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "n/a"}	Based on CYP2C9 status, prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >40mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). SLCO1B1 genotype result is not available.	Moderate	{"CYP2C9": "Intermediate Metabolizer", "SLCO1B1": "No Result"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5", "SLCO1B1": "No Result"}	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
7337451	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Based on SLCO1B1 status, prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >40mg per day. CYP2C9 genotype result is not available.	Moderate	{"CYP2C9": "No Result", "SLCO1B1": "Decreased Function"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "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
7337452	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Based on SLCO1B1 status, prescribe desired starting dose and adjust doses based on disease-specific guidelines. CYP2C9 genotype result is not available.	Strong	{"CYP2C9": "No Result", "SLCO1B1": "Increased Function"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "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
7337453	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "n/a"}	n/a	n/a	{"CYP2C9": "No Result", "SLCO1B1": "Indeterminate"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "SLCO1B1": "Indeterminate"}	general	n/a	1	f	f	f
7337454	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "Typical myopathy risk and statin exposure."}	Based on SLCO1B1 status, prescribe desired starting dose and adjust doses based on disease-specific guidelines. CYP2C9 genotype result is not available.	Strong	{"CYP2C9": "No Result", "SLCO1B1": "Normal Function"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "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
7337455	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "Increased fluvastatin exposure as compared to normal and decreased function; Typical myopathy risk with doses less ≤40 mg."}	Based on SLCO1B1 status, prescribe ≤40mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If patient is tolerating 40mg per day but higher potency is needed, a higher dose (>40mg) or an alternative statin (see Figure 1 of PMID: 35152405 for recommendations for alternative statins) or combination therapy (i.e. fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391) could be considered. Prescriber should be aware of possible increased risk for myopathy with fluvastatin especially with doses >40mg per day. CYP2C9 genotype result is not available.	Moderate	{"CYP2C9": "No Result", "SLCO1B1": "Poor Function"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "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
7337456	100426	RxNorm:41127	{"CYP2C9": "n/a", "SLCO1B1": "Increased fluvastatin exposure as compared to normal function; Typical myopathy risk with ≤40 mg."}	Based on SLCO1B1 status, prescribe desired starting dose and adjust doses of fluvastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >40mg per day. CYP2C9 genotype result is not available.	Moderate	{"CYP2C9": "No Result", "SLCO1B1": "Possible Decreased Function"}	{"CYP2C9": "No Result"}	{}	{"CYP2C9": "No Result", "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
7337480	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": "0.75"}	{}	{"CYP2D6": "0.75"}	general	n/a	1	f	f	f
7337459	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "n/a"}	Based on CYP2C9 status, prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). SLCO1B1 phenotype could not be assigned based on genotyping.	Moderate	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Indeterminate"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "Indeterminate"}	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
7337460	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "n/a"}	Based on CYP2C9 status, prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). SLCO1B1 phenotype could not be assigned based on genotyping.	Moderate	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "Indeterminate"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "Indeterminate"}	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
7337461	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "n/a"}	Based on CYP2C9 status, prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). SLCO1B1 genotype result is not available.	Moderate	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "No Result"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0", "SLCO1B1": "No Result"}	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
7337462	100426	RxNorm:41127	{"CYP2C9": "Increased fluvastatin exposure as compared to normal and intermediate metabolizer which may translate to increased myopathy risk.", "SLCO1B1": "n/a"}	Based on CYP2C9 status, prescribe ≤20mg per day as a starting dose and adjust doses of fluvastatin based on disease-specific guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., fluvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). SLCO1B1 genotype result is not available.	Moderate	{"CYP2C9": "Poor Metabolizer", "SLCO1B1": "No Result"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5", "SLCO1B1": "No Result"}	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
7337463	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	n/a	1	f	f	f
7337464	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	n/a	1	f	f	f
7337465	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	n/a	1	f	f	f
7337466	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	n/a	1	f	f	f
7337467	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	n/a	1	f	f	f
7337468	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	n/a	1	f	f	f
7337469	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	n/a	1	f	f	f
7337470	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	general	n/a	1	f	f	f
7337471	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	general	n/a	1	f	f	f
7337472	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	general	n/a	1	f	f	f
7337473	100413	RxNorm:42355	{"CYP2D6": "No data available for CYP2D6 ultrarapid metabolizers"}	No recommendation due to lack of evidence	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	n/a	1	f	f	f
7337474	100413	RxNorm:42355	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	general	n/a	1	f	f	f
7337475	100413	RxNorm:42355	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	general	n/a	1	f	f	f
7337476	100413	RxNorm:42355	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	general	n/a	1	f	f	f
7337483	100413	RxNorm:42355	{"CYP2D6": "Greatly reduced metabolism of fluvoxamine to less active compounds when compared to CYP2D6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a 25-50% lower starting dose and slower titration schedule as compared to normal metabolizers or consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.	Optional	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	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
7337484	100413	RxNorm:42355	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
7337485	6478852	RxNorm:5470	{"NAT2": "Predicted to have reduced plasma concentrations and efficacy of hydralazine compared to NAT2 poor metabolizers."}	Consider a starting total daily dose of at least 75 mg. Titrate up to 300 mg total daily hydralazine dose as tolerated. NAT2 rapid metabolizers typically require a 50-100% higher maintenance dose compared to poor metabolizers.	Moderate	{"NAT2": "Rapid Metabolizer"}	{}	{}	{"NAT2": "Rapid Metabolizer"}	general	n/a	1	f	f	f
7337486	6478852	RxNorm:5470	{"NAT2": "Predicted to have reduced plasma concentrations and efficacy of hydralazine compared to NAT2 poor metabolizers."}	Consider a starting total daily dose of at least 75 mg. Titrate up to 300 mg total daily hydralazine dose as tolerated. NAT2 intermediate metabolizers typically require a 50-100% higher maintenance dose compared to poor metabolizers.	Moderate	{"NAT2": "Intermediate Metabolizer"}	{}	{}	{"NAT2": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
7337487	6478852	RxNorm:5470	{"NAT2": "Predicted to have increased hydralazine plasma concentrations compared to NAT2 rapid and intermediate metabolizers, which may lead to both increased efficacy and adverse effects, including drug-induced systemic lupus erythematosus."}	Initiate therapy at a total daily dose of 40 to 75 mg. Carefully titrate dose upward to clinical effect or guideline-recommended dose; use caution with total daily hydralazine doses of 200 mg or more.	Moderate	{"NAT2": "Poor Metabolizer"}	{}	{}	{"NAT2": "Poor Metabolizer"}	general	n/a	1	f	f	f
7337488	6478852	RxNorm:5470	{"NAT2": "n/a"}	No Recommendation	No Recommendation	{"NAT2": "Indeterminate"}	{}	{}	{"NAT2": "Indeterminate"}	general	n/a	1	f	f	f
7337489	100416	RxNorm:5489	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
7337490	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	Use hydrocodone label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine or non-tramadol opioid.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	general	n/a	1	f	f	f
7337491	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	Use hydrocodone label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine or non-tramadol opioid.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	general	n/a	1	f	f	f
7337492	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	Use hydrocodone label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine or non-tramadol opioid.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	general	n/a	1	f	f	f
7337493	100416	RxNorm:5489	{"CYP2D6": "Minimal evidence for pharmacokinetic or clinical effect."}	Use hydrocodone label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine or non-tramadol opioid.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	general	n/a	1	f	f	f
7337494	100416	RxNorm:5489	{"CYP2D6": "Normal hydromorphone formation"}	Use hydrocodone label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	general	n/a	1	f	f	f
7337495	100416	RxNorm:5489	{"CYP2D6": "Normal hydromorphone formation"}	Use hydrocodone label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	general	n/a	1	f	f	f
7337496	100416	RxNorm:5489	{"CYP2D6": "Normal hydromorphone formation"}	Use hydrocodone label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	general	n/a	1	f	f	f
7337497	100416	RxNorm:5489	{"CYP2D6": "Normal hydromorphone formation"}	Use hydrocodone label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	general	n/a	1	f	f	f
7337498	100416	RxNorm:5489	{"CYP2D6": "Normal hydromorphone formation"}	Use hydrocodone label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	general	n/a	1	f	f	f
7337499	100416	RxNorm:5489	{"CYP2D6": "Decreased metabolism of hydrocodone to active metabolite, hydromorphone, but there is insufficient evidence to determine if these effects on pharmacokinetics translate into decreased analgesia or side effects."}	Use hydrocodone label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine and non-tramadol opioid.	Optional	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	general	n/a	1	f	f	f
7337500	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": "2.5"}	{}	{"CYP2D6": "2.5"}	general	n/a	1	f	f	f
7337501	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
7337502	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": "2.75"}	{}	{"CYP2D6": "2.75"}	general	n/a	1	f	f	f
7337503	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
7337511	100414	RxNorm:5691	{"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 imipramine use. If a imipramine 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
7337512	100414	RxNorm:5691	{"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
7337513	100414	RxNorm:5691	{"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
7337514	100414	RxNorm:5691	{"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
7337515	100414	RxNorm:5691	{"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
7337516	100414	RxNorm:5691	{"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
7337930	2405438	RxNorm:10184	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Optional	{"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
7337517	100414	RxNorm:5691	{"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
7337518	100414	RxNorm:5691	{"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
7337519	100414	RxNorm:5691	{"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
7337520	100414	RxNorm:5691	{"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
7337521	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337522	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337523	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337524	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337525	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337778	5290480	RxNorm:6918	{"CYP2D6": "Increased metabolism of metoprolol leading to decreased drug concentrations; however, it is unclear whether this results in clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	No recommendation for metoprolol therapy due to insufficient evidence regarding diminished metoprolol effectiveness clinically	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	n/a	1	f	f	f
7337526	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337527	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337528	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337529	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337530	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337531	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337532	100414	RxNorm:5691	{"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
7337533	100414	RxNorm:5691	{"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
7337534	100414	RxNorm:5691	{"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 imipramine use. If a imipramine 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
7337535	100414	RxNorm:5691	{"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
7337536	100414	RxNorm:5691	{"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
7337537	100414	RxNorm:5691	{"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
7337538	100414	RxNorm:5691	{"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
7337539	100414	RxNorm:5691	{"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
7337540	100414	RxNorm:5691	{"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
7337541	100414	RxNorm:5691	{"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
7337542	100414	RxNorm:5691	{"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
7337543	100414	RxNorm:5691	{"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
7337544	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337545	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337546	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337547	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337548	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337549	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337550	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337551	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337552	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337553	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337554	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337555	100414	RxNorm:5691	{"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
7337556	100414	RxNorm:5691	{"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
7337557	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337558	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337559	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337560	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337561	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337562	100414	RxNorm:5691	{"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 imipramine use. If imipramine 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
7337563	100414	RxNorm:5691	{"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 imipramine use. If imipramine 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
7337564	100414	RxNorm:5691	{"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 imipramine use. If imipramine 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
7337565	100414	RxNorm:5691	{"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 imipramine use. If imipramine 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
7337566	100414	RxNorm:5691	{"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 imipramine use. If imipramine 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
7337567	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337658	100414	RxNorm:5691	{"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
7337568	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337569	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337570	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337571	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337572	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337573	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337574	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337575	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337576	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337577	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337578	100414	RxNorm:5691	{"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
7337579	100414	RxNorm:5691	{"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
7337580	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337581	100414	RxNorm:5691	{"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 imipramine 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
7337582	100414	RxNorm:5691	{"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 imipramine 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
7337583	100414	RxNorm:5691	{"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 imipramine 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
7337584	100414	RxNorm:5691	{"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 imipramine 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
7337636	100414	RxNorm:5691	{"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
7337585	100414	RxNorm:5691	{"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 imipramine 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
7337586	100414	RxNorm:5691	{"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 imipramine 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
7337587	100414	RxNorm:5691	{"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 imipramine 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
7337588	100414	RxNorm:5691	{"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 imipramine 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
7337589	100414	RxNorm:5691	{"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 imipramine 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
7337590	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337637	100414	RxNorm:5691	{"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
7337591	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337592	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337593	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337594	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337595	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337596	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337597	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337598	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337599	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337600	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337601	100414	RxNorm:5691	{"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
7337602	100414	RxNorm:5691	{"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
7337779	5290480	RxNorm:6918	{"CYP2D6": "Increased metabolism of metoprolol leading to decreased drug concentrations; however, it is unclear whether this results in clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	No recommendation for metoprolol therapy due to insufficient evidence regarding diminished metoprolol effectiveness clinically	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	n/a	1	f	f	f
7337603	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337604	100414	RxNorm:5691	{"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 imipramine 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
7337605	100414	RxNorm:5691	{"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 imipramine 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
7337606	100414	RxNorm:5691	{"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 imipramine 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
7337607	100414	RxNorm:5691	{"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 imipramine 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
7337638	100414	RxNorm:5691	{"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
7337608	100414	RxNorm:5691	{"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 imipramine 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
7337609	100414	RxNorm:5691	{"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 imipramine 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
7337610	100414	RxNorm:5691	{"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 imipramine 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
7337611	100414	RxNorm:5691	{"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 imipramine 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
7337612	100414	RxNorm:5691	{"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 imipramine 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
7337613	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337655	100414	RxNorm:5691	{"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
7337614	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337615	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337616	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337617	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337618	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337619	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337620	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337621	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337622	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337623	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337624	100414	RxNorm:5691	{"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
7337625	100414	RxNorm:5691	{"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
7337830	110076	RxNorm:40790	{"CYP2C19": "Increased plasma concentration of PPI compared to CYP2C19 NMs; increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Optional	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
7337626	100414	RxNorm:5691	{"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
7337627	100414	RxNorm:5691	{"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
7337628	100414	RxNorm:5691	{"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
7337629	100414	RxNorm:5691	{"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
7337630	100414	RxNorm:5691	{"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
7337631	100414	RxNorm:5691	{"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
7337632	100414	RxNorm:5691	{"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
7337633	100414	RxNorm:5691	{"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
7337634	100414	RxNorm:5691	{"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
7337635	100414	RxNorm:5691	{"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
7337656	100414	RxNorm:5691	{"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
7337639	100414	RxNorm:5691	{"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
7337640	100414	RxNorm:5691	{"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
7337641	100414	RxNorm:5691	{"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
7337642	100414	RxNorm:5691	{"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
7337643	100414	RxNorm:5691	{"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
7337644	100414	RxNorm:5691	{"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
7337645	100414	RxNorm:5691	{"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
7337646	100414	RxNorm:5691	{"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
7337647	100414	RxNorm:5691	{"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
7337648	100414	RxNorm:5691	{"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
7337657	100414	RxNorm:5691	{"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
7337649	100414	RxNorm:5691	{"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 imipramine use. If a imipramine 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
7337650	100414	RxNorm:5691	{"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
7337651	100414	RxNorm:5691	{"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
7337652	100414	RxNorm:5691	{"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
7337653	100414	RxNorm:5691	{"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
7337654	100414	RxNorm:5691	{"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
7337948	2405438	RxNorm:10635	{"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
7337659	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337660	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337661	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337662	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337663	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337664	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337665	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337666	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337667	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337668	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337669	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337670	100414	RxNorm:5691	{"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
7337671	100414	RxNorm:5691	{"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
7337672	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337673	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337707	100414	RxNorm:5691	{"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
7337674	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337675	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337676	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337677	100414	RxNorm:5691	{"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 imipramine use. If imipramine 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
7337678	100414	RxNorm:5691	{"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 imipramine use. If imipramine 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
7337719	100426	RxNorm:6472	{"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
7337679	100414	RxNorm:5691	{"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 imipramine use. If imipramine 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
7337680	100414	RxNorm:5691	{"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 imipramine use. If imipramine 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
7337681	100414	RxNorm:5691	{"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 imipramine use. If imipramine 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
7337682	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337683	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337684	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7338226	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	n/a	1	f	f	f
7337685	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337686	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337687	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337688	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337689	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337690	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337691	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337692	100414	RxNorm:5691	{"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 imipramine use; If imipramine 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
7337693	100414	RxNorm:5691	{"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
7337694	100414	RxNorm:5691	{"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
7337695	100414	RxNorm:5691	{"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
7337696	100414	RxNorm:5691	{"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
7337697	100414	RxNorm:5691	{"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
7337698	100414	RxNorm:5691	{"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
7337699	100414	RxNorm:5691	{"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
7337700	100414	RxNorm:5691	{"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
7337701	100414	RxNorm:5691	{"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
7337702	100414	RxNorm:5691	{"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
7337703	100414	RxNorm:5691	{"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
7337704	100414	RxNorm:5691	{"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
7337705	100414	RxNorm:5691	{"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
7337706	100414	RxNorm:5691	{"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
7337708	100414	RxNorm:5691	{"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
7337709	100414	RxNorm:5691	{"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
7337710	100414	RxNorm:5691	{"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
7337711	100414	RxNorm:5691	{"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
7337712	100414	RxNorm:5691	{"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
7337713	100414	RxNorm:5691	{"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
7337714	100414	RxNorm:5691	{"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
7337715	100414	RxNorm:5691	{"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
7337716	100414	RxNorm:5691	{"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
7337717	100409	RxNorm:1243041	{"CFTR": "An individual diagnosed with cystic fibrosis (CF) and negative for a CFTR variant listed in the FDA-approved drug label as being responsive to ivacaftor."}	Ivacaftor is not recommended	Moderate	{"CFTR": "ivacaftor non-responsive in CF patients"}	{"CFTR": "n/a"}	{}	{"CFTR": "ivacaftor non-responsive in CF patients"}	general	n/a	1	f	f	f
7337718	100409	RxNorm:1243041	{"CFTR": "An individual diagnosed with cystic fibrosis (CF) and CFTR variants listed in the FDA-approved drug label as being responsive to ivacaftor"}	Use ivacaftor according to the product label	Moderate	{"CFTR": "ivacaftor responsive in CF patients"}	{"CFTR": "n/a"}	{}	{"CFTR": "ivacaftor responsive in CF patients"}	general	n/a	1	f	f	f
7337721	100426	RxNorm:6472	{"SLCO1B1": "Increased lovastatin acid exposure as compared to normal function which may translate to increased myopathy risk"}	Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins). If lovastatin therapy is warranted, limit dose to ≤20mg/day.	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
7337722	100426	RxNorm:6472	{"SLCO1B1": "Increased lovastatin acid exposure as compared to normal function which may translate to increased myopathy risk"}	Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins). If lovastatin therapy is warranted, limit dose to ≤20mg/day.	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
7337723	100426	RxNorm:6472	{"SLCO1B1": "Increased lovastatin acid exposure as compared to normal and decreased function which may translate to increased myopathy risk"}	Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins).	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
7337724	100426	RxNorm:6472	{"SLCO1B1": "n/a"}	No recommendation	No Recommendation	{"SLCO1B1": "Indeterminate"}	{}	{}	{"SLCO1B1": "Indeterminate"}	general	n/a	1	f	f	f
7337725	110058	RxNorm:41493	{"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
7337726	110058	RxNorm:41493	{"CYP2C9": "Mildly reduced metabolism"}	Initiate therapy with recommended starting dose. In accordance with the meloxicam 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.	1	f	f	f
7337727	110058	RxNorm:41493	{"CYP2C9": "Moderately reduced metabolism; higher plasma concentrations may increase probability of toxicities"}	Initiate therapy with 50% of the lowest recommended starting dose. Titrate dose upward to clinical effect or 50% of the maximum recommended dose with caution. In accordance with the meloxicam 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 7 days). Carefully monitor adverse events such as blood pressure and kidney function during course of therapy. Alternatively, consider alternative therapy. Choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life (see CPIC THERAPEUTIC RECOMMENDATIONS FOR CELECOXIB, FLURBIPROFEN, LORNOXICAM, AND IBUPROFEN BASED ON CYP2C9 PHENOTYPE).	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. 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
7337728	110058	RxNorm:41493	{"CYP2C9": "Significantly reduced metabolism and prolonged half-life; higher plasma concentrations may increase probability and/or severity of toxicities"}	Choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life (see CPIC THERAPEUTIC RECOMMENDATIONS FOR CELECOXIB, FLURBIPROFEN, LORNOXICAM, AND IBUPROFEN BASED ON CYP2C9 PHENOTYPE).	Moderate	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	general	n/a	1	f	f	f
7337729	110058	RxNorm:41493	{"CYP2C9": "Significantly reduced metabolism and prolonged half-life; higher plasma concentrations may increase probability and/or severity of toxicities"}	Choose an alternative therapy not metabolized by CYP2C9 or not significantly impacted by CYP2C9 genetic variants in vivo or choose an NSAID metabolized by CYP2C9 but with a shorter half-life (see CPIC THERAPEUTIC RECOMMENDATIONS FOR CELECOXIB, FLURBIPROFEN, LORNOXICAM, AND IBUPROFEN BASED ON CYP2C9 PHENOTYPE).	Moderate	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	general	n/a	1	f	f	f
7337730	110058	RxNorm:41493	{"CYP2C9": "n/a"}	No recommendation	No Recommendation	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	general	n/a	1	f	f	f
7337731	100428	RxNorm:103	{"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
7337774	5290480	RxNorm:6918	{"CYP2D6": "Decreased metabolism of metoprolol leading to markedly increased drug concentrations; this leads to greater heart rate and blood pressure reductions, but the effect on clinical outcomes is unclear"}	Initiate therapy with lowest recommended starting dose. Carefully titrate dose upward to clinical effect or guideline-recommended dose; monitor more closely for bradycardia. Alternatively, consider selecting another beta-blocker.	Moderate	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	general	n/a	1	f	f	f
7337775	5290480	RxNorm:6918	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
7337732	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Based NUDT15 status, start with reduced starting doses (30%-80% of normal dose) if normal starting dose is ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201, 18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537). If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. TPMT phenotype could not be assigned based on genotyping. 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": "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
7337733	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Based on NUDT15 status, start with normal starting dose (e.g., 75 mg/m2/day or 1.5 mg/kg/day) and adjust doses of mercaptopurine (and of any other myelosuppressive therapy) without any special emphasis on mercaptopurine compared to other agents. Allow at least 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 16401827, 11302950). TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte 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
7337734	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia, myelosuppression"}	Based on NUDT15 status, for malignancy, initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy (PMID 20354201, 1960624, 11302950, 16530532). TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte 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
7337735	100428	RxNorm:103	{"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 ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201, 18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537). If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. TPMT phenotype could not be assigned based on genotyping performed. Consider evaluating TPMT erythrocyte 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
7337736	100428	RxNorm:103	{"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 ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201,18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537). If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. 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
7337776	5290480	RxNorm:6918	{"CYP2D6": "Increased metabolism of metoprolol leading to decreased drug concentrations; however, it is unclear whether this results in clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	No recommendation for metoprolol therapy due to insufficient evidence regarding diminished metoprolol effectiveness clinically	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	n/a	1	f	f	f
7337737	100428	RxNorm:103	{"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 ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine 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. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201,18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537, 38230823). If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended.	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
7337738	100428	RxNorm:103	{"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 ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g. start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201,18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537). If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended.	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
7337739	100428	RxNorm:103	{"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 malignancy, initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy (PMID 20354201, 1960624, 11302950, 16530532).	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
7337740	100428	RxNorm:103	{"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 ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine 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. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201,18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537, 38230823). If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended.	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
7337741	100428	RxNorm:103	{"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 ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201,18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537). If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended. 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": "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
7337748	100428	RxNorm:103	{"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., 75 mg/m2/day or 1.5 mg/kg/day) and adjust doses of mercaptopurine (and of any other myelosuppressive therapy) without any special emphasis on mercaptopurine compared to other agents. Allow at least 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 16401827, 11302950).	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
7337742	100428	RxNorm:103	{"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 ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine 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. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201,18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537, 38230823). If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended.	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
7337743	100428	RxNorm:103	{"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 ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g. start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201,18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537). If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended.	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
7337744	100428	RxNorm:103	{"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 malignancy, initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy (PMID 20354201, 1960624, 11302950, 16530532).	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
7337745	100428	RxNorm:103	{"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 ≥ 75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 15-37.5 mg/m2/day or 0.3-0.75 mg/kg/day) and adjust doses of mercaptopurine 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. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201,18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537, 38230823). If normal starting dose is already < 37.5 mg/m2/day or < 0.75 mg/kg/day, dose reduction may not be recommended.	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
7337746	100428	RxNorm:103	{"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., 75 mg/m2/day or 1.5 mg/kg/day) and adjust doses of mercaptopurine (and of any other myelosuppressive therapy) without any special emphasis on mercaptopurine compared to other agents. Allow at least 2 weeks to reach steady-state after each dose adjustment (PMID 20354201, 16401827, 11302950). 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": "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
7337747	100428	RxNorm:103	{"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 ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201, 18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537). If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended.	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
7337749	100428	RxNorm:103	{"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 malignancy, initiate dose at 10 mg/m2/day and adjust dose based on myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy (PMID 20354201, 1960624, 11302950, 16530532).	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
7337750	100428	RxNorm:103	{"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 ≥75 mg/m2/day or ≥ 1.5 mg/kg/day (e.g., start at 22.5-60 mg/m2/day or 0.45-1.2 mg/kg/day) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 2-4 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, and depending on other therapy, emphasis should be on reducing mercaptopurine over other agents (PMID 20354201, 18685564, 8857546, 18987654, 20010622, 16401827, 11302950, 16530532, 9634537). If normal starting dose is already < 75 mg/m2/day or < 1.5 mg/kg/day, dose reduction may not be recommended.	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
7337751	100428	RxNorm:103	{"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 malignancy, start with drastically reduced doses (reduce daily dose by 10-fold and reduce frequency to thrice weekly instead of daily, e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy (PMID 20354201, 1960624, 11302950, 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": "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
7337752	100428	RxNorm:103	{"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 malignancy, start with drastically reduced doses (reduce daily dose by 10-fold and reduce frequency to thrice weekly instead of daily, e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy (PMID 20354201, 1960624, 11302950, 16530532).	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
7337753	100428	RxNorm:103	{"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 malignancy, start with drastically reduced doses (reduce daily dose by 10-fold and reduce frequency to thrice weekly instead of daily, e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy (PMID 20354201, 1960624, 11302950, 16530532).	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
7337754	100428	RxNorm:103	{"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 malignancy, start with drastically reduced doses (reduce daily dose by 10-fold and reduce frequency to thrice weekly instead of daily, e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy (PMID 20354201, 1960624, 11302950, 16530532).	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
7337755	100428	RxNorm:103	{"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 malignancy, start with drastically reduced doses (reduce daily dose by 10-fold and reduce frequency to thrice weekly instead of daily, e.g., 10 mg/m2/day given just 3 days/week) and adjust doses of mercaptopurine based on degree of myelosuppression and disease-specific guidelines. Allow 4-6 weeks to reach steady-state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For non-malignant conditions, consider alternative non-thiopurine immunosuppressant therapy (PMID 20354201, 1960624, 11302950, 16530532).	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
7337756	2405438	RxNorm:6878	{"G6PD": "Low risk of acute hemolytic anemia"}	No reason to avoid ased on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	\N	1	f	f	f
7337757	2405438	RxNorm:6878	{"G6PD": "High risk of acute hemolytic anemia"}	Avoid use	Moderate	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	\N	1	f	f	f
7337758	2405438	RxNorm:6878	{"G6PD": "High risk of acute exacerbation 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
7337759	2405438	RxNorm:6878	{"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
7337760	2405438	RxNorm:6878	{"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
7337761	5290480	RxNorm:6918	{"CYP2D6": "Increased metabolism of metoprolol leading to decreased drug concentrations; however, it is unclear whether this results in clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	No recommendation for metoprolol therapy due to insufficient evidence regarding diminished metoprolol effectiveness clinically	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	general	n/a	1	f	f	f
7337762	5290480	RxNorm:6918	{"CYP2D6": "Normal metabolism of metoprolol"}	Initiate standard dosing	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	general	n/a	1	f	f	f
7337763	5290480	RxNorm:6918	{"CYP2D6": "Normal metabolism of metoprolol"}	Initiate standard dosing	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	general	n/a	1	f	f	f
7337764	5290480	RxNorm:6918	{"CYP2D6": "Increased metabolism of metoprolol leading to decreased drug concentrations; however, it is unclear whether this results in clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	No recommendation for metoprolol therapy due to insufficient evidence regarding diminished metoprolol effectiveness clinically	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	n/a	1	f	f	f
7337765	5290480	RxNorm:6918	{"CYP2D6": "Increased metabolism of metoprolol leading to decreased drug concentrations; however, it is unclear whether this results in clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	No recommendation for metoprolol therapy due to insufficient evidence regarding diminished metoprolol effectiveness clinically	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	n/a	1	f	f	f
7337766	5290480	RxNorm:6918	{"CYP2D6": "Increased metabolism of metoprolol leading to decreased drug concentrations; however, it is unclear whether this results in clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	No recommendation for metoprolol therapy due to insufficient evidence regarding diminished metoprolol effectiveness clinically	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	general	n/a	1	f	f	f
7337767	5290480	RxNorm:6918	{"CYP2D6": "Increased metabolism of metoprolol leading to decreased drug concentrations; however, it is unclear whether this results in clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	No recommendation for metoprolol therapy due to insufficient evidence regarding diminished metoprolol effectiveness clinically	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	n/a	1	f	f	f
7337768	5290480	RxNorm:6918	{"CYP2D6": "Normal metabolism of metoprolol"}	Initiate standard dosing	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	general	n/a	1	f	f	f
7337769	5290480	RxNorm:6918	{"CYP2D6": "Normal metabolism of metoprolol"}	Initiate standard dosing	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	general	n/a	1	f	f	f
7337770	5290480	RxNorm:6918	{"CYP2D6": "Decreased metabolism of metoprolol leading to increased drug concentrations; however, this does not appear to translate into clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	Initiate standard dosing	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	general	n/a	1	f	f	f
7337771	5290480	RxNorm:6918	{"CYP2D6": "Decreased metabolism of metoprolol leading to increased drug concentrations; however, this does not appear to translate into clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	Initiate standard dosing	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	general	n/a	1	f	f	f
7337780	5290480	RxNorm:6918	{"CYP2D6": "Increased metabolism of metoprolol leading to decreased drug concentrations; however, it is unclear whether this results in clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	No recommendation for metoprolol therapy due to insufficient evidence regarding diminished metoprolol effectiveness clinically	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	n/a	1	f	f	f
7337781	5290480	RxNorm:6918	{"CYP2D6": "Increased metabolism of metoprolol leading to decreased drug concentrations; however, it is unclear whether this results in clinically significant changes in heart rate, blood pressure, or clinical outcomes"}	No recommendation for metoprolol therapy due to insufficient evidence regarding diminished metoprolol effectiveness clinically	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	n/a	1	f	f	f
7337782	5290480	RxNorm:6918	{"CYP2D6": "Normal metabolism of metoprolol"}	Initiate standard dosing	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	general	n/a	1	f	f	f
7337783	2405438	RxNorm:7454	{"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
7337784	2405438	RxNorm:7454	{"G6PD": "Medium risk of acute hemolytic anemia"}	Use at standard doses with caution and with close monitoring for anemia	Optional	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	Close monitoring may be more important at higher or more chronic dosage schedules, 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
7337785	2405438	RxNorm:7454	{"G6PD": "High risk of acute of acute exacerbation of chronic hemolysis"}	Avoid	Moderate	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	general	There are insufficient data in patients with the G6PD Deficient with CNSHA phenotype to rate as "strong," but all medium risk drugs should be avoided in these rare patients due to the underlying pathophysiology that confers high risk for acute exacerbation of chronic hemolysis.	1	f	f	f
7337786	2405438	RxNorm:7454	{"G6PD": "Variable risk of acute hemolytic anemia"}	If deemed necessary 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
7337787	2405438	RxNorm:7454	{"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
7337788	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	n/a	1	f	f	f
7337789	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	n/a	1	f	f	f
7337790	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	n/a	1	f	f	f
7337791	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	n/a	1	f	f	f
7337792	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	n/a	1	f	f	f
7337905	2405438	RxNorm:8120	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Optional	{"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
7337793	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	n/a	1	f	f	f
7337794	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	n/a	1	f	f	f
7337795	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	general	n/a	1	f	f	f
7337796	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	general	n/a	1	f	f	f
7337797	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	general	n/a	1	f	f	f
7337798	100414	RxNorm:7531	{"CYP2D6": "Increased metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Lower plasma concentrations of active drug will increase probability of pharmacotherapy failure."}	Avoid tricyclic use due to potential lack of efficacy. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider titrating to a higher target dose (compared to normal metabolizers). Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	n/a	1	f	f	f
7337799	100414	RxNorm:7531	{"CYP2D6": "Normal metabolism of tricyclic antidepressants"}	Initiate therapy with recommended starting dose	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	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
7337800	100414	RxNorm:7531	{"CYP2D6": "Normal metabolism of tricyclic antidepressants"}	Initiate therapy with recommended starting dose	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	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
7337801	100414	RxNorm:7531	{"CYP2D6": "Normal metabolism of tricyclic antidepressants"}	Initiate therapy with recommended starting dose	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	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
7337802	100414	RxNorm:7531	{"CYP2D6": "Normal metabolism of tricyclic antidepressants"}	Initiate therapy with recommended starting dose	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	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
7337803	100414	RxNorm:7531	{"CYP2D6": "Normal metabolism of tricyclic antidepressants"}	Initiate therapy with recommended starting dose	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	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
7337813	110076	RxNorm:7646	{"CYP2C19": "Likely increased plasma concentration of PPI compared to CYP2C19 NMs; likely increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Optional	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	general	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
7337804	100414	RxNorm:7531	{"CYP2D6": "Reduced metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects."}	Consider a 25% reduction of recommended starting dose. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	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 tricyclic antidepressants 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
7337805	100414	RxNorm:7531	{"CYP2D6": "Reduced metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects."}	Consider a 25% reduction of recommended starting dose. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	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 tricyclic antidepressants 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
7337806	100414	RxNorm:7531	{"CYP2D6": "Reduced metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects."}	Consider a 25% reduction of recommended starting dose. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	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 tricyclic antidepressants 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
7337807	100414	RxNorm:7531	{"CYP2D6": "Reduced metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects."}	Consider a 25% reduction of recommended starting dose. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	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 tricyclic antidepressants 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
7337808	100414	RxNorm:7531	{"CYP2D6": "Greatly reduced metabolism of tricyclic antidepressants to less active compounds compared to normal metabolizers. Higher plasma concentrations of active drug will increase the probability of side effects."}	Avoid tricyclic use due to potential for side effects. Consider alternative drug not metabolized by CYP2D6. If a tricyclic antidepressant is warranted, consider a 50% reduction of recommended starting dose. Titrate dose to observed clinical response with symptom improvement and minimal (if any) side effects. Utilize therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	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 tricyclic antidepressants 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
7337809	100414	RxNorm:7531	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	Because CYP2D6 phenotype could not be assigned based on genotyping performed, therapuetic monitoring should be considered. If therapuetic monitoring cannot be performed, monitor closely for toxicity and/or efficacy.	1	f	f	f
7337810	110076	RxNorm:7646	{"CYP2C19": "Decreased plasma concentrations of PPIs compared to CYP2C19 NMs; increased risk of therapeutic failure"}	Increase starting daily dose by 100%. Daily dose may be given in divided doses. Monitor for efficacy.	Optional	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	general	n/a	1	f	f	f
7337811	110076	RxNorm:7646	{"CYP2C19": "Decreased plasma concentrations of PPIs compared to CYP2C19 NMs; increased risk of therapeutic failure"}	Initiate standard starting daily dose. Consider increasing dose by 50-100% for the treatment of H. pylori infection and erosive esophagitis. Daily dose may be given in divided doses.\nMonitor for efficacy.	Moderate	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Rapid Metabolizer"}	general	n/a	1	f	f	f
7337812	110076	RxNorm:7646	{"CYP2C19": "Normal PPI metabolism; may be at increased risk of therapeutic failure compared to CYP2C19 IMs and PMs"}	Initiate standard starting daily dose. Consider increasing dose by 50-100% for the treatment of H. pylori infection and erosive esophagitis. Daily dose may be given in divided doses.\nMonitor for efficacy.	Moderate	{"CYP2C19": "Normal Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
7337814	110076	RxNorm:7646	{"CYP2C19": "Increased plasma concentration of PPI compared to CYP2C19 NMs; increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Optional	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
7337815	110076	RxNorm:7646	{"CYP2C19": "Likely increased plasma concentration of PPI compared to CYP2C19 NMs; likely increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Moderate	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	general	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
7337816	110076	RxNorm:7646	{"CYP2C19": "Increased plasma concentration of PPI compared to CYP2C19 NMs; increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Moderate	{"CYP2C19": "Poor Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Poor Metabolizer"}	general	n/a	1	f	f	f
7337817	110076	RxNorm:7646	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
7337818	110076	RxNorm:17128	{"CYP2C19": "Decreased plasma concentrations of PPIs compared to CYP2C19 NMs; increased risk of therapeutic failure"}	Increase starting daily dose by 100%. Daily dose may be given in divided doses. Monitor for efficacy.	Optional	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	general	n/a	1	f	f	f
7337819	110076	RxNorm:17128	{"CYP2C19": "Decreased plasma concentrations of PPIs compared to CYP2C19 NMs; increased risk of therapeutic failure"}	Initiate standard starting daily dose. Consider increasing dose by 50-100% for the treatment of H. pylori infection and erosive esophagitis. Daily dose may be given in divided doses.\nMonitor for efficacy.	Moderate	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Rapid Metabolizer"}	general	n/a	1	f	f	f
7337820	110076	RxNorm:17128	{"CYP2C19": "Normal PPI metabolism; may be at increased risk of therapeutic failure compared to CYP2C19 IMs and PMs"}	Initiate standard starting daily dose. Consider increasing dose by 50-100% for the treatment of H. pylori infection and erosive esophagitis. Daily dose may be given in divided doses.\nMonitor for efficacy.	Moderate	{"CYP2C19": "Normal Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
7337821	110076	RxNorm:17128	{"CYP2C19": "Likely increased plasma concentration of PPI compared to CYP2C19 NMs; likely increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Optional	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	general	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
7337822	110076	RxNorm:17128	{"CYP2C19": "Increased plasma concentration of PPI compared to CYP2C19 NMs; increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Optional	{"CYP2C19": "Intermediate Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
7337823	110076	RxNorm:17128	{"CYP2C19": "Likely increased plasma concentration of PPI compared to CYP2C19 NMs; likely increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Moderate	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	general	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
7337824	110076	RxNorm:17128	{"CYP2C19": "Increased plasma concentration of PPI compared to CYP2C19 NMs; increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Moderate	{"CYP2C19": "Poor Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Poor Metabolizer"}	general	n/a	1	f	f	f
7337825	110076	RxNorm:17128	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
7337826	110076	RxNorm:40790	{"CYP2C19": "Decreased plasma concentrations of PPIs compared to CYP2C19 NMs; increased risk of therapeutic failure"}	Increase starting daily dose by 100%. Daily dose may be given in divided doses. Monitor for efficacy.	Optional	{"CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	general	n/a	1	f	f	f
7337827	110076	RxNorm:40790	{"CYP2C19": "Decreased plasma concentrations of PPIs compared to CYP2C19 NMs; increased risk of therapeutic failure"}	Initiate standard starting daily dose. Consider increasing dose by 50-100% for the treatment of H. pylori infection and erosive esophagitis. Daily dose may be given in divided doses.\nMonitor for efficacy.	Moderate	{"CYP2C19": "Rapid Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Rapid Metabolizer"}	general	n/a	1	f	f	f
7337828	110076	RxNorm:40790	{"CYP2C19": "Normal PPI metabolism; may be at increased risk of therapeutic failure compared to CYP2C19 IMs and PMs"}	Initiate standard starting daily dose. Consider increasing dose by 50-100% for the treatment of H. pylori infection and erosive esophagitis. Daily dose may be given in divided doses.\nMonitor for efficacy.	Moderate	{"CYP2C19": "Normal Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
7337829	110076	RxNorm:40790	{"CYP2C19": "Likely increased plasma concentration of PPI compared to CYP2C19 NMs; likely increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Optional	{"CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	general	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
7337831	110076	RxNorm:40790	{"CYP2C19": "Likely increased plasma concentration of PPI compared to CYP2C19 NMs; likely increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Moderate	{"CYP2C19": "Likely Poor Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	general	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
7337832	110076	RxNorm:40790	{"CYP2C19": "Increased plasma concentration of PPI compared to CYP2C19 NMs; increased chance of efficacy and potentially toxicity"}	Initiate standard starting daily dose. For chronic therapy (>12 weeks) and efficacy achieved, consider 50% reduction in daily dose and monitor for continued efficacy.	Moderate	{"CYP2C19": "Poor Metabolizer"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Poor Metabolizer"}	general	n/a	1	f	f	f
7337833	110076	RxNorm:40790	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
7337834	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337835	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337836	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337837	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337838	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337839	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337840	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337841	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337842	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337843	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337844	100417	RxNorm:26225	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337845	100417	RxNorm:26225	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337846	100417	RxNorm:26225	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337847	100417	RxNorm:26225	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337848	100417	RxNorm:26225	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337849	100417	RxNorm:26225	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337850	100417	RxNorm:26225	{"CYP2D6": "Very limited data available for CYP2D6 intermediate metabolizers"}	Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. Initiate therapy with recommended starting dose.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337851	100417	RxNorm:26225	{"CYP2D6": "Very limited data available for CYP2D6 intermediate metabolizers"}	Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. Initiate therapy with recommended starting dose.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337852	100417	RxNorm:26225	{"CYP2D6": "Very limited data available for CYP2D6 intermediate metabolizers"}	Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. Initiate therapy with recommended starting dose.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337853	100417	RxNorm:26225	{"CYP2D6": "Very limited data available for CYP2D6 intermediate metabolizers"}	Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. Initiate therapy with recommended starting dose.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337854	100417	RxNorm:26225	{"CYP2D6": "Very limited data available for CYP2D6 poor metabolizers"}	Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. Initiate therapy with recommended starting dose.	No Recommendation	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337855	100417	RxNorm:26225	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
7337906	2405438	RxNorm:8120	{"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 for acute exacerbation of chronic hemolysis.	1	f	f	f
7337856	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337857	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337858	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337859	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337860	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337861	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337862	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337863	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337864	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337865	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337866	100417	RxNorm:27392	{"CYP2D6": "Increased metabolism to less active compounds when compared to normal metabolizers and is associated with decreased response to ondansetron and tropisetron (i.e. vomiting)."}	Select alternative drug not predominantly metabolized by CYP2D6 (i.e., granisetron).	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy. Dolasetron, palonosetron, and ramosetron are also metabolized by CYP2D6. Limited evidence is available regarding the utilization of CYP2D6 genetic variation to guide use of these drugs.	1	f	f	f
7337867	100417	RxNorm:27392	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337868	100417	RxNorm:27392	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337869	100417	RxNorm:27392	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337870	100417	RxNorm:27392	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337871	100417	RxNorm:27392	{"CYP2D6": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337872	100417	RxNorm:27392	{"CYP2D6": "Very limited data available for CYP2D6 intermediate metabolizers"}	Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. Initiate therapy with recommended starting dose.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337873	100417	RxNorm:27392	{"CYP2D6": "Very limited data available for CYP2D6 intermediate metabolizers"}	Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. Initiate therapy with recommended starting dose.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337874	100417	RxNorm:27392	{"CYP2D6": "Very limited data available for CYP2D6 intermediate metabolizers"}	Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. Initiate therapy with recommended starting dose.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337875	100417	RxNorm:27392	{"CYP2D6": "Very limited data available for CYP2D6 intermediate metabolizers"}	Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. Initiate therapy with recommended starting dose.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337876	100417	RxNorm:27392	{"CYP2D6": "Very limited data available for CYP2D6 poor metabolizers"}	Insufficient evidence demonstrating clinical impact based on CYP2D6 genotype. Initiate therapy with recommended starting dose.	No Recommendation	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, and liver function) should be considered when selecting alternative therapy.	1	f	f	f
7337877	100417	RxNorm:27392	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
7337878	100423	RxNorm:32624	{"HLA-B": "Normal risk of oxcarbazepine-induced SJS/TEN"}	Use oxcarbazepine per standard dosing guidelines.	Strong	{}	{}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative"}	OXC naive	n/a	1	f	f	f
7337879	100423	RxNorm:32624	{"HLA-B": "Greater risk of oxcarbazepine-induced SJS/TEN"}	If patient is oxcarbazepine-naïve, do not use oxcarbazepine.	Strong	{}	{}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive"}	OXC 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. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital.	1	f	f	f
7337880	100423	RxNorm:32624	{"HLA-B": "Normal risk of oxcarbazepine-induced SJS/TEN"}	Use oxcarbazepine per standard dosing guidelines.	Strong	{}	{"HLA-B": "n/a"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative"}	OXC use >3 mos	n/a	1	f	f	f
7337881	100423	RxNorm:32624	{"HLA-B": "Greater risk of oxcarbazepine-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 oxcarbazepine consistently for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of oxcarbazepine in the future.	Optional	{}	{"HLA-B": "n/a"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive"}	OXC use >3 mos	Previous tolerance of oxcarbazepine is not indicative of tolerance to other aromatic anticonvulsants. Aromatic anticonvulsants include carbamazepine, oxcarbazepine, eslicarbazepine, lamotrigine, phenytoin, fosphenytoin, and phenobarbital.	1	f	f	f
7337882	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337883	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337884	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337885	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337886	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337887	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337888	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337889	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337890	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337891	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337907	2405438	RxNorm:8120	{"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
7337892	100413	RxNorm:32937	{"CYP2D6": "Increased metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit. The extent to which ultrarapid metabolizers phenoconvert to normal, intermediate, or poor metabolizers due to paroxetine autoinhibition of CYP2D6 is unclear."}	Select alternative drug not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	Drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be considered when selecting an alternative therapy.	1	f	f	f
7337893	100413	RxNorm:32937	{"CYP2D6": "Normal metabolism of paroxetine to less active compounds. Paroxetine-associated phenoconversion of normal metabolizers to intermediate or poor metabolizers due to CYP2D6 autoinhibition may occur and is dose-dependent and greater at steady state concentrations."}	Initiate therapy with recommended starting dose	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	general	n/a	1	f	f	f
7337894	100413	RxNorm:32937	{"CYP2D6": "Normal metabolism of paroxetine to less active compounds. Paroxetine-associated phenoconversion of normal metabolizers to intermediate or poor metabolizers due to CYP2D6 autoinhibition may occur and is dose-dependent and greater at steady state concentrations."}	Initiate therapy with recommended starting dose	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.0"}	{}	{"CYP2D6": "2.0"}	general	n/a	1	f	f	f
7337895	100413	RxNorm:32937	{"CYP2D6": "Normal metabolism of paroxetine to less active compounds. Paroxetine-associated phenoconversion of normal metabolizers to intermediate or poor metabolizers due to CYP2D6 autoinhibition may occur and is dose-dependent and greater at steady state concentrations."}	Initiate therapy with recommended starting dose	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.75"}	{}	{"CYP2D6": "1.75"}	general	n/a	1	f	f	f
7337896	100413	RxNorm:32937	{"CYP2D6": "Normal metabolism of paroxetine to less active compounds. Paroxetine-associated phenoconversion of normal metabolizers to intermediate or poor metabolizers due to CYP2D6 autoinhibition may occur and is dose-dependent and greater at steady state concentrations."}	Initiate therapy with recommended starting dose	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.5"}	{}	{"CYP2D6": "1.5"}	general	n/a	1	f	f	f
7337897	100413	RxNorm:32937	{"CYP2D6": "Normal metabolism of paroxetine to less active compounds. Paroxetine-associated phenoconversion of normal metabolizers to intermediate or poor metabolizers due to CYP2D6 autoinhibition may occur and is dose-dependent and greater at steady state concentrations."}	Initiate therapy with recommended starting dose	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "1.25"}	{}	{"CYP2D6": "1.25"}	general	n/a	1	f	f	f
7337898	100413	RxNorm:32937	{"CYP2D6": "Reduced metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers when starting treatment or at lower doses. Higher plasma concentrations may increase the probability of side\\neffects. Paroxetine-associated phenoconversion of intermediate metabolizers to poor metabolizers due to CYP2D6 autoinhibition may occur and is dose-dependent and greater at steady state concentrations."}	Consider a lower starting dose and slower titration schedule as compared to normal metabolizers.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	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
7337899	100413	RxNorm:32937	{"CYP2D6": "Reduced metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers when starting treatment or at lower doses. Higher plasma concentrations may increase the probability of side\\neffects. Paroxetine-associated phenoconversion of intermediate metabolizers to poor metabolizers due to CYP2D6 autoinhibition may occur and is dose-dependent and greater at steady state concentrations."}	Consider a lower starting dose and slower titration schedule as compared to normal metabolizers.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	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
7337900	100413	RxNorm:32937	{"CYP2D6": "Reduced metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers when starting treatment or at lower doses. Higher plasma concentrations may increase the probability of side\\neffects. Paroxetine-associated phenoconversion of intermediate metabolizers to poor metabolizers due to CYP2D6 autoinhibition may occur and is dose-dependent and greater at steady state concentrations."}	Consider a lower starting dose and slower titration schedule as compared to normal metabolizers.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	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
7337901	100413	RxNorm:32937	{"CYP2D6": "Reduced metabolism of paroxetine to less active compounds when compared to CYP2D6 normal metabolizers when starting treatment or at lower doses. Higher plasma concentrations may increase the probability of side\\neffects. Paroxetine-associated phenoconversion of intermediate metabolizers to poor metabolizers due to CYP2D6 autoinhibition may occur and is dose-dependent and greater at steady state concentrations."}	Consider a lower starting dose and slower titration schedule as compared to normal metabolizers.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	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
7337902	100413	RxNorm:32937	{"CYP2D6": "Greatly reduced metabolism when compared to CYP2D6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects. The impact of paroxetine-associated autoinhibition of CYP2D6 is minimal in poor metabolizers."}	Consider a 50% reduction in recommended starting dose, slower titration schedule, and a 50% lower maintenance dose as compared to normal metabolizers.	Moderate	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	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
7337903	100413	RxNorm:32937	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
7337904	2405438	RxNorm:8120	{"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
7337911	2405438	RxNorm:9071	{"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 for acute exacerbation of chronic hemolysis.	1	f	f	f
7337912	2405438	RxNorm:9071	{"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
7337913	2405438	RxNorm:9071	{"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
7337914	2405438	RxNorm:10171	{"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
7337915	2405438	RxNorm:10171	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Optional	{"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
7337916	2405438	RxNorm:10171	{"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 for acute exacerbation of chronic hemolysis.	1	f	f	f
7337917	2405438	RxNorm:10171	{"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
7337918	2405438	RxNorm:10171	{"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
7337919	2405438	RxNorm:10178	{"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
7337920	2405438	RxNorm:10178	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Optional	{"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
7337921	2405438	RxNorm:10178	{"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 for acute exacerbation of chronic hemolysis.	1	f	f	f
7337922	2405438	RxNorm:10178	{"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
7337923	2405438	RxNorm:10178	{"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
7337924	2405438	RxNorm:10831	{"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
7337925	2405438	RxNorm:10831	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Optional	{"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
7337926	2405438	RxNorm:10831	{"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 for acute exacerbation of chronic hemolysis.	1	f	f	f
7337927	2405438	RxNorm:10831	{"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
7337929	2405438	RxNorm:10184	{"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
7337931	2405438	RxNorm:10184	{"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 for acute exacerbation of chronic hemolysis.	1	f	f	f
7337932	2405438	RxNorm:10184	{"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
7337933	2405438	RxNorm:10184	{"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
7337934	2405438	RxNorm:9524	{"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
7337935	2405438	RxNorm:9524	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Optional	{"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
7337936	2405438	RxNorm:9524	{"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 for acute exacerbation of chronic hemolysis.	1	f	f	f
7337937	2405438	RxNorm:9524	{"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
7337938	2405438	RxNorm:9524	{"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
7337939	2405438	RxNorm:10207	{"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
7337940	2405438	RxNorm:10207	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Optional	{"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
7337941	2405438	RxNorm:10207	{"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 for acute exacerbation of chronic hemolysis.	1	f	f	f
7337942	2405438	RxNorm:10207	{"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
7337943	2405438	RxNorm:10207	{"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
7337944	2405438	RxNorm:10635	{"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
7337945	2405438	RxNorm:10635	{"G6PD": "Low-to-no risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status at standard doses	Optional	{"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
7337946	2405438	RxNorm:10635	{"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 for acute exacerbation of chronic hemolysis.	1	f	f	f
