{"CYP2D6 and CYP2C19 genetic status may be predictive of an adverse reaction or poor response to this medication due to altered drug metabolism. This patient is predicted to be a CYP2D6 poor metabolizer and a CYP2C19 poor metabolizer. This patient may be at an increased risk of a sub-optimal response. Consider selecting an alternative drug. If doxepin is warranted utilize therapeutic drug monitoring to guide dose adjustments. Please consult a clinical pharmacist for more information."}