8351788	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351789	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351790	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351791	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351792	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351793	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351794	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351795	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351796	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351797	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351798	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": "Increased metabolism of tertiary amines compared to normal metabolizers; Greater 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": "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
8351799	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": "2.5", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.5", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8351800	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
8351801	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": "2.75", "CYP2C19": "n/a"}	{}	{"CYP2D6": "2.75", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8351802	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
8351803	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
8351804	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
8351805	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
8351806	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
8351807	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
8351808	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
8351809	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
8351810	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
8352661	100416	RxNorm:10689	{"CYP2D6": "Expected O-desmethyltramadol (active metabolite) formation"}	Use tramadol label recommended age- or weight-specific dosing.	Strong	{"CYP2D6": "Normal Metabolizer"}	{"CYP2D6": "2.25"}	{}	{"CYP2D6": "2.25"}	general	n/a	1	f	f	f
8351811	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
8351812	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
8351813	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
8351814	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
8351815	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
8351816	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
8351817	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
8351818	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
8351819	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
8351820	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
8351821	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
8351822	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
8351823	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
8351824	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
8351898	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
8351825	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
8351826	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
8351827	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
8351828	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
8351829	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
8351830	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
8351831	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
8351832	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
8351833	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
8351834	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
8351835	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
8351836	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
8351837	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
8351838	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
8351839	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
8351840	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
8351841	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
8351842	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
8351843	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
8351844	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
8351845	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
8351846	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
8351847	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
8351848	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
8351849	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
8351918	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
8351850	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
8351851	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
8351852	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
8351853	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
8351854	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
8351855	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
8351856	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
8351857	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
8351858	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
8351919	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
8351859	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
8351860	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
8351861	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
8351862	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
8351863	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
8351864	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
8351865	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
8351866	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
8351867	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
8351868	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
8351869	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
8351870	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
8351873	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
8351874	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
8351875	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
8351876	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
8351877	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
8351878	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
8351879	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
8351880	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
8351938	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
8351939	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
8351881	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
8351882	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
8351883	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
8351884	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
8351885	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
8351886	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
8351887	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
8351888	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
8351889	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
8351890	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
8351891	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
8351892	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
8351893	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
8351894	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
8351895	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
8351896	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
8351897	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
8351899	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
8351900	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
8351901	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
8351902	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
8351903	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
8351904	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
8351905	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
8351906	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
8351907	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
8351908	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
8351940	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
8351909	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
8351910	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
8351911	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
8351912	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
8351913	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
8351914	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
8351915	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
8351916	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
8351917	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
8351941	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
8351920	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
8351921	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
8351922	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
8351923	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
8351924	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
8351925	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
8351926	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
8351927	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
8351928	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
8351929	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
8351930	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
8351931	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
8351932	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
8351933	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
8351934	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
8351935	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
8351936	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
8351937	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
8351944	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
8351945	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
8351946	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
8351947	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
8351948	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
8351949	6478852	RxNorm:5470	{"NAT2": "n/a"}	No Recommendation	No Recommendation	{"NAT2": "Indeterminate"}	{}	{}	{"NAT2": "Indeterminate"}	general	n/a	1	f	f	f
8351950	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
8351951	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
8351952	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
8351953	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
8351954	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
8351955	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
8351956	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
8351957	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
8351958	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
8351959	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
8351960	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
8351961	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
8351962	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
8351963	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
8351964	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
8351972	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
8351973	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
8351974	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
8351975	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
8351976	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
8351977	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
8352229	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
8351978	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
8351979	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
8351980	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
8351981	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
8351982	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
8351983	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
8351984	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
8351985	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
8351986	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
8352232	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
8351987	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
8351988	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
8351989	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
8351990	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
8351991	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
8351992	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
8351993	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
8351994	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
8351995	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
8351996	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
8351997	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
8351998	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
8351999	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
8352000	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
8352001	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
8352002	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
8352003	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
8352004	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
8352005	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
8352006	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
8352007	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
8352008	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
8352009	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
8352010	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
8352011	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
8352012	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
8352013	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
8352014	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
8352015	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
8352016	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
8352017	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
8352018	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
8352019	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
8352020	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
8352021	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
8352022	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
8352233	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
8352023	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
8352024	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
8352025	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
8352026	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
8352027	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
8352028	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
8352119	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
8352029	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
8352030	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
8352031	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
8352032	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
8352033	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
8352034	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
8352035	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
8352036	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
8352037	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
8352038	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
8352039	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
8352040	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
8352041	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
8352042	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
8352043	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
8352044	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
8352045	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
8352097	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
8352046	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
8352047	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
8352048	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
8352049	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
8352050	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
8352051	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
8352098	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
8352052	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
8352053	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
8352054	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
8352055	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
8352056	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
8352057	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
8352058	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
8352059	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
8352060	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
8352061	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
8352062	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
8352063	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
8352234	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
8352064	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
8352065	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
8352066	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
8352067	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
8352068	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
8352099	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
8352069	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
8352070	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
8352071	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
8352072	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
8352073	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
8352074	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
8352116	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
8352075	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
8352076	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
8352077	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
8352078	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
8352079	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
8352080	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
8352081	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
8352082	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
8352083	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
8352084	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
8352085	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
8352086	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
8352255	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
8352087	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
8352088	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
8352089	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
8352090	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
8352091	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
8352092	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
8352093	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
8352094	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
8352095	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
8352096	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
8352117	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
8352100	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
8352101	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
8352102	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
8352103	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
8352104	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
8352105	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
8352106	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
8352107	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
8352108	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
8352109	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
8352118	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
8352110	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
8352111	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
8352112	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
8352113	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
8352114	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
8352115	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
8352288	110076	RxNorm:7646	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8352120	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
8352121	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
8352122	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
8352123	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
8352124	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
8352125	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
8352126	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
8352127	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
8352128	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
8352129	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
8352130	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
8352131	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
8352132	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
8352133	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
8352134	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
8352168	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
8352135	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
8352136	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
8352137	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
8352138	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
8352139	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
8352180	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
8352140	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
8352141	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
8352142	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
8352143	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
8352144	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
8352145	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
8352289	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
8352146	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
8352147	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
8352148	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
8352149	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
8352150	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
8352151	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
8352152	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
8352153	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
8352154	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
8352155	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
8352156	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
8352157	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
8352158	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
8352159	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
8352160	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
8352161	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
8352162	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
8352163	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
8352164	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
8352165	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
8352166	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
8352167	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
8352169	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
8352170	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
8352171	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
8352172	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
8352173	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
8352174	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
8352175	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
8352176	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
8352177	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
8352178	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
8352179	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
8352182	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
8352183	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
8352184	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
8352185	100426	RxNorm:6472	{"SLCO1B1": "n/a"}	No recommendation	No Recommendation	{"SLCO1B1": "Indeterminate"}	{}	{}	{"SLCO1B1": "Indeterminate"}	general	n/a	1	f	f	f
8352186	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
8352187	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
8352188	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
8352189	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
8352190	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
8352191	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
8352192	100428	RxNorm:103	{"TPMT": "TPMT NMs have lower erythrocyte concentrations of TGN metabolites and higher concentrations of MeMPNs compared to TPMT IMs and TPMT PMs. This is the 'normal' pattern.", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Initiate therapy with standard starting dose of mecaptopurine (e.g., 75 mg/m2/day for malignancy or 1.5 mg/kg/day for nonmalignancy). During therapy, adjust the doses of myelosuppressive agents, as per standard clinical practice. It usually takes at least 2 weeks of stable dosing to reach steady state after each dose adjustment.	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Normal Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352235	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
8352193	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs when receiving standard dose. TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs when receiving standard dose.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352194	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs when receiving standard dose. TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs when receiving standard dose.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352195	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs when receiving standard dose.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352196	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs when receiving standard dose.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Normal Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352197	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Poor Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352198	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352367	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
8352199	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Poor Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352200	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Poor Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352201	100428	RxNorm:103	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites and no MeMPN compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Indeterminate"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352202	100428	RxNorm:103	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites and no MeMPN compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352203	100428	RxNorm:103	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites and no MeMPN compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352204	100428	RxNorm:103	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites and no MeMPN compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Normal Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352230	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
8352461	110058	RxNorm:8356	{"CYP2C9": "n/a"}	No recommendation	No Recommendation	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{}	{"CYP2C9": "n/a"}	general	n/a	1	f	f	f
8352205	100428	RxNorm:103	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites and no MeMPN compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "Poor Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352206	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Higher risk of toxicity compared to single IM."}	Initiate therapy with decreased starting doses (20-50% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352207	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Higher risk of toxicity compared to single IM."}	Initiate therapy with decreased starting doses (20-50% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352208	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Higher risk of toxicity compared to single IM."}	Initiate therapy with decreased starting doses (20-50% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352209	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Higher risk of toxicity compared to single IM."}	Initiate therapy with decreased starting doses (20-50% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Possible Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352210	100428	RxNorm:103	{"TPMT": "TPMT NMs have lower erythrocyte concentrations of TGN metabolites and higher concentrations of MeMPNs compared to TPMT IMs and TPMT PMs. This is the 'normal' pattern.", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on TPMT, initiate therapy with standard starting dose of mecaptopurine (e.g., 75 mg/m2/day for malignancy or 1.5 mg/kg/day for nonmalignancy). During therapy, adjust the doses of myelosuppressive agents, as per standard clinical practice. It usually takes at least 2 weeks of stable dosing to reach steady state after each dose adjustment.	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "Indeterminate"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352231	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
8352211	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs when receiving standard dose.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on TPMT, initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "Indeterminate"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352212	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs when receiving standard dose.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on TPMT, initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "Indeterminate"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352213	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on NUDT15, initiate therapy with standard starting dose of mecaptopurine (e.g., 75 mg/m2/day for malignancy or 1.5 mg/kg/day for nonmalignancy). During therapy, adjust the doses of myelosuppressive agents, as per standard clinical practice. It usually takes at least 2 weeks of stable dosing to reach steady state after each dose adjustment.	Strong	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Normal Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352214	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on NUDT15, initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352215	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on NUDT15, initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "Possible Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352216	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": "Indeterminate", "NUDT15": "Indeterminate"}	general	\N	1	f	f	f
8352217	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on NUDT15, initiate therapy with standard starting dose of mecaptopurine (e.g., 75 mg/m2/day for malignancy or 1.5 mg/kg/day for nonmalignancy). During therapy, adjust the doses of myelosuppressive agents, as per standard clinical practice. It usually takes at least 2 weeks of stable dosing to reach steady state after each dose adjustment.	Strong	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Normal Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352218	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on NUDT15, initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352219	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on NUDT15, initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Possible Intermediate Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352220	100428	RxNorm:103	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Poor Metabolizer"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352221	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": "No Result", "NUDT15": "Indeterminate"}	{}	{}	{"TPMT": "No Result", "NUDT15": "Indeterminate"}	general	\N	1	f	f	f
8352222	100428	RxNorm:103	{"TPMT": "TPMT NMs have lower erythrocyte concentrations of TGN metabolites and higher concentrations of MeMPNs compared to TPMT IMs and TPMT PMs. This is the 'normal' pattern.", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on TPMT, initiate therapy with standard starting dose of mecaptopurine (e.g., 75 mg/m2/day for malignancy or 1.5 mg/kg/day for nonmalignancy). During therapy, adjust the doses of myelosuppressive agents, as per standard clinical practice. It usually takes at least 2 weeks of stable dosing to reach steady state after each dose adjustment.	Strong	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Normal Metabolizer", "NUDT15": "No Result"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352223	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs when receiving standard dose.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on TPMT, initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Intermediate Metabolizer", "NUDT15": "No Result"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352224	100428	RxNorm:103	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites and low concentrations of MeMPNs compared to TPMT NMs when receiving standard dose.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on TPMT, initiate therapy with decreased starting doses (30-80% of standard starting dose) if starting dose is ≥75 mg/m2/day (for malignancy) or ≥1.5 mg/kg/day (for nonmalignancy). If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 2-4 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, and the patient is on combination therapy, emphasis should be on reducing mercaptopurine over other agents.	Strong	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Possible Intermediate Metabolizer", "NUDT15": "No Result"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352225	100428	RxNorm:103	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites and no MeMPN compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	For malignancy: initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily (e.g. 10 mg/m2/day given 3 days/week). During therapy, adjust mercaptopurine doses based on the degree of myelosuppression and disease-specific guidelines. It usually takes at least 4-6 weeks of stable dosing to reach steady state after each dose adjustment. If myelosuppression occurs, emphasis should be on reducing mercaptopurine over other agents. For nonmalignancy: consider alternative nonthiopurine immunosuppressant therapy.	Strong	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	{}	{}	{"TPMT": "Poor Metabolizer", "NUDT15": "No Result"}	general	Standard starting doses may vary by patient characteristics and/or treatment regimens and according to local clinical practice.	1	f	f	f
8352226	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": "No Result"}	{}	{}	{"TPMT": "Indeterminate", "NUDT15": "No Result"}	general	\N	1	f	f	f
8352227	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
8352236	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
8352237	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
8352238	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
8352239	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
8352240	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
8352241	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
8352242	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
8352243	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": "0.5"}	{}	{"CYP2D6": "0.5"}	general	n/a	1	f	f	f
8352244	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": "0.25"}	{}	{"CYP2D6": "0.25"}	general	n/a	1	f	f	f
8352245	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
8352246	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
8352247	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
8352248	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
8352249	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
8352250	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
8352251	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
8352252	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
8352253	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
8352256	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
8352257	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
8352258	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
8352259	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
8352260	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
8352261	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
8352262	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
8352263	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
8352264	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
8352265	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
8352266	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
8352267	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
8352268	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
8352269	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
8352270	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
8352271	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
8352272	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
8352273	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
8352274	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
8352275	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
8352276	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
8352290	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
8352291	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
8352277	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
8352278	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
8352279	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
8352280	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
8352281	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
8352282	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
8352283	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
8352284	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
8352285	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
8352286	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
8352287	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
8352292	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
8352293	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
8352294	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
8352295	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
8352296	110076	RxNorm:17128	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8352297	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
8352298	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
8352299	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
8352300	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
8352301	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
8352302	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
8352303	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
8352304	110076	RxNorm:40790	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{"CYP2C19": "n/a"}	{}	{"CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8352305	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
8352306	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
8352308	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
8352309	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
8352310	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
8352311	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
8352312	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
8352313	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
8352314	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
8352315	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
8352316	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
8352317	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
8352662	100416	RxNorm:10689	{"CYP2D6": "Greatly reduced O-desmethyltramadol (active metabolite) formation leading to diminished analgesia."}	Avoid tramadol use because of possibility of diminished analgesia. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	general	n/a	1	f	f	f
8352318	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
8352319	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
8352320	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
8352321	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
8352322	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
8352323	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
8352324	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
8352325	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
8352326	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
8352327	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
8352328	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
8352462	100426	RxNorm:861634	{"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
8352329	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
8352330	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
8352331	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
8352332	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
8352333	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
8352334	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
8352335	2405438	RxNorm:8120	{"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
8352336	2405438	RxNorm:9071	{"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
8352337	2405438	RxNorm:9071	{"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
8352338	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
8352339	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
8352340	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
8352341	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
8352342	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
8352343	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
8352344	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
8352345	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
8352346	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
8352348	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
8352349	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
8352350	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
8352351	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
8352352	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
8352353	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
8352354	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
8352355	2405438	RxNorm:10831	{"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
8352356	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
8352357	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
8352358	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
8352359	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
8352360	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
8352361	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
8352362	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
8352363	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
8352364	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
8352366	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
8352368	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
8352369	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
8352370	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
8352371	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
8352372	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
8352373	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
8352374	2405438	RxNorm:10635	{"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
8352375	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
8352376	100412	RxNorm:8183	{"HLA-B": "n/a", "CYP2C9": "Normal phenytoin metabolism"}	No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN and patients should be carefully monitored according to a usual standard.	Strong	{"CYP2C9": "Normal Metabolizer"}	{"CYP2C9": "2.0"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "2.0"}	PHT naive	n/a	1	f	f	f
8352377	100412	RxNorm:8183	{"HLA-B": "n/a", "CYP2C9": "Slightly reduced phenytoin metabolism; however, this does not appear to translate into increased side effects."}	No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN and patients should be carefully monitored according to a usual standard.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "1.5"}	PHT naive	n/a	1	f	f	f
8352378	100412	RxNorm:8183	{"HLA-B": "n/a", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	For first dose, use typical initial or loading dose. For subsequent doses, use approximately 25% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN, and patients should be carefully monitored according to a usual standard.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "1.0"}	PHT naive	n/a	1	f	f	f
