8352379	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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.5"}	PHT naive	n/a	1	f	f	f
8352380	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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.0"}	PHT naive	n/a	1	f	f	f
8352381	100412	RxNorm:8183	{"HLA-B": "n/a", "CYP2C9": "n/a"}	No recommendation	n/a	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "n/a"}	PHT naive	n/a	1	f	f	f
8352463	100426	RxNorm:861634	{"SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe desired starting dose and adjust doses based on disease-specific guidelines.	Strong	{"SLCO1B1": "Normal Function"}	{}	{}	{"SLCO1B1": "Normal Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.	1	f	f	f
8352382	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Normal phenytoin metabolism"}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Normal Metabolizer"}	{"CYP2C9": "2.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "2.0"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352383	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Slightly reduced phenytoin metabolism; however, this does not appear to translate into increased side effects."}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.5"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352384	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.0"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352385	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.5"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352386	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.0"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352387	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "n/a"}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "n/a"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352388	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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "2.0"}	PHT naive	n/a	1	f	f	f
8352389	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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "1.5"}	PHT naive	n/a	1	f	f	f
8352390	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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "1.0"}	PHT naive	n/a	1	f	f	f
8352391	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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "0.5"}	PHT naive	n/a	1	f	f	f
8352392	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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "0.0"}	PHT naive	n/a	1	f	f	f
8352393	100412	RxNorm:8183	{"HLA-B": "n/a", "CYP2C9": "n/a"}	No recommendation	n/a	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "n/a"}	PHT naive	n/a	1	f	f	f
8352394	100412	RxNorm:8183	{"HLA-B": "n/a", "CYP2C9": "n/a"}	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": "No Result"}	{"CYP2C9": "No Result"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "No Result"}	PHT naive	n/a	1	f	f	f
8352395	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "n/a"}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "No Result"}	{"CYP2C9": "No Result"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "No Result"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352396	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 use >3mos	n/a	1	f	f	f
8352397	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 use >3mos	n/a	1	f	f	f
8352398	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 use >3mos	n/a	1	f	f	f
8352399	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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.5"}	PHT use >3mos	n/a	1	f	f	f
8352400	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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.0"}	PHT use >3mos	n/a	1	f	f	f
8352401	100412	RxNorm:8183	{"HLA-B": "n/a", "CYP2C9": "n/a"}	No recommendation	n/a	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "n/a"}	PHT use >3mos	n/a	1	f	f	f
8352402	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Normal phenytoin metabolism"}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Normal Metabolizer"}	{"CYP2C9": "2.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "2.0"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352403	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Slightly reduced phenytoin metabolism; however, this does not appear to translate into increased side effects."}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.5"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352404	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.0"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352663	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	n/a	1	f	f	f
8352405	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.5"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352406	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.0"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352407	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "n/a"}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "n/a"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352408	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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "2.0"}	PHT use >3mos	n/a	1	f	f	f
8352409	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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "1.5"}	PHT use >3mos	n/a	1	f	f	f
8352410	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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "1.0"}	PHT use >3mos	n/a	1	f	f	f
8352411	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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "0.5"}	PHT use >3mos	n/a	1	f	f	f
8352412	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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "0.0"}	PHT use >3mos	n/a	1	f	f	f
8352413	100412	RxNorm:8183	{"HLA-B": "n/a", "CYP2C9": "n/a"}	No recommendation	n/a	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "n/a"}	PHT use >3mos	n/a	1	f	f	f
8352414	100412	RxNorm:8183	{"HLA-B": "n/a", "CYP2C9": "n/a"}	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": "No Result"}	{"CYP2C9": "No Result"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "No Result"}	PHT use >3mos	n/a	1	f	f	f
8352415	100412	RxNorm:8183	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "n/a"}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "No Result"}	{"CYP2C9": "No Result"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "No Result"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352664	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	general	n/a	1	f	f	f
8352416	100412	RxNorm:72236	{"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
8352417	100412	RxNorm:72236	{"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
8352418	100412	RxNorm:72236	{"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
8352419	100412	RxNorm:72236	{"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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.5"}	PHT naive	n/a	1	f	f	f
8352420	100412	RxNorm:72236	{"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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.0"}	PHT naive	n/a	1	f	f	f
8352421	100412	RxNorm:72236	{"HLA-B": "n/a", "CYP2C9": "n/a"}	No recommendation	n/a	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "n/a"}	PHT naive	n/a	1	f	f	f
8352422	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Normal phenytoin metabolism"}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Normal Metabolizer"}	{"CYP2C9": "2.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "2.0"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352423	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Slightly reduced phenytoin metabolism; however, this does not appear to translate into increased side effects."}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.5"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352424	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.0"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352425	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.5"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352426	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.0"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352665	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	general	n/a	1	f	f	f
8352427	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "n/a"}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "n/a"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352428	100412	RxNorm:72236	{"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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "2.0"}	PHT naive	n/a	1	f	f	f
8352429	100412	RxNorm:72236	{"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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "1.5"}	PHT naive	n/a	1	f	f	f
8352430	100412	RxNorm:72236	{"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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "1.0"}	PHT naive	n/a	1	f	f	f
8352431	100412	RxNorm:72236	{"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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "0.5"}	PHT naive	n/a	1	f	f	f
8352432	100412	RxNorm:72236	{"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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "0.0"}	PHT naive	n/a	1	f	f	f
8352433	100412	RxNorm:72236	{"HLA-B": "n/a", "CYP2C9": "n/a"}	No recommendation	n/a	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "n/a"}	PHT naive	n/a	1	f	f	f
8352434	100412	RxNorm:72236	{"HLA-B": "n/a", "CYP2C9": "n/a"}	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": "No Result"}	{"CYP2C9": "No Result"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "No Result"}	PHT naive	n/a	1	f	f	f
8352435	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "n/a"}	If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine.	Strong	{"CYP2C9": "No Result"}	{"CYP2C9": "No Result"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "No Result"}	PHT naive	Other aromatic anticonvulsants, including eslicarbazepine, lamotrigine, and phenobarbital, have weaker evidence linking SJS/TEN with the HLA-B*15:02 allele; however, caution should still be used in choosing an alternative agent.	1	f	f	f
8352436	100412	RxNorm:72236	{"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 use >3mos	n/a	1	f	f	f
8352437	100412	RxNorm:72236	{"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 use >3mos	n/a	1	f	f	f
8352438	100412	RxNorm:72236	{"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 use >3mos	n/a	1	f	f	f
8352439	100412	RxNorm:72236	{"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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.5"}	PHT use >3mos	n/a	1	f	f	f
8352440	100412	RxNorm:72236	{"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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "0.0"}	PHT use >3mos	n/a	1	f	f	f
8352441	100412	RxNorm:72236	{"HLA-B": "n/a", "CYP2C9": "n/a"}	No recommendation	n/a	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "n/a"}	PHT use >3mos	n/a	1	f	f	f
8352442	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Normal phenytoin metabolism"}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Normal Metabolizer"}	{"CYP2C9": "2.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "2.0"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352443	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Slightly reduced phenytoin metabolism; however, this does not appear to translate into increased side effects."}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.5"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352444	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "1.0"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352445	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.5"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352446	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "Reduced phenytoin metabolism; Higher plasma concentrations will increase probability of toxicities."}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "0.0"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352447	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "n/a"}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "n/a"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352448	100412	RxNorm:72236	{"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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "2.0"}	PHT use >3mos	n/a	1	f	f	f
8352530	100413	RxNorm:36437	{"CYP2B6": "Normal metabolism of sertraline to less active compounds.", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose.	Moderate	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352449	100412	RxNorm:72236	{"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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "1.5"}	PHT use >3mos	n/a	1	f	f	f
8352450	100412	RxNorm:72236	{"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": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "1.0"}	PHT use >3mos	n/a	1	f	f	f
8352451	100412	RxNorm:72236	{"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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "0.5"}	PHT use >3mos	n/a	1	f	f	f
8352452	100412	RxNorm:72236	{"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 50% 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.	Strong	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "0.0"}	PHT use >3mos	n/a	1	f	f	f
8352453	100412	RxNorm:72236	{"HLA-B": "n/a", "CYP2C9": "n/a"}	No recommendation	n/a	{"CYP2C9": "Indeterminate"}	{"CYP2C9": "n/a"}	{"HLA-B": "No HLA-B Result"}	{"HLA-B": "No Result", "CYP2C9": "n/a"}	PHT use >3mos	n/a	1	f	f	f
8352454	100412	RxNorm:72236	{"HLA-B": "n/a", "CYP2C9": "n/a"}	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": "No Result"}	{"CYP2C9": "No Result"}	{"HLA-B": "HLA-B*15:02 negative"}	{"HLA-B": "*15:02 negative", "CYP2C9": "No Result"}	PHT use >3mos	n/a	1	f	f	f
8352455	100412	RxNorm:72236	{"HLA-B": "Increased risk of phenytoin-induced SJS/TEN", "CYP2C9": "n/a"}	If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. 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.	Optional	{"CYP2C9": "No Result"}	{"CYP2C9": "No Result"}	{"HLA-B": "HLA-B*15:02 positive"}	{"HLA-B": "*15:02 positive", "CYP2C9": "No Result"}	PHT use >3mos	Previous tolerance of phenytoin is not indicative of tolerance to other aromatic anticonvulsants.	1	f	f	f
8352456	110058	RxNorm:8356	{"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
8352457	110058	RxNorm:8356	{"CYP2C9": "Mildly reduced metabolism"}	Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	general	IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age.	1	f	f	f
8352458	110058	RxNorm:8356	{"CYP2C9": "Moderately reduced metabolism; higher plasma concentrations may increase probability 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": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
8352459	110058	RxNorm:8356	{"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	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
8352460	110058	RxNorm:8356	{"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	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
8352464	100426	RxNorm:861634	{"SLCO1B1": "Increased pitavastatin exposure as compared to normal function which may translate to increased myopathy risk"}	Prescribe ≤ 2mg as a starting dose and adjust doses of pitavastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >1mg. If dose >2mg needed for desired efficacy, consider an alternative statin (see Figure 1 of PMID: 35152405 for recommendations for alternative statins) or combination therapy (i.e. pitavastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"SLCO1B1": "Possible Decreased Function"}	{}	{}	{"SLCO1B1": "Possible Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352465	100426	RxNorm:861634	{"SLCO1B1": "Increased pitavastatin exposure as compared to normal function which may translate to increased myopathy risk"}	Prescribe ≤ 2mg as a starting dose and adjust doses of pitavastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >1mg. If dose >2mg needed for desired efficacy, consider an alternative statin (see Figure 1 of PMID: 35152405 for recommendations for alternative statins) or combination therapy (i.e. pitavastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"SLCO1B1": "Decreased Function"}	{}	{}	{"SLCO1B1": "Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352466	100426	RxNorm:861634	{"SLCO1B1": "Increased pitavastatin exposure as compared to normal and decreased function which may translate to increased myopathy risk."}	Prescribe ≤1mg as a starting dose and adjust doses of pitavastatin based on disease-specific guidelines. If dose >1mg needed for desired efficacy, consider an alternative statin (see Figure 1 of PMID: 35152405 for recommendations for alternative statins) or combination therapy (i.e. pitavastatin plus non-statin guideline directed medical therapy)(PMID: 30423391).	Moderate	{"SLCO1B1": "Poor Function"}	{}	{}	{"SLCO1B1": "Poor Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function should be evaluated prior to initiating a statin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352467	100426	RxNorm:861634	{"SLCO1B1": "n/a"}	No recommendation	No Recommendation	{"SLCO1B1": "Indeterminate"}	{}	{}	{"SLCO1B1": "Indeterminate"}	general	n/a	1	f	f	f
8352468	100426	RxNorm:42463	{"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
8352469	100426	RxNorm:42463	{"SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe desired starting dose and adjust doses based on disease-specific guidelines.	Strong	{"SLCO1B1": "Normal Function"}	{}	{}	{"SLCO1B1": "Normal Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.	1	f	f	f
8352470	100426	RxNorm:42463	{"SLCO1B1": "Increased pravastatin exposure as compared to normal function; Typical myopathy risk with doses ≤40 mg."}	Prescribe desired starting dose and adjust doses of pravastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy with pravastatin especially with doses >40mg per 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
8352471	100426	RxNorm:42463	{"SLCO1B1": "Increased pravastatin exposure as compared to normal function; Typical myopathy risk with doses ≤40 mg."}	Prescribe desired starting dose and adjust doses of pravastatin based on disease-specific guidelines. Prescriber should be aware of possible increased risk for myopathy with pravastatin especially with doses >40mg per 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
8352472	100426	RxNorm:42463	{"SLCO1B1": "Increased pravastatin statin exposure as compared to normal and decreased function; Typical myopathy risk with doses ≤40 mg."}	Prescribe ≤40mg as a starting dose and adjust doses of pravastatin based on disease-specific guidelines. If patient is tolerating 40mg dose but higher potency is needed, a higher dose (>40mg) or an alternative statin (see Figure 1 of of PMID: 35152405 for recommendations for alternative statins) or combination therapy (i.e. pravastatin plus non-statin guideline directed medical therapy)(PMID: 30423391) could be considered. Prescriber should be aware of possible increased risk for myopathy especially with pravastatin doses >40mg.	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
8352473	100426	RxNorm:42463	{"SLCO1B1": "n/a"}	No recommendation	No Recommendation	{"SLCO1B1": "Indeterminate"}	{}	{}	{"SLCO1B1": "Indeterminate"}	general	n/a	1	f	f	f
8352474	2405438	RxNorm:8687	{"G6PD": "Low risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	\N	1	f	f	f
8352493	100426	RxNorm:301542	{"ABCG2": "Typical myopathy risk and rosuvastatin exposure", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function; Typical myopathy risk with doses ≤20 mg."}	Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >20mg.	Strong	{"ABCG2": "Normal Function", "SLCO1B1": "Possible Decreased Function"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Possible Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry 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
8352475	2405438	RxNorm:8687	{"G6PD": "High risk of acute hemolytic anemia with standard (or higher than standard) anti-relapse dosages for Plasmodium vivax or Plasmodium ovale of 0.25-0.5 mg/kg daily for 14 days"}	Avoid primaquine, except in the following cases where established expert consensus guidelines for the treatment of malaria should be followed: (1) Treating Plasmodium vivax or Plasmodium ovale malaria for radical cure of liver-stage infections: 0.75 mg/kg once weekly x8 weeks (WHO) or 45 mg once weekly x8 weeks (CDC) - with close monitoring for hemolysis; (2) Treating Plasmodium falciparum malaria by using primaquine single dose as a gametocytocide at 0.25 mg/kg (WHO) - without need for monitoring for hemolysis.	Strong	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	Dosing recommendations for primaquine in patients with G6PD deficiency are derived from the malaria treatment guidelines issued by the World Health Organization and the U.S. Centers for Disease Control and Prevention.	1	f	f	f
8352476	2405438	RxNorm:8687	{"G6PD": "High risk of acute of acute exacerbation of chronic hemolysis"}	Avoid primaquine	Strong	{"G6PD": "Deficient with CNSHA"}	{}	{}	{"G6PD": "Deficient with CNSHA"}	general	The strength of evidence among patients with the G6PD Deficient phenotype provides strong rationale to also avoid primaquine in the setting of the more severe G6PD Deficient with CNSHA phenotype.	1	f	f	f
8352477	2405438	RxNorm:8687	{"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 nondeficient (class IV) and one deficient (class I–III) allele may display a normal or a deficient phenotype; an enzyme activity test is needed to guide treatment in such cases.	1	f	f	f
8352478	2405438	RxNorm:8687	{"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
8352479	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure compared to normal and decreased function; unknown myopathy risk; increased lipid-lowering effects", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function; Typical myopathy risk with doses ≤20 mg."}	Prescribe ≤10mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If dose >10mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., rosuvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Optional	{"ABCG2": "Poor Function", "SLCO1B1": "Decreased Function"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry 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
8352480	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure compared to normal and decreased function; unknown myopathy risk; increased lipid-lowering effects", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function; Typical myopathy risk with doses ≤20 mg."}	Prescribe ≤10mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If dose >10mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., rosuvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Optional	{"ABCG2": "Poor Function", "SLCO1B1": "Possible Decreased Function"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Possible Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry 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
8352481	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure compared to normal and decreased function; unknown myopathy risk; increased lipid-lowering effects", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function and decreased function; Typical myopathy risk with doses ≤20 mg."}	Prescribe ≤10mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If dose >10mg needed for desired efficacy, consider combination therapy (i.e., rosuvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Optional	{"ABCG2": "Poor Function", "SLCO1B1": "Poor Function"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Poor Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry 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
8352482	100426	RxNorm:301542	{"ABCG2": "Typical myopathy risk and rosuvastatin exposure", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function and decreased function; Typical myopathy risk with doses ≤20 mg."}	Prescribe ≤20mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If dose > 20mg needed for desired efficacy, consider combination therapy (i.e., rosuvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"ABCG2": "Normal Function", "SLCO1B1": "Poor Function"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Poor Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry 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
8352483	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure compared to normal and decreased function; unknown myopathy risk; increased lipid-lowering effects", "SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe ≤20mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., rosuvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Optional	{"ABCG2": "Poor Function", "SLCO1B1": "Increased Function"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Increased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352484	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure compared to normal and decreased function; unknown myopathy risk; increased lipid-lowering effects", "SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe ≤20mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., rosuvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Optional	{"ABCG2": "Poor Function", "SLCO1B1": "Normal Function"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Normal Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352485	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure as compared to normal function; unknown risk for myopathy; increased lipid lowering effects", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function and decreased function; Typical myopathy risk with doses ≤20 mg."}	Prescribe ≤20mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If dose >20mg needed for desired efficacy, consider combination therapy (i.e., rosuvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391).	Moderate	{"ABCG2": "Decreased Function", "SLCO1B1": "Poor Function"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Poor Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352486	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure as compared to normal function; unknown risk for myopathy; increased lipid lowering effects", "SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines.	Moderate	{"ABCG2": "Decreased Function", "SLCO1B1": "Increased Function"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Increased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352487	100426	RxNorm:301542	{"ABCG2": "Typical myopathy risk and rosuvastatin exposure", "SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines.	Strong	{"ABCG2": "Normal Function", "SLCO1B1": "Increased Function"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Increased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin.	1	f	f	f
8352488	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure as compared to normal function; unknown risk for myopathy; increased lipid lowering effects", "SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines.	Moderate	{"ABCG2": "Decreased Function", "SLCO1B1": "Normal Function"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Normal Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352489	100426	RxNorm:301542	{"ABCG2": "Typical myopathy risk and rosuvastatin exposure", "SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines.	Strong	{"ABCG2": "Normal Function", "SLCO1B1": "Normal Function"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Normal Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin.	1	f	f	f
8352490	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure as compared to normal function; unknown risk for myopathy; increased lipid lowering effects", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function; Typical myopathy risk with doses ≤20 mg."}	Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >20mg.	Moderate	{"ABCG2": "Decreased Function", "SLCO1B1": "Decreased Function"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352491	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure as compared to normal function; unknown risk for myopathy; increased lipid lowering effects", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function; Typical myopathy risk with doses ≤20 mg."}	Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >20mg.	Moderate	{"ABCG2": "Decreased Function", "SLCO1B1": "Possible Decreased Function"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Possible Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352492	100426	RxNorm:301542	{"ABCG2": "Typical myopathy risk and rosuvastatin exposure", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function; Typical myopathy risk with doses ≤20 mg."}	Prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >20mg.	Strong	{"ABCG2": "Normal Function", "SLCO1B1": "Decreased Function"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry 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
8352494	100426	RxNorm:301542	{"ABCG2": "n/a", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function; Typical myopathy risk with doses ≤20 mg."}	Based on SLCO1B1 status, prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >20mg. ABCG2 genotype result is not available.	Strong	{"ABCG2": "No Result", "SLCO1B1": "Decreased Function"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry 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
8352495	100426	RxNorm:301542	{"ABCG2": "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. ABCG2 genotype result is not available.	Strong	{"ABCG2": "No Result", "SLCO1B1": "Increased Function"}	{}	{}	{"ABCG2": "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
8352496	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure as compared to normal function; unknown risk for myopathy; increased lipid lowering effects", "SLCO1B1": "n/a"}	Based on ABCG2 status, prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific guidelines and specific population guidelines. SLCO1B1 phenotype could not be assigned based on genotyping.	Moderate	{"ABCG2": "Decreased Function", "SLCO1B1": "Indeterminate"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "Indeterminate"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352497	100426	RxNorm:301542	{"ABCG2": "n/a", "SLCO1B1": "n/a"}	n/a	n/a	{"ABCG2": "No Result", "SLCO1B1": "Indeterminate"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "Indeterminate"}	general	n/a	1	f	f	f
8352498	100426	RxNorm:301542	{"ABCG2": "Typical myopathy risk and rosuvastatin exposure", "SLCO1B1": "n/a"}	Based on ABCG2 status, prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. SLCO1B1 phenotype could not be assigned based on genotyping.	Strong	{"ABCG2": "Normal Function", "SLCO1B1": "Indeterminate"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "Indeterminate"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin.	1	f	f	f
8352499	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure compared to normal and decreased function; unknown myopathy risk; increased lipid-lowering effects", "SLCO1B1": "n/a"}	Based on ABCG2 status, prescribe ≤20mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., rosuvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). SLCO1B1 phenotype could not be assigned based on genotyping.	Moderate	{"ABCG2": "Poor Function", "SLCO1B1": "Indeterminate"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "Indeterminate"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352500	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure as compared to normal function; unknown risk for myopathy; increased lipid lowering effects", "SLCO1B1": "n/a"}	Based on ABCG2 status, prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific guidelines and specific population guidelines. SLCO1B1 genotype result is not available.	Moderate	{"ABCG2": "Decreased Function", "SLCO1B1": "No Result"}	{}	{}	{"ABCG2": "Decreased Function", "SLCO1B1": "No Result"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352501	100426	RxNorm:301542	{"ABCG2": "Typical myopathy risk and rosuvastatin exposure", "SLCO1B1": "n/a"}	Based on ABCG2 status, prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. SLCO1B1 genotype result is not available.	Strong	{"ABCG2": "Normal Function", "SLCO1B1": "No Result"}	{}	{}	{"ABCG2": "Normal Function", "SLCO1B1": "No Result"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin.	1	f	f	f
8352502	100426	RxNorm:301542	{"ABCG2": "Increased rosuvastatin exposure compared to normal and decreased function; unknown myopathy risk; increased lipid-lowering effects", "SLCO1B1": "n/a"}	Based on ABCG2 status, prescribe ≤20mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. If dose >20mg needed for desired efficacy, consider an alternative statin or combination therapy (i.e., rosuvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). SLCO1B1 genotype result is not available.	Moderate	{"ABCG2": "Poor Function", "SLCO1B1": "No Result"}	{}	{}	{"ABCG2": "Poor Function", "SLCO1B1": "No Result"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry should be evaluated prior to initiating rosuvastatin. The effects of drug-drug interactions may be more pronounced resulting in a higher risk of myopathy.	1	f	f	f
8352503	100426	RxNorm:301542	{"ABCG2": "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. ABCG2 genotype result is not available.	Strong	{"ABCG2": "No Result", "SLCO1B1": "Normal Function"}	{}	{}	{"ABCG2": "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
8352529	100413	RxNorm:36437	{"CYP2B6": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352504	100426	RxNorm:301542	{"ABCG2": "n/a", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function and decreased function; Typical myopathy risk with doses ≤20 mg."}	Based on SLCO1B1 status, prescribe ≤20mg as a starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines If dose >20mg needed for desired efficacy, consider combination therapy (i.e. rosuvastatin plus non-statin guideline directed medical therapy) (PMID: 30423391). ABCG2 genotype result is not available.	Moderate	{"ABCG2": "No Result", "SLCO1B1": "Poor Function"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "Poor Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry 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
8352505	100426	RxNorm:301542	{"ABCG2": "n/a", "SLCO1B1": "Increased rosuvastatin exposure as compared to normal function; Typical myopathy risk with doses ≤20 mg."}	Based on SLCO1B1 status, prescribe desired starting dose and adjust doses of rosuvastatin based on disease-specific and specific population guidelines. Prescriber should be aware of possible increased risk for myopathy especially for doses >20mg. ABCG2 genotype result is not available.	Strong	{"ABCG2": "No Result", "SLCO1B1": "Possible Decreased Function"}	{}	{}	{"ABCG2": "No Result", "SLCO1B1": "Possible Decreased Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and Asian ancestry 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
8352506	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Strong	{"CYP2B6": "No Result", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "No Result", "CYP2C19": "Ultrarapid Metabolizer"}	general	CYP2B6 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352507	100413	RxNorm:36437	{"CYP2B6": "Increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher\nmaintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19 or CYP2B6.	Optional	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	general	n/a	1	f	f	f
8352508	100413	RxNorm:36437	{"CYP2B6": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher\nmaintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19 or CYP2B6.	Optional	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	general	n/a	1	f	f	f
8352509	100413	RxNorm:36437	{"CYP2B6": "Normal metabolism of sertraline to less active compounds.", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Strong	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	general	n/a	1	f	f	f
8352510	100413	RxNorm:36437	{"CYP2B6": "Reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	general	n/a	1	f	f	f
8352511	100413	RxNorm:36437	{"CYP2B6": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Optional	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Ultrarapid Metabolizer"}	general	n/a	1	f	f	f
8352512	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Strong	{"CYP2B6": "Indeterminate", "CYP2C19": "Ultrarapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Ultrarapid Metabolizer"}	general	n/a	1	f	f	f
8352513	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Strong	{"CYP2B6": "No Result", "CYP2C19": "Rapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "No Result", "CYP2C19": "Rapid Metabolizer"}	general	CYP2B6 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352514	100413	RxNorm:36437	{"CYP2B6": "Increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher\nmaintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19 or CYP2B6.	Optional	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	general	n/a	1	f	f	f
8352515	100413	RxNorm:36437	{"CYP2B6": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. If patient does not adequately respond to recommended maintenance dosing, consider titrating to a higher\nmaintenance dose or switching to a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19 or CYP2B6.	Optional	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Rapid Metabolizer"}	general	n/a	1	f	f	f
8352516	100413	RxNorm:36437	{"CYP2B6": "Normal metabolism of sertraline to less active compounds.", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Strong	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Rapid Metabolizer"}	general	n/a	1	f	f	f
8352517	100413	RxNorm:36437	{"CYP2B6": "Reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Rapid Metabolizer"}	general	n/a	1	f	f	f
8352518	100413	RxNorm:36437	{"CYP2B6": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Optional	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Rapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Rapid Metabolizer"}	general	n/a	1	f	f	f
8352519	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Strong	{"CYP2B6": "Indeterminate", "CYP2C19": "Rapid Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Rapid Metabolizer"}	general	n/a	1	f	f	f
8352520	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Normal metabolism"}	Initiate therapy with recommended starting dose	Strong	{"CYP2B6": "No Result", "CYP2C19": "Normal Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "No Result", "CYP2C19": "Normal Metabolizer"}	general	CYP2B6 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352521	100413	RxNorm:36437	{"CYP2B6": "Increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
8352522	100413	RxNorm:36437	{"CYP2B6": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
8352523	100413	RxNorm:36437	{"CYP2B6": "Normal metabolism of sertraline to less active compounds.", "CYP2C19": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
8352524	100413	RxNorm:36437	{"CYP2B6": "Reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Normal metabolism"}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose.	Moderate	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
8352525	100413	RxNorm:36437	{"CYP2B6": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.", "CYP2C19": "Normal metabolism"}	Consider a lower starting dose, slower titration schedule and 25% reduction of standard maintenance dose as compared to CYP2B6 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2B6.	Optional	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Normal Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
8352526	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Normal metabolism"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2B6": "Indeterminate", "CYP2C19": "Normal Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Normal Metabolizer"}	general	n/a	1	f	f	f
8352527	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.	Moderate	{"CYP2B6": "No Result", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "No Result", "CYP2C19": "Likely Intermediate Metabolizer"}	general	CYP2B6 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352528	100413	RxNorm:36437	{"CYP2B6": "Increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352531	100413	RxNorm:36437	{"CYP2B6": "Reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.	Optional	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352532	100413	RxNorm:36437	{"CYP2B6": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2B6 normal metabolizers	Optional	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Likely Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352533	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose.	Moderate	{"CYP2B6": "Indeterminate", "CYP2C19": "Likely Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Likely Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352534	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than CYP2C19 normal metabolizers.	Moderate	{"CYP2B6": "No Result", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "No Result", "CYP2C19": "Intermediate Metabolizer"}	general	CYP2B6 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352535	100413	RxNorm:36437	{"CYP2B6": "Increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352536	100413	RxNorm:36437	{"CYP2B6": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352537	100413	RxNorm:36437	{"CYP2B6": "Normal metabolism of sertraline to less active compounds.", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose.	Moderate	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352538	100413	RxNorm:36437	{"CYP2B6": "Reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than normal metabolizers.	Optional	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352539	100413	RxNorm:36437	{"CYP2B6": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2B6 normal metabolizers	Optional	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352540	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers."}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose.	Moderate	{"CYP2B6": "Indeterminate", "CYP2C19": "Intermediate Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Intermediate Metabolizer"}	general	n/a	1	f	f	f
8352541	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Moderate	{"CYP2B6": "No Result", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "No Result", "CYP2C19": "Likely Poor Metabolizer"}	general	CYP2B6 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352551	100413	RxNorm:36437	{"CYP2B6": "Normal metabolism of sertraline to less active compounds.", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Moderate	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Poor Metabolizer"}	general	n/a	1	f	f	f
8352542	100413	RxNorm:36437	{"CYP2B6": "Increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Optional	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	general	n/a	1	f	f	f
8352543	100413	RxNorm:36437	{"CYP2B6": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Optional	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	general	n/a	1	f	f	f
8352544	100413	RxNorm:36437	{"CYP2B6": "Normal metabolism of sertraline to less active compounds.", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Moderate	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	general	n/a	1	f	f	f
8352545	100413	RxNorm:36437	{"CYP2B6": "Reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Moderate	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	general	n/a	1	f	f	f
8352546	100413	RxNorm:36437	{"CYP2B6": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Select an alternative antidepressant not primarily metabolized by CYP2C19 or CYP2B6.	Optional	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Likely Poor Metabolizer"}	general	n/a	1	f	f	f
8352547	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Moderate	{"CYP2B6": "Indeterminate", "CYP2C19": "Likely Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Likely Poor Metabolizer"}	general	n/a	1	f	f	f
8352548	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Moderate	{"CYP2B6": "No Result", "CYP2C19": "Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "No Result", "CYP2C19": "Poor Metabolizer"}	general	CYP2B6 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352549	100413	RxNorm:36437	{"CYP2B6": "Increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Optional	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	general	n/a	1	f	f	f
8352550	100413	RxNorm:36437	{"CYP2B6": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Optional	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Poor Metabolizer"}	general	n/a	1	f	f	f
8352592	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	general	n/a	1	f	f	f
8352552	100413	RxNorm:36437	{"CYP2B6": "Reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Moderate	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Poor Metabolizer"}	general	n/a	1	f	f	f
8352553	100413	RxNorm:36437	{"CYP2B6": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Select an alternative antidepressant not primarily metabolized by CYP2C19 or CYP2B6.	Optional	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Poor Metabolizer"}	general	n/a	1	f	f	f
8352554	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2C19 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Consider a lower starting dose, slower titration schedule and 50% reduction of standard maintenance dose as compared to CYP2C19 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2C19.	Moderate	{"CYP2B6": "Indeterminate", "CYP2C19": "Poor Metabolizer"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Poor Metabolizer"}	general	n/a	1	f	f	f
8352555	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2B6": "No Result", "CYP2C19": "Indeterminate"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "No Result", "CYP2C19": "Indeterminate"}	general	CYP2B6 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352556	100413	RxNorm:36437	{"CYP2B6": "Increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8352557	100413	RxNorm:36437	{"CYP2B6": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8352558	100413	RxNorm:36437	{"CYP2B6": "Normal metabolism of sertraline to less active compounds.", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8352559	100413	RxNorm:36437	{"CYP2B6": "Reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose.	Moderate	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8352560	100413	RxNorm:36437	{"CYP2B6": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.", "CYP2C19": "n/a"}	Consider a lower starting dose, slower titration schedule and 25% reduction of standard maintenance dose as CYP2B6 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2B6.	Optional	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Indeterminate"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8352561	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2B6": "Indeterminate", "CYP2C19": "Indeterminate"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "Indeterminate"}	general	n/a	1	f	f	f
8352562	100413	RxNorm:36437	{"CYP2B6": "Increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Ultrarapid Metabolizer", "CYP2C19": "No Result"}	general	CYPC19 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352563	100413	RxNorm:36437	{"CYP2B6": "Small increase in metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "No Result"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Rapid Metabolizer", "CYP2C19": "No Result"}	general	CYPC19 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352564	100413	RxNorm:36437	{"CYP2B6": "Normal metabolism of sertraline to less active compounds.", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose.	Strong	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "No Result"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Normal Metabolizer", "CYP2C19": "No Result"}	general	CYPC19 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352593	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	general	n/a	1	f	f	f
8352594	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	n/a	1	f	f	f
8352565	100413	RxNorm:36437	{"CYP2B6": "Reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers.", "CYP2C19": "n/a"}	Initiate therapy with recommended starting dose. Consider a slower titration schedule and lower maintenance dose than CYP2B6 normal metabolizers.	Optional	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Intermediate Metabolizer", "CYP2C19": "No Result"}	general	CYPC19 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352566	100413	RxNorm:36437	{"CYP2B6": "Greatly reduced metabolism of sertraline to less active compounds when compared to CYP2B6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects.", "CYP2C19": "n/a"}	Consider a lower starting dose, slower titration schedule and 25% reduction of standard maintenance dose as compared to CYP2B6 normal metabolizers or select a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2B6.	Optional	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "No Result"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Poor Metabolizer", "CYP2C19": "No Result"}	general	CYPC19 metabolizer status, drug-drug interactions and other patient characteristics (e.g., age, renal function, liver function) should be also considered.	1	f	f	f
8352567	100413	RxNorm:36437	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2B6": "Indeterminate", "CYP2C19": "No Result"}	{"CYP2B6": "n/a", "CYP2C19": "n/a"}	{}	{"CYP2B6": "Indeterminate", "CYP2C19": "No Result"}	general	n/a	1	f	f	f
8352568	100426	RxNorm:36567	{"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
8352569	100426	RxNorm:36567	{"SLCO1B1": "Typical myopathy risk and statin exposure"}	Prescribe desired starting dose and adjust doses based on disease-specific guidelines.	Strong	{"SLCO1B1": "Normal Function"}	{}	{}	{"SLCO1B1": "Normal Function"}	general	The potential for drug-drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated prior to initiating a statin.	1	f	f	f
8352570	100426	RxNorm:36567	{"SLCO1B1": "Increased simvastatin acid exposure as compared to normal function; increased risk of myopathy"}	Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins). If simvastatin therapy is warranted, limit dose to <20mg/day.	Strong	{"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
8352571	100426	RxNorm:36567	{"SLCO1B1": "Increased simvastatin acid exposure as compared to normal function; increased risk of myopathy"}	Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins). If simvastatin therapy is warranted, limit dose to <20mg/day.	Strong	{"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
8352572	100426	RxNorm:36567	{"SLCO1B1": "Increased simvastatin acid exposure compared to normal and decreased function; highly increased myopathy risk"}	Prescribe an alternative statin depending on the desired potency (see Figure 1 of PMID: 35152405 for recommendations for alternative statins).	Strong	{"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
8352573	100426	RxNorm:36567	{"SLCO1B1": "n/a"}	No recommendation	No Recommendation	{"SLCO1B1": "Indeterminate"}	{}	{}	{"SLCO1B1": "Indeterminate"}	general	n/a	1	f	f	f
8352574	100418	RxNorm:42316	{"CYP3A5": "Lower dose-adjusted trough concentrations of tacrolimus and decreased chance of achieving target tacrolimus concentrations."}	Increase starting dose 1.5 to 2 times recommended starting dose. Total starting dose should not exceed 0.3 mg/kg/day. Use therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP3A5": "Normal Metabolizer"}	{"CYP3A5": "n/a"}	{}	{"CYP3A5": "Normal Metabolizer"}	general	This recommendation includes the use of tacrolimus in kidney, heart, lung and hematopoietic stem cell transplant patients, and liver transplant patients where the donor and recipient genotypes are identical. Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors (e.g., medication interactions, or hepatic function). Typically with other CYP enzymes, a normal metabolizer would be classified as having normal metabolism, and therefore, the drug dose would not change based on the patient's genotype. However, in the case of CYP3A5 and tacrolimus, a CYP3A5 expresser (i.e., CYP3A5 normal metabolizer or intermediate metabolizer) would require a higher recommended starting dose, and the CYP3A5 non-expresser (i.e., poor metabolizer) would require the standard recommended starting dose.	1	f	f	f
8352575	100418	RxNorm:42316	{"CYP3A5": "Lower dose-adjusted trough concentrations of tacrolimus and decreased chance of achieving target tacrolimus concentrations."}	Increase starting dose 1.5 to 2 times recommended starting dose. Total starting dose should not exceed 0.3 mg/kg/day. Use therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP3A5": "Possible Intermediate Metabolizer"}	{"CYP3A5": "n/a"}	{}	{"CYP3A5": "Possible Intermediate Metabolizer"}	general	This recommendation includes the use of tacrolimus in kidney, heart, lung and hematopoietic stem cell transplant patients, and liver transplant patients where the donor and recipient genotypes are identical. Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors (e.g., medication interactions, or hepatic function).Typically with other CYP enzymes, a normal metabolizer would be classified as having normal metabolism, and therefore, the drug dose would not change based on the patient's genotype. However, in the case of CYP3A5 and tacrolimus, a CYP3A5 expresser (i.e., CYP3A5 normal metabolizer or intermediate metabolizer) would require a higher recommended starting dose and the CYP3A5 non-expresser (i.e., poor metabolizer) would require the standard recommended starting dose.	1	f	f	f
8352576	100418	RxNorm:42316	{"CYP3A5": "Lower dose-adjusted trough concentrations of tacrolimus and decreased chance of achieving target tacrolimus concentrations."}	Increase starting dose 1.5 to 2 times recommended starting dose. Total starting dose should not exceed 0.3 mg/kg/day. Use therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP3A5": "Intermediate Metabolizer"}	{"CYP3A5": "n/a"}	{}	{"CYP3A5": "Intermediate Metabolizer"}	general	This recommendation includes the use of tacrolimus in kidney, heart, lung and hematopoietic stem cell transplant patients, and liver transplant patients where the donor and recipient genotypes are identical. Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors (e.g., medication interactions, or hepatic function).Typically with other CYP enzymes, a normal metabolizer would be classified as having normal metabolism, and therefore, the drug dose would not change based on the patient's genotype. However, in the case of CYP3A5 and tacrolimus, a CYP3A5 expresser (i.e., CYP3A5 normal metabolizer or intermediate metabolizer) would require a higher recommended starting dose and the CYP3A5 non-expresser (i.e., poor metabolizer) would require the standard recommended starting dose.	1	f	f	f
8352577	100418	RxNorm:42316	{"CYP3A5": "Higher (\\"normal\\") dose-adjusted trough concentrations of tacrolimus and increased chance of achieving target tacrolimus concentrations."}	Initiate therapy with standard recommended dose. Use therapeutic drug monitoring to guide dose adjustments.	Strong	{"CYP3A5": "Poor Metabolizer"}	{"CYP3A5": "n/a"}	{}	{"CYP3A5": "Poor Metabolizer"}	general	This recommendation includes the use of tacrolimus in kidney, heart, lung and hematopoietic stem cell transplant patients, and liver transplant patients where the donor and recipient genotypes are identical. Typically with other CYP enzymes, a normal metabolizer would be classified as having normal metabolism, and therefore, the drug dose would not change based on the patient's genotype. However, in the case of CYP3A5 and tacrolimus, a CYP3A5 expresser (i.e., CYP3A5 normal metabolizer or intermediate metabolizer) would require a higher recommended starting dose and the CYP3A5 non-expresser (i.e., poor metabolizer) would require the standard recommended starting dose.	1	f	f	f
8352578	100418	RxNorm:42316	{"CYP3A5": "n/a"}	No recommendation	No Recommendation	{"CYP3A5": "Indeterminate"}	{"CYP3A5": "n/a"}	{}	{"CYP3A5": "Indeterminate"}	general	n/a	1	f	f	f
8352579	2405438	RxNorm:2054023	{"G6PD": "Low risk of acute hemolytic anemia"}	No reason to avoid based on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	Tafenoquine's safety has been established for a G6PD enzyme activity ≥70% of normal. (Inclusion criteria for clinical trials involving tafenoquine included G6PD activity ≥70%.)	1	f	f	f
8352580	2405438	RxNorm:2054023	{"G6PD": "High risk of acute hemolytic anemia"}	Avoid use	Strong	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	\N	1	f	f	f
8352581	2405438	RxNorm:2054023	{"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
8352582	2405438	RxNorm:2054023	{"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. Tafenoquine's safety has been established for a G6PD enzyme activity ≥70% of normal. (Inclusion criteria for clinical trials involving tafenoquine included G6PD activity ≥70%.)	1	f	f	f
8352583	2405438	RxNorm:2054023	{"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
8352584	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	n/a	1	f	f	f
8352585	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	n/a	1	f	f	f
8352586	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	n/a	1	f	f	f
8352587	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	n/a	1	f	f	f
8352588	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	n/a	1	f	f	f
8352589	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	n/a	1	f	f	f
8352590	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	n/a	1	f	f	f
8352591	100415	RxNorm:10324	{"CYP2D6": "Therapeutic endoxifen concentrations"}	Avoid moderate and strong CYP2D6 inhibitors. Initiate therapy with recommended standard of care dosing (tamoxifen 20 mg/day).	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	general	n/a	1	f	f	f
8352600	100415	RxNorm:10324	{"CYP2D6": "Lower endoxifen concentrations compared to normal metabolizers; higher risk of breast cancer recurrence, event-free and recurrence-free survival compared to normal metabolizers."}	Consider hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women, given that these approaches are superior to tamoxifen regardless of CYP2D6 genotype (PMID 26211827). If aromatase inhibitor use is contraindicated, consideration should be given to use a higher but FDA approved tamoxifen dose (40 mg/day)(PMID 27226358). Avoid CYP2D6 strong to weak inhibitors.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	general	n/a	1	f	f	f
8352601	100415	RxNorm:10324	{"CYP2D6": "Lower endoxifen concentrations compared to normal metabolizers; higher risk of breast cancer recurrence, event-free and recurrence-free survival compared to normal metabolizers."}	Consider hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women, given that these approaches are superior to tamoxifen regardless of CYP2D6 genotype (PMID 26211827). If aromatase inhibitor use is contraindicated, consideration should be given to use a higher but FDA approved tamoxifen dose (40 mg/day)(PMID 27226358). Avoid CYP2D6 strong to weak inhibitors.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	general	n/a	1	f	f	f
8352602	100415	RxNorm:10324	{"CYP2D6": "Lower endoxifen concentrations compared to normal metabolizers; higher risk of breast cancer recurrence, event-free and recurrence-free survival compared to normal metabolizers."}	Consider hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women, given that these approaches are superior to tamoxifen regardless of CYP2D6 genotype (PMID 26211827). If aromatase inhibitor use is contraindicated, consideration should be given to use a higher but FDA approved tamoxifen dose (40 mg/day)(PMID 27226358). Avoid CYP2D6 strong to weak inhibitors.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	general	n/a	1	f	f	f
8352603	100415	RxNorm:10324	{"CYP2D6": "Lower endoxifen concentrations compared to normal metabolizers; higher risk of breast cancer recurrence, event-free and recurrence-free survival compared to normal metabolizers."}	Consider hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women, given that these approaches are superior to tamoxifen regardless of CYP2D6 genotype (PMID 26211827). If aromatase inhibitor use is contraindicated, consideration should be given to use a higher but FDA approved tamoxifen dose (40 mg/day)(PMID 27226358). Avoid CYP2D6 strong to weak inhibitors.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	general	n/a	1	f	f	f
8352604	100415	RxNorm:10324	{"CYP2D6": "Lower endoxifen concentrations compared to normal metabolizers; higher risk of breast cancer recurrence, event-free and recurrence-free survival compared to normal metabolizers."}	Recommend alternative hormonal therapy such as an aromatase inhibitor for postmenopausal women or aromatase inhibitor along with ovarian function suppression in premenopausal women given that these approaches are superior to tamoxifen regardless of CYP2D6 genotype (PMID 26211827) and based on knowledge that CYP2D6 poor metabolizers switched from tamoxifen to anastrozole do not have an increased risk of recurrence (PMID 23213055). Note, higher dose tamoxifen (40 mg/day) increases but does not normalize endoxifen concentrations and can be considered if there are contraindications to aromatase inhibitor therapy (PMID 27226358, 21768473).	Strong	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	general	n/a	1	f	f	f
8352605	100415	RxNorm:10324	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
8352606	110058	RxNorm:37790	{"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
8352607	110058	RxNorm:37790	{"CYP2C9": "Mildly reduced metabolism"}	Initiate therapy with recommended starting dose. In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.	Moderate	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.5"}	{}	{"CYP2C9": "1.5"}	general	IMs might have a higher than normal risk of adverse events especially in individuals with other factors affecting clearance of these drugs such as hepatic impairment or advanced age.	1	f	f	f
8352608	110058	RxNorm:37790	{"CYP2C9": "Moderately reduced metabolism; higher plasma concentrations may increase probability 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).	Optional	{"CYP2C9": "Intermediate Metabolizer"}	{"CYP2C9": "1.0"}	{}	{"CYP2C9": "1.0"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
8352609	110058	RxNorm:37790	{"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).	Optional	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.5"}	{}	{"CYP2C9": "0.5"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
8352610	110058	RxNorm:37790	{"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).	Optional	{"CYP2C9": "Poor Metabolizer"}	{"CYP2C9": "0.0"}	{}	{"CYP2C9": "0.0"}	general	Alternative therapies not primarily metabolized by CYP2C9 include aspirin, ketorolac, naproxen and sulindac. Selection of therapy will depend on individual patient treatment goals and risks for toxicity.	1	f	f	f
8352612	100428	RxNorm:10485	{"TPMT": "TPMT NMs have lower erythrocyte concentrations of TGN metabolites 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 thioguanine (e.g., 40 mg/m2/day for malignancy). 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
8352613	100428	RxNorm:10485	{"TPMT": "TPMT NMs have lower erythrocyte concentrations of TGN metabolites compared to TPMT IMs and TPMT PMs. This is the 'normal' pattern. TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Initiate therapy with decreased starting doses (30-80% of standard starting dose) if standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352614	100428	RxNorm:10485	{"TPMT": "TPMT NMs have lower erythrocyte concentrations of TGN metabolites compared to TPMT IMs and TPMT PMs. This is the 'normal' pattern. TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Initiate therapy with decreased starting doses (30-80% of standard starting dose) if standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352615	100428	RxNorm:10485	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Initiate therapy with decreased starting doses (30-80% of standard starting dose) if standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352616	100428	RxNorm:10485	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "NUDT15": "Increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Initiate therapy with decreased starting doses (30-80% of standard starting dose) if standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352617	100428	RxNorm:10485	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352618	100428	RxNorm:10485	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352619	100428	RxNorm:10485	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352620	100428	RxNorm:10485	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352621	100428	RxNorm:10485	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352622	100428	RxNorm:10485	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352623	100428	RxNorm:10485	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352624	100428	RxNorm:10485	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352625	100428	RxNorm:10485	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352666	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	general	n/a	1	f	f	f
8352667	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	n/a	1	f	f	f
8352626	100428	RxNorm:10485	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites 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 standard starting dose is ≥ 40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352627	100428	RxNorm:10485	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites 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 standard starting dose is ≥ 40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352628	100428	RxNorm:10485	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites 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 standard starting dose is ≥ 40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352629	100428	RxNorm:10485	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites 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 standard starting dose is ≥ 40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352630	100428	RxNorm:10485	{"TPMT": "TPMT NMs have lower erythrocyte concentrations of TGN metabolites 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 thioguanine (e.g., 40 mg/m2/day for malignancy). 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
8352631	100428	RxNorm:10485	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "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 standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352640	100428	RxNorm:10485	{"TPMT": "n/a", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352632	100428	RxNorm:10485	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "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 standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352633	100428	RxNorm:10485	{"TPMT": "n/a", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on NUDT15, initiate therapy with standard starting dose of thioguanine (e.g., 40 mg/m2/day for malignancy). 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
8352634	100428	RxNorm:10485	{"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 standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352635	100428	RxNorm:10485	{"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 standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352636	100428	RxNorm:10485	{"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
8352637	100428	RxNorm:10485	{"TPMT": "n/a", "NUDT15": "Normal risk of thiopurine-related leukopenia, neutropenia and myelosuppression."}	Based on NUDT15, initiate therapy with standard starting dose of thioguanine (e.g., 40 mg/m2/day for malignancy). 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
8352638	100428	RxNorm:10485	{"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 standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352639	100428	RxNorm:10485	{"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 standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352641	100428	RxNorm:10485	{"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
8352642	100428	RxNorm:10485	{"TPMT": "TPMT NMs have lower erythrocyte concentrations of TGN metabolites 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 thioguanine (e.g., 40 mg/m2/day for malignancy). 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
8352643	100428	RxNorm:10485	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "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 standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352644	100428	RxNorm:10485	{"TPMT": "TPMT IMs have moderate to high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "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 standard starting dose is ≥40 mg/m2/day. If starting dose is already below standard starting dose, dose reduction might not be necessary. During therapy, adjust the doses of thioguanine 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 thioguanine over other agents.	Moderate	{"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
8352645	100428	RxNorm:10485	{"TPMT": "TPMT PMs have extremelly high erythrocyte concentrations of TGN metabolites compared to TPMT NMs.", "NUDT15": "Greatly increased risk of thiopurine-related leukopenia, neutropenia and myelosuppression. Fatal toxicity possible without dose decrease."}	Initiate therapy with drastically reduced starting doses. Reduce starting dose by 10-fold and reduce frequency to thrice weekly instead of daily. During therapy, adjust thioguanine doses based on 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 thioguanine over other agents.	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
8352646	100428	RxNorm:10485	{"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
8352647	2405438	RxNorm:10638	{"G6PD": "Low risk of acute hemolytic anemia"}	No reason to avoid ased on G6PD status	Strong	{"G6PD": "Normal"}	{}	{}	{"G6PD": "Normal"}	general	Toluidine blue classification strength is based on extrapolation from methylene blue data	1	f	f	f
8352648	2405438	RxNorm:10638	{"G6PD": "High risk of acute hemolytic anemia"}	Avoid use	Moderate	{"G6PD": "Deficient"}	{}	{}	{"G6PD": "Deficient"}	general	Toluidine blue classification strength is based on extrapolation from methylene blue data	1	f	f	f
8352649	2405438	RxNorm:10638	{"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. Toluidine blue classification strength is based on extrapolation from methylene blue data	1	f	f	f
8352650	2405438	RxNorm:10638	{"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. Toluidine blue classification strength is based on extrapolation from methylene blue data	1	f	f	f
8352651	2405438	RxNorm:10638	{"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	Toluidine blue classification strength is based on extrapolation from methylene blue data	1	f	f	f
8352652	100416	RxNorm:10689	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
8352653	100416	RxNorm:10689	{"CYP2D6": "Reduced O-desmethyltramadol (active metabolite) formation"}	Use tramadol label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine opioid.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	general	n/a	1	f	f	f
8352654	100416	RxNorm:10689	{"CYP2D6": "Reduced O-desmethyltramadol (active metabolite) formation"}	Use tramadol label recommended age- or weight-specific dosing. If no response and opioid use is warranted, consider non-codeine opioid.	Optional	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	general	n/a	1	f	f	f
8352668	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	n/a	1	f	f	f
8352669	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	n/a	1	f	f	f
8352670	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	n/a	1	f	f	f
8352671	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	n/a	1	f	f	f
8352672	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	n/a	1	f	f	f
8352673	100416	RxNorm:10689	{"CYP2D6": "Increased formation of O-desmethyltramadol (active metabolite) leading to higher risk of toxicity"}	Avoid tramadol use because of potential for toxicity. If opioid use is warranted, consider a non-codeine opioid.	Strong	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	n/a	1	f	f	f
8352674	100414	RxNorm:10834	{"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
8352675	100414	RxNorm:10834	{"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
8352676	100414	RxNorm:10834	{"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
8352677	100414	RxNorm:10834	{"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
8352678	100414	RxNorm:10834	{"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
8352679	100414	RxNorm:10834	{"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
8352680	100414	RxNorm:10834	{"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
8352681	100414	RxNorm:10834	{"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
8352682	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352683	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352684	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352685	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352686	100414	RxNorm:10834	{"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 trimipramine 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
8352687	100414	RxNorm:10834	{"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 trimipramine 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
8352688	100414	RxNorm:10834	{"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 trimipramine 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
8352689	100414	RxNorm:10834	{"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 trimipramine 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
8352690	100414	RxNorm:10834	{"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 trimipramine 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
8352691	100414	RxNorm:10834	{"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 trimipramine 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
8352692	100414	RxNorm:10834	{"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 trimipramine 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
8352693	100414	RxNorm:10834	{"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 trimipramine 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
8352712	100414	RxNorm:10834	{"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
8352694	100414	RxNorm:10834	{"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
8352695	100414	RxNorm:10834	{"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
8352696	100414	RxNorm:10834	{"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
8352697	100414	RxNorm:10834	{"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
8352698	100414	RxNorm:10834	{"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
8352699	100414	RxNorm:10834	{"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
8352713	100414	RxNorm:10834	{"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
8352700	100414	RxNorm:10834	{"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
8352701	100414	RxNorm:10834	{"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
8352702	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352703	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352704	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352737	100414	RxNorm:10834	{"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
8352705	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352706	100414	RxNorm:10834	{"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
8352707	100414	RxNorm:10834	{"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
8352708	100414	RxNorm:10834	{"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
8352709	100414	RxNorm:10834	{"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
8352710	100414	RxNorm:10834	{"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
8352711	100414	RxNorm:10834	{"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
8352738	100414	RxNorm:10834	{"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
8352714	100414	RxNorm:10834	{"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
8352715	100414	RxNorm:10834	{"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
8352716	100414	RxNorm:10834	{"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
8352717	100414	RxNorm:10834	{"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
8352718	100414	RxNorm:10834	{"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
8352719	100414	RxNorm:10834	{"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
8352720	100414	RxNorm:10834	{"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 trimipramine use. If trimipramine 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
8352721	100414	RxNorm:10834	{"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 trimipramine use. If trimipramine 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
8352722	100414	RxNorm:10834	{"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 trimipramine use. If trimipramine 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
8352739	100414	RxNorm:10834	{"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
8352723	100414	RxNorm:10834	{"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 trimipramine use. If trimipramine 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
8352724	100414	RxNorm:10834	{"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 trimipramine use. If trimipramine 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
8352725	100414	RxNorm:10834	{"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 trimipramine 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
8352726	100414	RxNorm:10834	{"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 trimipramine 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
8352727	100414	RxNorm:10834	{"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 trimipramine 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
8352728	100414	RxNorm:10834	{"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 trimipramine 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
8352740	100414	RxNorm:10834	{"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
8352729	100414	RxNorm:10834	{"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 trimipramine 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
8352730	100414	RxNorm:10834	{"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 trimipramine 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
8352731	100414	RxNorm:10834	{"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 trimipramine 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
8352732	100414	RxNorm:10834	{"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 trimipramine 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
8352733	100414	RxNorm:10834	{"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 trimipramine 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
8352734	100414	RxNorm:10834	{"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 trimipramine 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
8352735	100414	RxNorm:10834	{"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
8352736	100414	RxNorm:10834	{"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
8352741	100414	RxNorm:10834	{"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
8352742	100414	RxNorm:10834	{"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
8352743	100414	RxNorm:10834	{"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
8352744	100414	RxNorm:10834	{"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
8352745	100414	RxNorm:10834	{"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 trimipramine use. If trimipramine 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
8352746	100414	RxNorm:10834	{"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 trimipramine use. If trimipramine 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
8352747	100414	RxNorm:10834	{"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 trimipramine use. If trimipramine 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
8352748	100414	RxNorm:10834	{"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 trimipramine use. If trimipramine 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
8352749	100414	RxNorm:10834	{"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 trimipramine use. If trimipramine 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
8352750	100414	RxNorm:10834	{"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
8352751	100414	RxNorm:10834	{"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
8352752	100414	RxNorm:10834	{"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
8352753	100414	RxNorm:10834	{"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
8352754	100414	RxNorm:10834	{"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
8352755	100414	RxNorm:10834	{"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 trimipramine use. If a trimipramine 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
8352756	100414	RxNorm:10834	{"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 trimipramine use. If a trimipramine 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
8352757	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352758	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352759	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352760	100414	RxNorm:10834	{"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
8352761	100414	RxNorm:10834	{"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 trimipramine use. If a trimipramine 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
8352762	100414	RxNorm:10834	{"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 trimipramine use; If trimipramine 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
8352763	100414	RxNorm:10834	{"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
8352764	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352765	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352766	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352767	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352768	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352769	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352770	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352771	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352772	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352773	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352774	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352775	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352776	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352777	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352778	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352779	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352780	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352781	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352782	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352783	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352784	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352785	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine 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
8352786	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352787	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352788	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352819	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352789	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352790	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352791	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352792	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352793	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352794	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352795	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352796	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352797	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352798	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352799	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352800	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352801	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352802	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352803	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352804	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352805	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352806	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352807	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352808	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352809	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352810	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352811	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352812	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352813	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352814	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352815	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352816	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352817	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352818	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352820	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352821	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352822	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352823	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352824	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352825	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352826	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352827	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352828	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352829	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352830	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352831	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352832	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352833	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352834	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352835	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352836	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352837	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352838	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352839	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352840	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352841	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352842	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352843	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352844	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352845	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352846	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352847	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352848	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352849	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352850	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352851	100414	RxNorm:10834	{"CYP2D6": "Increased 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 trimipramine use; If trimipramine is warranted, 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
8352852	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352853	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352854	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352855	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352856	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352857	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352858	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352859	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352860	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352861	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352862	100414	RxNorm:10834	{"CYP2D6": "Increased 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
8352863	100414	RxNorm:10834	{"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
8352864	100414	RxNorm:10834	{"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
8352865	100414	RxNorm:10834	{"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
8352866	100414	RxNorm:10834	{"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
8352886	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.0"}	{}	{"CYP2D6": "≥3.0"}	general	n/a	1	f	f	f
8352867	100414	RxNorm:10834	{"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
8352868	100414	RxNorm:10834	{"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
8352869	100414	RxNorm:10834	{"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
8352870	100414	RxNorm:10834	{"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
8352871	100414	RxNorm:10834	{"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
8352872	100414	RxNorm:10834	{"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
8352873	100414	RxNorm:10834	{"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
8352874	100414	RxNorm:10834	{"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
8352875	100414	RxNorm:10834	{"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
8352887	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "4.0"}	{}	{"CYP2D6": "4.0"}	general	n/a	1	f	f	f
8352876	100414	RxNorm:10834	{"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
8352877	100414	RxNorm:10834	{"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
8352878	100414	RxNorm:10834	{"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
8352879	100414	RxNorm:10834	{"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
8352880	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥6.0"}	{}	{"CYP2D6": "≥6.0"}	general	n/a	1	f	f	f
8352881	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥5.0"}	{}	{"CYP2D6": "≥5.0"}	general	n/a	1	f	f	f
8352882	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.75"}	{}	{"CYP2D6": "≥3.75"}	general	n/a	1	f	f	f
8352883	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥4.0"}	{}	{"CYP2D6": "≥4.0"}	general	n/a	1	f	f	f
8352884	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.5"}	{}	{"CYP2D6": "≥3.5"}	general	n/a	1	f	f	f
8352885	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "≥3.25"}	{}	{"CYP2D6": "≥3.25"}	general	n/a	1	f	f	f
8352888	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.75"}	{}	{"CYP2D6": "2.75"}	general	n/a	1	f	f	f
8352889	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "3.0"}	{}	{"CYP2D6": "3.0"}	general	n/a	1	f	f	f
8352890	100413	RxNorm:39786	{"CYP2D6": "Increased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and increased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal metabolizers. There is insufficient evidence supporting the clinical impact of increased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 ultrarapid metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Ultrarapid Metabolizer"}	{"CYP2D6": "2.5"}	{}	{"CYP2D6": "2.5"}	general	n/a	1	f	f	f
8352891	100413	RxNorm:39786	{"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
8352892	100413	RxNorm:39786	{"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
8352893	100413	RxNorm:39786	{"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
8352894	100413	RxNorm:39786	{"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
8352895	100413	RxNorm:39786	{"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
8352896	100413	RxNorm:39786	{"CYP2D6": "Decreased metabolism of venlafaxine to active metabolite O-desmethylvenlafaxine (desvenlafaxine) and decreased O-desmethylvenlafaxine:venlafaxine ratio as compared to normal metabolizers. There is insufficient evidence supporting the clinical impact of the decreased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 intermediate metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "1.0"}	{}	{"CYP2D6": "1.0"}	general	n/a	1	f	f	f
8352897	100413	RxNorm:39786	{"CYP2D6": "Decreased metabolism of venlafaxine to active metabolite O-desmethylvenlafaxine (desvenlafaxine) and decreased O-desmethylvenlafaxine:venlafaxine ratio as compared to normal metabolizers. There is insufficient evidence supporting the clinical impact of the decreased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 intermediate metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.75"}	{}	{"CYP2D6": "0.75"}	general	n/a	1	f	f	f
8352898	100413	RxNorm:39786	{"CYP2D6": "Decreased metabolism of venlafaxine to active metabolite O-desmethylvenlafaxine (desvenlafaxine) and decreased O-desmethylvenlafaxine:venlafaxine ratio as compared to normal metabolizers. There is insufficient evidence supporting the clinical impact of the decreased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 intermediate metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.5"}	{}	{"CYP2D6": "0.5"}	general	n/a	1	f	f	f
8352899	100413	RxNorm:39786	{"CYP2D6": "Decreased metabolism of venlafaxine to active metabolite O-desmethylvenlafaxine (desvenlafaxine) and decreased O-desmethylvenlafaxine:venlafaxine ratio as compared to normal metabolizers. There is insufficient evidence supporting the clinical impact of the decreased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 intermediate metabolizers."}	No action recommended based on genotype for venlafaxine because of minimal evidence regarding the impact on efficacy or side effects.	No Recommendation	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	general	n/a	1	f	f	f
8352900	100413	RxNorm:39786	{"CYP2D6": "Decreased metabolism of venlafaxine to the active metabolite O-desmethylvenlafaxine (desvenlafaxine) and greatly decreased O-desmethylvenlafaxine:venlafaxine ratio as compared to CYP2D6 normal and intermediate metabolizers. The clinical impact of increased venlafaxine and decreased O-desmethylvenlafaxine:venlafaxine ratio in CYP2D6 poor metabolizers is unclear, but CYP2D6 PM genotype has been associated with adverse effects."}	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
8352901	100413	RxNorm:39786	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
8352911	100410	RxNorm:121243	{"CYP2C19": "In patients for whom a rapid metabolizer genotype (*1/*17) is identified, the probability of attainment of therapeutic concentrations is modest with standard dosing"}	Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy in lieu of voriconazole. Such agents include isavuconazole, liposomal amphotericin B, and posaconazole.	Moderate	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	adults	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.	1	f	f	f
8352902	100410	RxNorm:121243	{"CYP2C19": "In patients for whom an ultrarapid metabolizer genotype (*17/*17) is identified, the probability of attainment of therapeutic concentrations is small"}	Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy in lieu of voriconazole. Such agents include liposomal amphotericin B and posaconazole.	Moderate	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	pediatrics	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities. Achieving voriconazole therapeutic concentrations in the pediatric population with ultrarapid and rapid metabolizer phenotypes in a timely manner is difficult. As critical time may be lost in achieving therapeutic concentrations, an alternative antifungal agent is recommended in order that the child receives effective antifungal therapy as soon as possible.	1	f	f	f
8352903	100410	RxNorm:121243	{"CYP2C19": "In patients for whom a rapid metabolizer genotype (*1/*17) is identified, the probability of attainment of therapeutic concentrations is variable."}	Initiate therapy with recommended standard of care dosing. Use therapeutic drug monitoring to titrate dose to therapeutic trough concentrations.	Moderate	{"CYP2C19": "Rapid Metabolizer"}	{}	{}	{"CYP2C19": "Rapid Metabolizer"}	pediatrics	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring (TDM), and comorbidities. Achieving voriconazole therapeutic concentrations in the pediatric population with ultrarapid and rapid metabolizer phenotypes in a timely manner is difficult. As critical time may be lost in achieving therapeutic concentrations, an alternative antifungal agent is recommended in order that the child receives effective antifungal therapy as soon as possible. Meticulous TDM is critical for rapid metabolizers. There is insufficient evidence to distinguish a CYP2C19*1/*17 and *1/*1 pediatric patient due to large variability in trough concentrations.	1	f	f	f
8352904	100410	RxNorm:121243	{"CYP2C19": "Normal voriconazole metabolism"}	Initiate therapy with recommended standard of care dosing	Strong	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	pediatrics	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.	1	f	f	f
8352905	100410	RxNorm:121243	{"CYP2C19": "Higher dose-adjusted trough concentrations of voriconazole compared with normal metabolizers"}	Initiate therapy with recommended standard of care dosing	Moderate	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	pediatrics	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.	1	f	f	f
8352906	100410	RxNorm:121243	{"CYP2C19": "Higher dose-adjusted trough concentrations of voriconazole compared with normal metabolizers"}	Initiate therapy with recommended standard of care dosing	Moderate	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	pediatrics	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.	1	f	f	f
8352907	100410	RxNorm:121243	{"CYP2C19": "Higher dose-adjusted trough concentrations of voriconazole and may increase probability of adverse events"}	Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy in lieu of voriconazole. Such agents include liposomal amphotericin B and posaconazole. In the event that voriconazole is considered to be the most appropriate agent, based on clinical advice, for a patient with poor metabolizer genotype, voriconazole should be administered at a preferably lower than standard dosage with careful therapeutic drug monitoring.	Moderate	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	pediatrics	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities. Recommendation based upon data extrapolated from adults.	1	f	f	f
8352908	100410	RxNorm:121243	{"CYP2C19": "Higher dose-adjusted trough concentrations of voriconazole and may increase probability of adverse events"}	Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy in lieu of voriconazole. Such agents include liposomal amphotericin B and posaconazole. In the event that voriconazole is considered to be the most appropriate agent, based on clinical advice, for a patient with poor metabolizer genotype, voriconazole should be administered at a preferably lower than standard dosage with careful therapeutic drug monitoring.	Moderate	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	pediatrics	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities. Recommendation based upon data extrapolated from adults.	1	f	f	f
8352909	100410	RxNorm:121243	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	pediatrics	n/a	1	f	f	f
8352910	100410	RxNorm:121243	{"CYP2C19": "In patients for whom an ultrarapid metabolizer genotype (*17/*17) is identified, the probability of attainment of therapeutic voriconazole concentrations is small with standard dosing"}	Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy in lieu of voriconazole. Such agents include isavuconazole, liposomal amphotericin B, and posaconazole.	Moderate	{"CYP2C19": "Ultrarapid Metabolizer"}	{}	{}	{"CYP2C19": "Ultrarapid Metabolizer"}	adults	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities. Recommendations based upon data extrapolated from patients with CYP2C19*1/*17 genotype.	1	f	f	f
8352912	100410	RxNorm:121243	{"CYP2C19": "Normal voriconazole metabolism"}	Initiate therapy with recommended standard of care dosing	Strong	{"CYP2C19": "Normal Metabolizer"}	{}	{}	{"CYP2C19": "Normal Metabolizer"}	adults	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.	1	f	f	f
8352913	100410	RxNorm:121243	{"CYP2C19": "Higher dose-adjusted trough concentrations of voriconazole compared with normal metabolizers"}	Initiate therapy with recommended standard of care dosing	Moderate	{"CYP2C19": "Likely Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Likely Intermediate Metabolizer"}	adults	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.	1	f	f	f
8352914	100410	RxNorm:121243	{"CYP2C19": "Higher dose-adjusted trough concentrations of voriconazole compared with normal metabolizers"}	Initiate therapy with recommended standard of care dosing	Moderate	{"CYP2C19": "Intermediate Metabolizer"}	{}	{}	{"CYP2C19": "Intermediate Metabolizer"}	adults	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.	1	f	f	f
8352915	100410	RxNorm:121243	{"CYP2C19": "Higher dose-adjusted trough concentrations of voriconazole and may increase probability of adverse events"}	Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy in lieu of voriconazole. Such agents include isavuconazole, liposomal amphotericin B, and posaconazole. In the event that voriconazole is considered to be the most appropriate agent, based on clinical advice, for a patient with poor metabolizer genotype, voriconazole should be administered at a preferably lower than standard dosage with careful therapeutic drug monitoring.	Moderate	{"CYP2C19": "Likely Poor Metabolizer"}	{}	{}	{"CYP2C19": "Likely Poor Metabolizer"}	adults	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.	1	f	f	f
8352916	100410	RxNorm:121243	{"CYP2C19": "Higher dose-adjusted trough concentrations of voriconazole and may increase probability of adverse events"}	Choose an alternative agent that is not dependent on CYP2C19 metabolism as primary therapy in lieu of voriconazole. Such agents include isavuconazole, liposomal amphotericin B, and posaconazole. In the event that voriconazole is considered to be the most appropriate agent, based on clinical advice, for a patient with poor metabolizer genotype, voriconazole should be administered at a preferably lower than standard dosage with careful therapeutic drug monitoring.	Moderate	{"CYP2C19": "Poor Metabolizer"}	{}	{}	{"CYP2C19": "Poor Metabolizer"}	adults	Further dose adjustments or selection of alternative therapy may be necessary due to other clinical factors, such as drug interactions, hepatic function, renal function, species, site of infection, therapeutic drug monitoring, and comorbidities.	1	f	f	f
8352917	100410	RxNorm:121243	{"CYP2C19": "n/a"}	No recommendation	No Recommendation	{"CYP2C19": "Indeterminate"}	{}	{}	{"CYP2C19": "Indeterminate"}	adults	n/a	1	f	f	f
8352918	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352919	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352920	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352921	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352922	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352923	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352924	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352925	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352926	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352927	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352928	100413	RxNorm:1455099	{"CYP2D6": "Increased metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Lower plasma concentrations decrease the probability of clinical benefit."}	Select alternative drug not predominantly metabolized by CYP2D6. If vortioxetine use is warranted, initiate therapy at standard starting dose and titrate to maintenance dose based on efficacy and side effects. Increasing the target maintenance dose by 50% or more may be needed for efficacy.	Optional	{"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
8352929	100413	RxNorm:1455099	{"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
8352930	100413	RxNorm:1455099	{"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
8352931	100413	RxNorm:1455099	{"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
8352932	100413	RxNorm:1455099	{"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
8352933	100413	RxNorm:1455099	{"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
8352934	100413	RxNorm:1455099	{"CYP2D6": "Reduced metabolism of vortioxetine 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
8352935	100413	RxNorm:1455099	{"CYP2D6": "Reduced metabolism of vortioxetine 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
8352936	100413	RxNorm:1455099	{"CYP2D6": "Reduced metabolism of vortioxetine 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": "0.5"}	{}	{"CYP2D6": "0.5"}	general	n/a	1	f	f	f
8352937	100413	RxNorm:1455099	{"CYP2D6": "Reduced metabolism of vortioxetine to less active compounds when compared to CYP2D6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Initiate therapy with recommended starting dose.	Moderate	{"CYP2D6": "Intermediate Metabolizer"}	{"CYP2D6": "0.25"}	{}	{"CYP2D6": "0.25"}	general	n/a	1	f	f	f
8352938	100413	RxNorm:1455099	{"CYP2D6": "Greatly reduced metabolism of vortioxetine to inactive compounds when compared to CYP2D6 normal metabolizers. Higher plasma concentrations may increase the probability of side effects."}	Initiate 50% of starting dose (e.g., 5 mg) and titrate to the maximum recommended dose of 10 mg or consider a clinically appropriate alternative antidepressant not predominantly metabolized by CYP2D6.	Moderate	{"CYP2D6": "Poor Metabolizer"}	{"CYP2D6": "0.0"}	{}	{"CYP2D6": "0.0"}	general	Drug-drug interactions, indication 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
8352939	100413	RxNorm:1455099	{"CYP2D6": "n/a"}	No recommendation	No Recommendation	{"CYP2D6": "Indeterminate"}	{"CYP2D6": "n/a"}	{}	{"CYP2D6": "n/a"}	general	n/a	1	f	f	f
\.


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