PHARMACOGENETICS TESTING MENU

PHARMACOGENETICS TESTING MENU

Pharmacogenetics and the Patient Seeking Recovery Pharmacogenetics, as the name suggests, refers to the combined study of medications and inherited genetic traits. The manner by which medications are processed in the body, known as metabolic pathways, will vary from person to person according to each individual s DNA. Why does this matter? These common variations lead to differences in the ways medications affect individuals. Our genetic makeup determines the nature of the drug-metabolizing enzymes in the liver, the method by which medications are absorbed, distributed, metabolized, eliminated from body, and the receptors upon which medications work or fail to work. Even members of the same family will sometimes react very differently to the same drug, with one person receiving an inadequate dose and another afflicted with toxicity. Pharmacogenetic testing will guide the physician in selecting the right dose for the right medication, getting it right the first time. How Common Are Medication Failures? Failure rates are surprisingly high with commonly prescribed medications: Antidepressants (SSRIs) 38% failure Asthma drugs 40% failure Diabetes drugs 43% failure Alzheimer s drugs 70% failure Cancer medications 75% failure For this reason, the FDA now includes pharmacogenetic information to identify significant genetic markers on the labels of many medications. This information includes dosing guidance, risk for adverse reactions, and drug interactions for medications such as citalopram, risperidone, and others commonly used in the addiction treatment environment. Are there other concerns unique to Addiction Treatment? The patients we serve, because they have endured the effects of the powerful substances they abuse, will very commonly have accompanying physiological and behavioral comorbidities. It is critical that their physicians know how their patient will process the medication (pharmacokinetics) and what that medication will do to the patient (pharmacodynamics). Furthermore, because our focus is the needs of patients seeking recovery, our testing can offer insights into why patients seek particular substances to abuse. Pharmacogenetics and our understanding of the physiology of addiction (such as the dopamine tone and reward system, receptor function, etc.) can illuminate why some patients are compelled to seek stimulants vs. depressants. Our reporting can offer your team choices in treatment suited to each patient s unique needs.

Pain & Psychiatry Panel (Comprehensive) This panel provides a comprehensive test for all the pain and psychiatric medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Furthermore, this panel provides a risk assessment for Tardive Dyskinesia, Hyperprolactinemia, and weight gain for patients taking an antipsychotic medication, as well as a risk factor for inadequate antidepressant response. DRUG NAME TRADE NAME CATEGORY GENES RESPONSIBLE Amphetamine Adderall Anti-ADHD COMT Atomoxetine Strattera Anti-ADHD CYP2D6 Clonidine Catapres, Kapvay, Duraclon, Nexiclon Anti-ADHD CYP2D6 Dexmethylphenidate Focalin Anti-ADHD COMT Dextroamphetamine Dexedrine, ProCentra, Dextrostat Anti-ADHD COMT Lisdexamfetamine Vyvanse Anti-ADHD COMT Methylphenidate Daytrana, Concerta, Methylin, Aptensio, Ritalin Anti-ADHD COMT Bupropion Wellbutrin, Zyban, Aplenzin Antiaddictive ANKK1/DRD2, CYP2B6 Naltrexone Vivitrol, Revia Antiaddictive OPRM1 Carbamazepine Tegretol, Carbatrol Anticonvulsant CYP3A4, 5 Fosphenytoin Cerebyx Anticonvulsant CYP2C9 Lacosamide Vimpat Anticonvulsant CYP2C19 Phenobarbital Luminal Anticonvulsant CYP2C19 Phenytoin Phenytek, Dilantin Anticonvulsant CYP2C9 Primidone Mysoline Anticonvulsant CYP2C9, CYP2C19 Zonisamide Zonegran Anticonvulsant CYP2C19 Donepezil Aricept Antidementia CYP2D6 Galantamine Razadyne Antidementia CYP2D6 Mirtazapine Remeronsoltab, Remeron Antidepressant - Atypical CYP2D6 Nefazodone Serzone Antidepressant - Atypical CYP2D6 Vortioxetine Brintellix Antidepressant - Atypical CYP2D6 Desvenlafaxine Pristiq Antidepressant - SNRI CYP2D6 Duloxetine Cymbalta Antidepressant - SNRI CYP2D6, CYP1A2 Venlafaxine Effexor Antidepressant - SNRI CYP2D6 Citalopram Celexa Antidepressant - SSRI CYP2C19, GRIK4, HTR2A Escitalopram Lexapro Antidepressant - SSRI CYP2C19 Fluoxetine Prozac, Sarafem Antidepressant - SSRI CYP2D6 Fluvoxamine Luvox Antidepressant - SSRI CYP2D6 Paroxetine Paxil, Pexeva, Brisdelle Antidepressant - SSRI CYP2D6 Sertraline Zoloft Antidepressant - SSRI CYP2C19 Vilazodone Viibryd Antidepressant - SSRI CYP3A4 Amitriptyline Vanatrip, Elavil Antidepressant - TCA CYP2D6, CYP2C19 Amoxapine Asendin Antidepressant - TCA CYP2D6 Clomipramine Anafranil Antidepressant - TCA CYP2D6, CYP2C19 Desipramine Norpramine Antidepressant - TCA CYP2D6

Pain & Psychiatry Panel (Comprehensive) DRUG NAME TRADE NAME CATEGORY GENES RESPONSIBLE Doxepin Silenor, Prudoxin, Zonalon Antidepressant - TCA CYP2D6, CYP2C19 Imipramine Tofranil Antidepressant - TCA CYP2D6, CYP2C19 Maprotiline Ludiomil Antidepressant - TCA CYP2D6 Nortriptyline Aventyl, Pamelor Antidepressant - TCA CYP2D6 Protriptyline Vivactil Antidepressant - TCA CYP2D6 Trimipramine Rhotrimine, Stangyl, Surmontil Antidepressant - TCA CYP2D6, CYP2C19 Aripiprazole Abilify Antipsychotic CYP2D6 Brexpiprazole Rexulti Antipsychotic CYP2D6 Chlorpromazine Thorazine Antipsychotic CYP2D6 Clozapine FazaClo, Clozaril Antipsychotic CYP2D6, CYP1A2, HTR2A, HTR2C Fluphenazine Prolixin Antipsychotic CYP2D6 Haloperidol Haldol Antipsychotic CYP2D6 Iloperidone Fanapt Antipsychotic CYP2D6 Olanzapine Zyprexa Antipsychotic CYP2D6, CYP1A2, HTR2C Paliperidone Invega Antipsychotic CYP2D6 Perphenazine Trilafon Antipsychotic CYP2D6 Pimozide Orap Antipsychotic CYP2D6 Quetiapine Seroquel Antipsychotic CYP3A4, 5 Risperidone Risperdal Antipsychotic CYP2D6, HTR2C, ANKK1/DRD2 Tetrabenazine Xenazine Antipsychotic CYP2D6 Thioridazine Mellaril Antipsychotic CYP2D6 Trazodone Desyrel, Oleptro Antipsychotic CYP3A4 Ziprasidone Zeldox, Zipwell, Geodon Antipsychotic CYP3A4 Alprazolam Xanax Benzodiazepine CYP3A4, 5 Clobazam Onfi Benzodiazepine CYP2C19 Diazepam Diastat, Valium Benzodiazepine CYP2C19 Lorazepam Ativan Benzodiazepine UGT2B15 Oxazepam Serax Benzodiazepine UGT2B15 Carisoprodol Soma Muscle Relaxant CYP2C19 Tizanidine Zanaflex Muscle Relaxant CYP1A2 Celecoxib Celebrex NSAID CYP2C9 Diclofenac Voltaren, Zipsor, Pennsaid, Cambia, Flector, Dyloject NSAID CYP2C9 Flurbiprofen Ocufen, Ansaid NSAID CYP2C9 Ibuprofen Advil, Motrin, Midol NSAID CYP2C9 Indomethacin Tivorbex, Indocin NSAID CYP2C9 Meloxicam Mobic NSAID CYP2C9 Naproxen Naprosyn, Anaprox, Naprelan, Aleve NSAID CYP2C9 Piroxicam Feldene NSAID CYP2C9 Sulindac Clinoril NSAID CYP2C9 Buprenorphine Butrans, Suboxone, Buprenex Opioid CYP3A4

Pain & Psychiatry Panel (Comprehensive) DRUG NAME TRADE NAME CATEGORY GENES RESPONSIBLE Codeine Codeine Opioid CYP2D6 Dihydrocodeine Synalgos-DC Opioid CYP2D6 Fentanyl Duragesic, Abstral, Subsys, Ionsys, Sublimaze Opioid OPRM1 Hydrocodone Lortab, Vicodin Opioid CYP2D6, OPRM1 Meperidine Demerol Opioid CYP2B6 Methadone Diskets, Dolophine, Methadose Opioid CYP2B6 Morphine MS Contin, Duramorph, DepoDur, Astramorph, Infumorph Opioid OPRM1, COMT Oxycodone Oxycontin, Percocet, Roxicodone, Oxecta Opioid CYP2D6 Tramadol ConZip, Ryzolt, Ultram Opioid CYP2D6 Ketamine Ketalar Sedative/Antidepressant - Atypical CYP2B6 Pain Panel This panel provides a comprehensive test for all the pain medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Buprenorphine Butrans, Suboxone, Buprenex CYP3A4 Carisoprodol Soma CYP2C19 Celecoxib Celebrex CYP2C9 Codeine Codeine CYP2D6 Diclofenac Voltaren, Zipsor, Pennsaid, Cambia, Flector, Dyloject CYP2C9 Dihydrocodeine Synalgos-DC CYP2D6 Fentanyl Duragesic, Abstral, Subsys, Ionsys, Sublimaze OPRM1 Fentanyl Abstral OPRM1 Flurbiprofen Ocufen, Ansaid CYP2C9 Hydrocodone Lortab, Vicodin CYP2D6, OPRM1 Ibuprofen Advil, Motrin, Midol CYP2C9 Indomethacin Tivorbex CYP2C9 Indomethacin Indocin CYP2C9 Meloxicam Mobic CYP2C9 Meperidine Demerol CYP2B6 Methadone Diskets, Dolophine, Methadose CYP2B6 Morphine MS Contin, Duramorph, DepoDur, Astramorph, Infumorph OPRM1, COMT Naproxen Naprosyn, Anaprox, Naprelan, Aleve CYP2C9 Oxycodone Oxycontin, Percocet, Roxicodone, Oxecta CYP2D6 Piroxicam Feldene CYP2C9 Sulindac Clinoril CYP2C9

Pain Panel Tizanidine Zanaflex CYP1A2 Tramadol ConZip, Ryzolt, Ultram CYP2D6 Psychiatry Panel This panel provides a comprehensive test for all the psychiatric medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Furthermore, this panel provides a risk assessment for Tardive Dyskinesia, Hyperprolactinemia, and weight gain for patients taking an antipsychotic medication, as well as a risk factor for inadequate antidepressant response. Alprazolam Xanax CYP3A4, 5 Amitriptyline Vanatrip, Elavil CYP2D6, CYP2C19 Amoxapine Asendin CYP2D6 Amphetamine Adderall COMT Aripiprazole Abilify CYP2D6 Atomoxetine Strattera CYP2D6

Psychiatry Panel Brexpiprazole Rexulti CYP2D6 Bupropion Wellbutrin, Zyban, Aplenzin ANKK1/DRD2, CYP2B6 Carbamazepine Tegretol, Carbatrol CYP3A4, 5 Chlorpromazine Thorazine CYP2D6 Citalopram Celexa CYP2C19, GRIK4, HTR2A Clobazam Onfi CYP2C19 Clomipramine Anafranil CYP2D6, CYP2C19 Clonidine Catapres, Kapvay, Duraclon, Nexiclon, FazaClo, Clozaril CYP2D6 Clonidine Kapvay CYP2D6 Desipramine Norpramine CYP2D6 Desvenlafaxine Pristiq CYP2D6 Dexmethylphenidate Focalin, Dexedrine, ProCentra, Dextrostat COMT Diazepam Diastat, Valium CYP2C19 Donepezil Aricept CYP2D6 Doxepin Silenor, Prudoxin, Zonalon CYP2D6, CYP2C19 Duloxetine Cymbalta CYP2D6, CYP1A2 Escitalopram Lexapro CYP2C19 Fluoxetine Prozac, Sarafem CYP2D6 Fluphenazine Prolixin CYP2D6 Fluvoxamine Luvox CYP2D6 Fosphenytoin Cerebyx CYP2C9 Galantamine Razadyne CYP2D6 Haloperidol Haldol CYP2D6 Iloperidone Fanapt CYP2D6 Imipramine Tofranil CYP2D6, CYP2C19 Ketamine Ketalar CYP2B6 Lacosamide Vimpat CYP2C19 Lisdexamfetamine Vyvanse COMT Lorazepam Ativan UGT2B15 Maprotiline Ludiomil CYP2D6 Methylphenidate Daytrana, Concerta, Methylin, Aptensio, Ritalin COMT, ADRA2A Midazolam Versed CYP3A4, 5 Mirtazapine Remeronsoltab, Remeron CYP2D6 Naltrexone Vivitrol, Revia OPRM1 Nefazodone Serzone CYP2D6, CYP3A4, 5 Nortriptyline Aventyl, Pamelor CYP2D6 Olanzapine Zyprexa CYP2D6, CYP1A2, HTR2C Oxazepam Serax UGT2B15 Paliperidone Invega CYP2D6 Paroxetine Paxil, Pexeva, Brisdelle CYP2D6

Psychiatry Panel Perphenazine Trilafon CYP2D6 Phenobarbital Luminal CYP2C19 Phenytoin Phenytek, Dilantin CYP2C9 Pimozide Orap CYP2D6 Primidone Mysoline CYP2C9, CYP2C19 Protriptyline Vivactil CYP2D6 Quetiapine Seroquel CYP3A4, 5 Risperidone Risperdal CYP2D6, HTR2C, ANKK1/DRD2 Sertraline Zoloft CYP2C19 Tetrabenazine Xenazine CYP2D6 Thioridazine Mellaril CYP2D6 Trazodone Desyrel, Oleptro CYP3A4 Trimipramine Rhotrimine, Stangyl, Surmontil CYP2D6, CYP2C19 Venlafaxine Effexor CYP2D6 Vilazodone Viibryd CYP3A4 Vortioxetine Brintellix CYP2D6 Ziprasidone Zeldox, Zipwell, Geodon CYP3A4 Zonisamide Zonegran CYP2C19 Antidepressant Panel This panel provides a test specifically for the antidepressant medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Furthermore, this panel provides a risk assessment for inadequate antidepressant response. Amitriptyline Vanatrip, Elavil CYP2D6, CYP2C19 Amoxapine Asendin CYP2D6 Citalopram Celexa CYP2C19, GRIK4, HTR2A Clomipramine Anafranil CYP2D6, CYP2C19 Desipramine Norpramine CYP2D6 Desvenlafaxine Pristiq CYP2D6 Doxepin Silenor, Prudoxin, Zonalon CYP2D6, CYP2C19 Duloxetine Cymbalta CYP2D6, CYP1A2 Escitalopram Lexapro CYP2C19 Fluoxetine Prozac, Sarafem CYP2D6 Fluvoxamine Luvox CYP2D6 Imipramine Tofranil CYP2D6, CYP2C19 Maprotiline Ludiomil CYP2D6 Mirtazapine Remeronsoltab, Remeron CYP2D6 Nefazodone Serzone CYP2D6 Nortriptyline Aventyl, Pamelor CYP2D6

Antidepressant Panel Paroxetine Paxil, Pexeva, Brisdelle CYP2D6 Protriptyline Vivactil CYP2D6 Sertraline Zoloft CYP2C19 Trimipramine Rhotrimine, Stangyl, Surmontil CYP2D6, CYP2C19 Venlafaxine Effexor CYP2D6 Vilazodone Viibryd CYP3A4 Vortioxetine Brintellix CYP2D6 Opioid Panel This panel provides a test specifically for the opioid pain medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Buprenorphine Butrans, Suboxone, Buprenex CYP3A4 Codeine Codeine CYP2D6 Dihydrocodeine Synalgos-DC CYP2D6 Fentanyl Duragesic, Abstral, Subsys, Ionsys, Sublimaze OPRM1 Hydrocodone Lortab, Vicodin CYP2D6, OPRM1 Meperidine Demerol CYP2B6 Methadone Diskets, Dolophine, Methadose CYP2B6 Morphine MS Contin, Duramorph, DepoDur, Astramorph, Infumorph OPRM1, COMT Oxycodone Oxycontin, Percocet, Roxicodone, Oxecta CYP2D6 Tramadol ConZip, Ryzolt, Ultram CYP2D6 Antipsychotic Panel This panel provides a test specifically for the antipsychotic medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Furthermore, this panel provides a risk assessment for Tardive Dyskinesia, Hyperprolactinemia, and weight gain for patients taking an antipsychotic medication. Aripiprazole Abilify CYP2D6 Brexpiprazole Rexulti CYP2D6 Chlorpromazine Thorazine CYP2D6 Clozapine FazaClo, Clozaril CYP2D6, CYP1A2, HTR2A, HTR2C Fluphenazine Prolixin CYP2D6 Haloperidol Haldol CYP2D6 Iloperidone Fanapt CYP2D6 Olanzapine Zyprexa CYP2D6, CYP1A2, HTR2C Paliperidone Invega CYP2D6

Antipsychotic Panel Perphenazine Trilafon CYP2D6 Pimozide Orap CYP2D6 Quetiapine Seroquel CYP3A4, 5 Risperidone Risperdal CYP2D6, HTR2C, ANKK1/DRD2 Tetrabenazine Xenazine CYP2D6 Thioridazine Mellaril CYP2D6 Trazodone Desyrel, Oleptro CYP3A4 Ziprasidone Zeldox, Zipwell, Geodon CYP3A4 ADHD Panel This panel provides a test specifically for the ADHD medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Amphetamine Adderall COMT Atomoxetine Strattera CYP2D6 Clonidine Catapres, Kapvay, Duraclon, Nexiclon CYP2D6 Dexmethylphenidate Focalin, Dexedrine, ProCentra, Dextrostat COMT Lisdexamfetamine Vyvanse COMT Methylphenidate Daytrana, Concerta, Methylin, Aptensio, Ritalin COMT Benzodiazepine Panel This panel provides a test specifically for the benzodiazepine medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Alprazolam Xanax CYP3A4, 5 Clobazam Onfi CYP2C19 Diazepam Diastat, Valium CYP2C19 Lorazepam Ativan UGT2B15 Oxazepam Serax UGT2B15

NSAID Panel This panel provides a test specifically for the NSAID pain medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Celecoxib Celebrex CYP2C9 Diclofenac Voltaren, Zipsor, Pennsaid, Cambia, Flector, Dyloject CYP2C9 Flurbiprofen Ocufen, Ansaid CYP2C9 Ibuprofen Advil, Motrin, Midol CYP2C9 Indomethacin Tivorbex, Indocin CYP2C9 Meloxicam Mobic CYP2C9 Naproxen Naprosyn, Anaprox, Naprelan, Aleve CYP2C9 Piroxicam Feldene CYP2C9 Sulindac Clinoril CYP2C9 Muscle Relaxant Panel This panel provides a test specifically for the muscle relaxant medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Carisoprodol Soma CYP2C19 Tizanidine Zanaflex CYP1A2 Anticonvulsant Panel This panel provides a test specifically for the anticonvulsant medications listed below. The report will include guidance on potentially harmful or ineffective medications, polypharmacy recommendations, potential drug-drug interactions, and dosing information when appropriate. Carbamazepine Tegretol, Carbatrol CYP3A4, 5 Fosphenytoin Cerebyx CYP2C9 Lacosamide Vimpat CYP2C19 Phenobarbital Luminal CYP2C19 Phenytoin Phenytek, Dilantin CYP2C9 Primidone Mysoline CYP2C9, CYP2C19 Zonisamide Zonegran CYP2C19

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