In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.
Intermediate Metabolizer with an enzyme Activity Score of 1.5
Clinical Implication
Decreased CYP2C9 enzyme activity.
Slightly increased risk of adverse events (e.g., GI bleed, cardiovascular).
Therapeutic Recommendation
Initiate therapy with recommended starting dose. For ibuprofen, may consider initiating with a lower starting dose if CYP2C9 genotype includes *2.
In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.
Intermediate Metabolizer with an enzyme Activity Score of 1
Clinical Implication
Decreased CYP2C9 enzyme activity.
Increased risk of adverse events (e.g., GI bleed, cardiovascular).
Therapeutic Recommendation
Initiate therapy with lowest starting dose and titrate dose upward to clinical effect or maximum recommended dose with caution. Additional caution should be implemented with ibuprofen if CYP2C9 genotype includes *2.
In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.
Poor Metabolizer
Clinical Implication
Little to no CYP2C9 enzyme activity.
Increased risk of adverse events (e.g., GI bleed, cardiovascular).
Therapeutic Recommendation
Initiate therapy with a 25-50% initial dose reduction and titrate slowly, up to 50% of the maximum recommended dose. Allow at least one week between dose titrations.
Alternatively, consider an alternate NSAID not metabolized by CYP2C9 (e.g., aspirin, ketorolac, naproxen, and sulindac).
In accordance with the prescribing information, use the lowest effective dosage for shortest duration consistent with individual patient treatment goals.
Unable to Genotype or Assay Failure
The analysis failed to yield an informative result and thus no genotype is reported.
Unknown Phenotype
This individual is carrying at least one allele with uncertain/unknown function and the predicted phenotype cannot be determined at this time.