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.
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 1
Clinical Implication
Decreased CYP2C9 enzyme activity.
Increased risk of adverse events (e.g., GI bleed, cardiovascular).
Therapeutic Recommendation
Initiate therapy with a 50% initial dose reduction and titrate slowly, up to 50% of the maximum recommended dose. Allow at least one week between dose titrations. OR…
Choose an alternative non-NSAID pain medication not metabolized by CYP2C9 (e.g. acetaminophen). OR…
If an NSAID is indicated, ibuprofen, celecoxib, or flurbiprofen can be used at the lowest starting dose and titrated. Other NSAIDs not metabolized by CYP2C9 can be used at standard doses (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.
Poor Metabolizer
Clinical Implication
Little to no CYP2C9 enzyme activity.
Increased risk of adverse events (e.g., GI bleed, cardiovascular).
Therapeutic Recommendation
Choose an alternative non-NSAID pain medication not metabolized by CYP2C9 (e.g. acetaminophen). OR…
If an NSAID is indicated, ibuprofen, celecoxib, or flurbiprofen can be used with a 25-50% initial dose reduction and slow titration up to 50% of the maximum recommended dose. Other NSAIDs not metabolized by CYP2C9 can be used at standard doses (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.