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Sample-Report-8 30 2019.Pdf Mehdi Dehghani, Ph.D, DABCC Laboratory Director • CLIA# 11D2071408, 45D2138167 333 Research Ct • Ste 200 • Peachtree Corners, GA 30092 t 678.250.9222 • 1.888.250.6228 • f 770.545.8592 • AlphaGenomix.com Alpha Genomix Comprehensive Extended Created for: John Doe Jr. Paent: John Doe Jr. DOB: 1/1/1900 Accession #: 12345678910 Gender: Collecon Date: 8/27/2019 Received Date: 8/28/2019 Ordered By: Alpha Genomix Report Generated: 8/30/2019 Referred By: Kevin Rosenbla, MD, PhD Comments: Current Patient Medications Current Medication List: Oxycodone, Warfarin, Gabapentin, Ibuprofen, Simvastatin, Morphine, Lorazepam Medications Affected by Patient Genetic Results Gabapentin (Neurontin®) Normal Response to Gabapentin Evidence Level: Informative Pharmacogenetic guidance: no genetically guided drug selection or dosing recommendations are available. Polypharmacy guidance: Gabapentin is eliminated primarily through renal excretion and is not metabolized by CYPs. Genetic variations in these metabolizing enzymes are not expected to affect its efficacy or toxicity profiles. Gabapentin can be prescribed at standard label-recommended dosage and administration. Ibuprofen (Advil®, Motrin®) Normal Sensitivity to Ibuprofen (CYP2C9 *1/*1 Normal Metabolizer) Evidence Level: Informative Individuals with a normal CYP2C9 activity (i.e normal metabolizers) can be prescribed ibuprofen according to standard label recommended-dosage and administration. Lorazepam (Ativan®) Possible Altered Response to Lorazepam (UGT2B15 *1/*2 Intermediate Evidence Level: Informative Metabolizer) Lorazepam clearance may be reduced in this patient. However, there is insufficient evidence whether this change results in a significant clinical effect. Consider monitoring the patient for increased sedation and adjust dosing accordingly. Morphine (MS Contin®) Altered Response to Morphine (COMT Val158Met G/G High/Normal COMT Evidence Level: Informative Activity) The patient does not carry the COMT Val158Met variant. The patient may require higher doses of morphine for adequate pain control. The dosing regimen needs to be individualized for each patient, taking into account the patient's prior analgesic treatment experience. Oxycodone (Percocet®, Oxycontin®) Normal Response to Oxycodone (CYP2D6 *1/*4 Normal Metabolizer) Evidence Level: Actionable Oxycodone can be prescribed at standard label-recommended dosage and administration. Simvastatin (Zocor®) Intermediate Myopathy Risk (SLCO1B1 521T>C T/C Decreased Function) Evidence Level: Actionable Simvastatin plasma concentrations are expected to be elevated. Consider avoiding simvastatin, and prescribe an alternative statin or another hypolipidemic drug, or consider prescribing simvastatin at a lower starting dose (20 mg/day). Routine creatine kinase (CK) monitoring is also advised. The FDA recommends against the 80 mg daily dose. Although the association between the SLCO1B1 521T>C variant and myopathy risk is not clearly established for other statins such as atorvastatin, pitavastatin, rosuvastatin, and pravastatin, caution is advised if high doses of these statins are used in this patient. Fluvastatin plasma levels are not affected by the SLCO1B1 521T>C variant. Warfarin (Coumadin®) Genetic Test Results For John Doe Jr. Page 1 of 17 Mehdi Dehghani, Ph.D, DABCC Laboratory Director • CLIA# 11D2071408, 45D2138167 333 Research Ct • Ste 200 • Peachtree Corners, GA 30092 t 678.250.9222 • 1.888.250.6228 • f 770.545.8592 • AlphaGenomix.com Average Dosing Requirements are Expected (CYP2C9 *1/*1; VKORC1 -1639G>A Evidence Level: Actionable G/G) When initiating warfarin treatment for indications with a target INR of 2-3, consider one of the following methods to estimate dosing requirements: FDA Label: CYP2C9 and VKORC1 genotype results indicate an expected therapeutic dose of 5-7 mg/day. Pharmacogenomics algorithms/calculators available at www.warfarindosing.org: Caucasians and Asians: Use the patient's demographics and other clinical factors along with CYP2C9 and VKORC1 genotypes to calculate the expected therapeutic dose. Africans and African Americans: Use the patient's demographics and other clinical factors along with CYP2C9 and VKORC1 genotypes to calculate the expected therapeutic dose. The provided recommendations in Africans and African Americans apply only when all the following CYP2C9 alleles are tested: *5, *6, *8, *11. Guidance Levels Based upon the patient's genotype, a medication has potentially reduced efficacy or increased toxicity or the patient has an increased risk for the indicated condition. Based upon the patient's genotype, guidelines exist for adjusting dosage or increased vigilance or the patient has a moderate risk for the indicated condition. Based on this patient's genotype, the medication can be prescribed according to standard regimens or the patient's risk for the indicated condition is not increased. Evidence Levels Actionable - Recommendations based upon publications by international pharmacogenetic expert groups, consortia or regulatory bodies (CPIC, DPWG, FDA. EMEA). Recommendations are suitable for implementation in a clinical setting. Guidelines may change as new knowledge arises. Informative - There are insufficient or contradictory findings documenting the impact of a given genetic polymorphism or drug interaction. Recommendations are informative and implementation in a clinical setting is optional. Additional Risk Factors Antipsychotic-Induced Tardive Dyskinesia Moderate Risk of Antipsychotic-Induced Tardive Dyskinesia The patient carries one copy of the Taq1A variant (heterozygous for the A1 allele). The genotype results predict that the patient may have reduced dopamine receptor DRD2 density and hypodopaminergic functioning. The patient has moderate risk for tardive dyskinesia when treated with antipsychotics. Monitor the patient for any signs of tardive dyskinesia. Antipsychotic-Induced Hyperprolactinemia Moderate Risk of Antipsychotic-induced Hyperprolactinemia The patient carries one copy of the Taq1A variant (heterozygous for the A1 allele). The genotype results predict that the patient may have reduced dopamine receptor DRD2 density and hypodopaminergic functioning. The patient has moderate risk of hyperprolactinemia when treated with antipsychotics. Monitor patient closely for signs of hyperprolactinemia. An evaluation of the risk-benefit profile of the antipsychotic medication may be required. Genetic Test Results For John Doe Jr. Page 2 of 17 Mehdi Dehghani, Ph.D, DABCC Laboratory Director • CLIA# 11D2071408, 45D2138167 333 Research Ct • Ste 200 • Peachtree Corners, GA 30092 t 678.250.9222 • 1.888.250.6228 • f 770.545.8592 • AlphaGenomix.com Antipsychotic-Induced Weight Gain Moderate Risk of Antipsychotic-Induced Weight Gain The patient carries one copy of the Taq1A variant (heterozygous for the A1 allele). The genotype results predict that the patient may have reduced dopamine receptor DRD2 density and hypodopaminergic functioning. The patient has moderate risk for weight gain when treated with antipsychotics. Monitor patient closely for signs of weight gain. Type III Hyperlipoproteinemia Not Associated with Type III Hyperlipoproteinemia The patient is negative for both the APOE c.388 T>C (Cys130Arg) and c.526 C>T (Arg176Cys) mutations. The patient's genotype is wild-type, which is the most common genotype in the general population (frequency: >60%). A patient with wild-type genotype does not have a defect in the apolipoprotein E (APOE), which is an integral structure of lipoprotein particles that have critical roles in blood lipid metabolism and transport. The APOE ε3/ε3 genotype is not associated with increased risk of cardiovascular disease. No action is needed when a patient is normolipidemic. Hyperhomocysteinemia - Depression No Increased Risk of Hyperhomocysteinemia The patient carries one copy of the MTHFR c.665C>T variant (heterozygous). MTHFR enzyme activity is reduced (60% of normal activity). Patients diagnosed with depression often have low folate levels and homocysteine is a highly sensitive marker of folate status. Functional folate deficiency is indicated by elevated homocysteine. The patient's small reduction in MTHFR activity is not a risk factor for hyperhomocysteinemia. Patients diagnosed with depression: as lower folate levels are associated with poorer antidepressant response, and baseline levels of folate within the normal range predict antidepressant response, testing for homocysteine levels and serum folate levels may be informative for this patient before prescribing methylfolate as an antidepressant-augmenting agent. Genetic Test Results For John Doe Jr. Page 3 of 17 Mehdi Dehghani, Ph.D, DABCC Laboratory Director • CLIA# 11D2071408, 45D2138167 333 Research Ct • Ste 200 • Peachtree Corners, GA 30092 t 678.250.9222 • 1.888.250.6228 • f 770.545.8592 • AlphaGenomix.com Thrombophilia Increased Risk of Thrombosis The patient carries one copy (heterozygous) of the F5 c.1601G>A variant (also known as Factor V Leiden) and does not carry the F2 c.*97G>A variant (also known as Factor II 20210G>A). The patient's risk of thrombosis is 3 to 8 times higher than average (average risk of clotting is about 1 in 1000 for anyone in a year). Other risk factors may have additive effects on thrombotic risk, increasing it further. Anticoagulation: Post-VTE patients with a low or moderate bleeding risk: long-term anticoagulation may be considered with periodic reevaluation to assess risks versus benefits. Asymptomatic individual without a history of thrombosis: a short course of prophylactic
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