Comprehensive PGx report for SANDRA HENRY PERSONAL DETAILS Redwood Lab Services LLC CLIA:45D2108203 Fax: PATIENT ENRY DOB 281-378-2116 281-466-2483 Address: 6776 Southwest Fwy Suite 600, Houston, TX 77074 GENDER Female Website: http://www.redwoodlabservices.com/ SPECIMEN TYPE Buccal Swab LABORATORY INFORMATION ORDERING PHYSICIAN - ACCESSION NUMBER 2006271582 FACILITY Elite Clinical Lab COLLECTION DATE 06/03/2020 RECEIVED DATE 07/01/2020 REPORT GENERATED 09/21/2020 LABORATORY DIRECTOR Chad Harper Current Patient Medication This patient is either not receiving any medication or may be receiving medications that are outside the scope of this report. A medication has potentially reduced ecacy, increased toxicity or the patient has a risk for the indicated condition. Guidelines exist for adjusting dosage, increased vigilance or the patient has risk for the indicated condition. The medication can be prescribed according to standard regimens or the patient's risk for the indicated condition is not increased. Comprehensive PGx report for SANDRA HENRY 1 / 29 G E NOTYP E /HAP L OTYP E /P HE NOTYP E DE TAIL Dis claimer: No patient should evaluate or use the information contained herein without the advice, consultation and supervision of a licensed healthcare professional such as a pharmacist or G ene G enotype-Haplotype P henotype physician. Laboratory-developed testing characteristics and protocols. R esults have not been reviewed or approved by the U.S . Food & Drug Administration (FDA). * This call was defaulted to the wild-type allele frequency because during review of the genotyping data, the genotype was C YP 1A2 *1A/*1A E xtensive metabolizer indeterminate. For copy number: ** This copy number was defaulted to the wild-type frequency because during review of the copy number variation data, the copy number was indeterminate. C YP 2B6 *1/*1 E xtensive metabolizer C YP 2C 8 *1/*1 E xtensive metabolizer Methodology: Array based assays detect listed alleles, including all common and most rare C YP 2C 9 *1/*1 E xtensive metabolizer variants with known clinical significance at analytical sensitivity and specificity >99%. C YP 2C 19 *1/*1 E xtensive metabolizer L imitations : Testing cannot detect all genetic mutations, inactive or altered genes. The absence of C YP 2D6 *1/*39 E xtensive metabolizer a finding of a detectable gene, polymorphism or mutation does not necessarily indicate patient C YP 3A4 *1/*1 E xtensive metabolizer possesses intermediate or high sensitivity phenotypes or that patient has an undetected polymorphism. Absence of finding may be due to drug-drug interaction. C YP 3A5 *3/*3 P oor metabolizer C YP 4F2 *1/*1 E xtensive metabolizer P HAR MAC OG E NOMIC S VK OR C 1 *1/*1 Warfarin res is tance S LC O1B1 *1/*1 E xtensive function G enetic Markers Tested for P harmacogenomics: TP MT *1/*1 E xtensive metabolizer R esults are arranged by drug response. E ach individual report contains six sections, including: UG T1A1 *1/*1 E xtensive metabolizer P atient’s current medication (if any), Medication history, genotype/haplotype/phenotype detail, P G x DP YD *1/*1 E xtensive metabolizer report, G enomic Test R esults, and P atient Information C ard. Inclusion of the P G x R eport indicates that the tested individual: displays decreased ecacy to the drug (yellow check marks), should use OP R M1 *1/*1 S ensitive to Opioids the drug as directed (green check marks), or exhibits increased toxicity to the drug (red check marks). Inclusion of G enomic Test R esults indicates genotype, haplotype, phenotype, or presence of mutation. Organization of Table: 1. G ene/Locus refers to gene or intergenic region of genetic marker location. 2. Marker refers to the tested marker’s unique identifier. 3. G enotype/Haplotype refers to the particular marker’s combination of nucleotides. The letter(s) on either side of the slash refer(s) to the two (2) copies of the patient DNA. Del and dashes denotes nucleotide indels in patient DNA. E mpty cells indicate an absence of genotyping results. 4. P henotype refers to the C YP specific drug metabolizing capabilities of an individual. S ee R IS KS AND LIMITATIONS on the last pages of this R eport. C omprehens ive P G x report for S ANDR A HE NR Y 2 / 29 P G x R eport - P ain Management Type: Anti-inflammatory Agent, Analgesic, Antipyretic May Have May Have Used As Drug C lass G eneric P rimary Mechanism Involved Other Mechanisms Involved Decreased Increased Directed E fficacy Toxicity The Nonsteroidal Antiinflammatory Drugs (NS AIDs) Nabumetone (R elafen) C YP 1A2 C YP 2C 19, C YP 3A4 Acetic acid derivatives Indomethacin (Tivorbex) C YP 2C 9 C YP 2C 19 Ketorolac (Toradol, Acular, C YP 2C 8 C YP 2C 9, UG T2B7 S prix) Meloxicam (Mobic, Vivlodex) C YP 2C 9 C YP 1A2, C YP 3A4, C YP 3A5 E nolic acid (Oxicam) P iroxicam (Feldene) C YP 2C 9 C YP 3A4, C YP 3A5 derivatives Tenoxicam (Mobiflex) C YP 2C 9 Lornoxicam (FLE XILOR ) C YP 2C 9 E toricoxib (Arcoxia) C YP 3A4 C YP 3A5, C YP 2C 9, C YP 2D6, C YP 1A2 S elective C OX-2 inhibitors P arecoxib (Dynastat) C YP 2C 9 C YP 3A4, C YP 3A5 (C oxibs) C elecoxib (C elebrex) C YP 2C 9 C YP 2C 19 Ibuprofen (Motrin, Advil) C YP 2C 9 C YP 2C 19, C YP 2C 8 Flurbiprofen (Ocufen) C YP 2C 9 Ketoprofen (Frotek) C YP 3A4 C YP 2C 9, C YP 3A5 Fenoprofen (Nalfon, P ropionic acid derivatives C YP 2C 9 Fenortho) Vicoprofen (R eprexain, C YP 2D6 C YP 3A4 Ibudone) Naproxen (Aleve, Naprosyn) C YP 2C 9 C YP 1A2, C YP 2C 8 Anthranilic acid derivatives Mefenamic acid (P onstel) C YP 2C 9 (Fenamates) UG T1A1, UG T1A6, UG T1A9, The Non-NS AIDs Analgesic Acetaminophen (Tylenol) C YP 3A4, C YP 3A5, C YP 2D6, C YP 1A2 S ULT1A1, G S Hs P G x R eport - P ain Management Type: Opioid May Have May Have Used As Drug C lass G eneric P rimary Mechanism Involved Other Mechanisms Involved Decreased Increased Directed E fficacy Toxicity Opioid Analgesics C YP 3A4, UG T2B4, FMO3, C YP 3A5, Opium alkaloids C odeine C YP 2D6 OP R M1 E sters of morphine Diacetylmorphine (Heroin) C E S 1 C E S 2, OP R M1 Dihydrocodeine (DHC P lus, C YP 3A4 C YP 2D6, C YP 3A5 E thers of morphine P anlor) E thylmorphine (C odethyline) C YP 2D6 C YP 3A4, C YP 3A5 Hydrocodone (Hysingla, C YP 2D6 C YP 3A4, C YP 3A5, OP R M1 S emi-synthetic alkaloid Vicodin) derivatives Oxycodone (Oxycontin, C YP 3A4 C YP 3A5, C YP 2D6, C OMT R oxicodone) S ynthetic opioids Alfentanyl C YP 3A4 C YP 3A5, OP R M1 Fentanyl (Duragesic, Anilidopiperidine derivatives C YP 3A4 C YP 3A5, OP R M1 S ubsys) S ufentanil (S ufenta) C YP 3A4 C YP 3A5, OP R M1 Meperidine (Demerol) C YP 2B6 C YP 3A4, C YP 2C 19, C YP 3A5 P henylpiperidine derivatives Ketobemidone (Ketogan) C YP 2C 9 C YP 3A4, C YP 3A5 Dextropropoxyphene C YP 3A4 C YP 3A5, R enal E xcretion (Darvon) Levacetylmethadol (Orlaam) C YP 3A4 C YP 3A5 Diphenylpropylamine Loperamide (Anti-diarrhea, derivatives C YP 3A4 C YP 2C 8, C YP 3A5 Diamode) Methadone (Methadose, C YP 3A4 C YP 2B6, C YP 2D6, C YP 3A5, C OMT Diskets) Buprenorphine (Buprenex, Oripavine derivatives C YP 3A4 C YP 3A5, C YP 2C 8, UG T1A1 Butrans) Dextromethorphan Morphinan derivatives C YP 2D6 C YP 3A4, C YP 3A5 (R obitussin, Dayquil) C YP 3A4, C YP 2B6, C YP 3A5, OP R M1, Tramadol C YP 2D6 C OMT Tapentadol (Nucynta, Others C YP 2C 9 C YP 2C 19, C YP 2D6 Nucynta E R ) Tilidine (Valoron) C YP 3A4 C YP 2C 19, C YP 3A5 Anti-opioid Methylnaltrexone (R elistor) C YP 2D6 C YP 3A4, C YP 3A5 C omprehens ive P G x report for S ANDR A HE NR Y 3 / 29 P G x R eport - P ain Management Type: Drugs P rescribed for the Treatment of G out, Antirheumatic May Have May Have Used As Drug C lass G eneric P rimary Mechanism Involved Other Mechanisms Involved Decreased Increased Directed E fficacy Toxicity Drugs P rescribed for G out Uricosurics S ulfinpyrazone (Anturane) C YP 2C 9 C YP 3A4, C YP 3A5 Mitotic inhibitors C olchicine (C olcrys, Mitigare) C YP 3A4 C YP 3A5 Febuxostat (Uloric) C YP 1A2, C YP 2C 8 C YP 2C 9, UG T1A1 Allopurinol (Zyloprim, Xanthine oxidase inhibitors AOX1 R enal E xcretion, HLA-B*5801 Aloprim) Oxypurinol R enal E xcretion R ecombinant urate oxidase R asburicase (E litek) C YB5R 1, C YB5R 2, C YB5R 3, C YB5R 4 DMAR Ds Leflunomide (Arava) C YP 1A2 Tofacitinib (Xeljanz, Anti-inflammatory C YP 3A4 C YP 2C 19, C YP 3A5 J akvinus) Abbreviations: DMAR Ds, Disease-modifying antirheumatic drugs; R E , renal excretion (unchanged drug). Additional S NP s of Importance for P ain Management Level of G ene Marker G enotype Drug R esults E vidence OP R M1 rs1799971 A/A Naloxone (Narcan, E vzio) 2B P atients may have lower cortisol response Morphine (Duramorph, P ain patients may experience increased efficacy of opioids and may be less susceptible to opioid addiction, OP R M1 rs1799971 A/A 2B Infumorph P /F) and may require a decreased dose of opioids P ain patients may experience increased efficacy of opioids and may be less susceptible to opioid addiction, OP R M1 rs1799971 A/A Alfentanil 2B and may require a decreased dose of opioids Fentanyl (Duragesic, P ain patients may experience increased efficacy of opioids and may be less susceptible to opioid addiction, OP R M1 rs1799971 A/A 2B S ubsys) and may require a decreased dose of opioids P ain patients may experience increased efficacy of opioids and may be less susceptible to opioid addiction, OP R M1 rs1799971 A/A Tramadol 2B and may require a decreased dose of opioids Hydrocodone (Hysingla, P atients may have a decreased risk for experiencing side effects, including constipation, dry mouth or OP R M1 rs1799971 A/A 3 Vicodin) respiratory depression C OMT rs4680 * P aroxetine (P axil, S eroxat)