Making prescriptions personal RightMed® comprehensive test report The RightMed comprehensive test is a pharmacogenomic test that identi]es how a patient’s DNA affects their response to hundreds of medications. This report can be used to help determine safer, more effective medications and doses tailored to a patient’s unique genomic pro]le. Additional reports, including RightMed Advisor custom reports and specialty reports, are available through the provider portal at portal.oneome.com. Patient and report summary Patient name: Jane Doe Ordering provider: Sample Doctor Patient date of birth: 1972-07-08 Ordering facility: Healthcare Institution OneOme report date: 2018-05-17 Product type: Comprehensive Report type: Original Report legend Based on the genes in our panel, medications are reported according to genotype-predicted interactions described below. Major gene-drug Major genotype-drug interaction identi]ed that affects the metabolism of the medication and/or interaction indicates an elevated risk of adverse reaction or loss of e_cacy. Moderate gene-drug Moderate genotype-drug interaction identi]ed that affects the metabolism of the medication and/or interaction indicates an elevated risk of adverse reaction or loss of e_cacy. Minimal gene-drug Minimal genotype-drug interaction identi]ed that does not signi]cantly impact medication interaction metabolism or predict an elevated risk of adverse reaction or loss of e_cacy. Icon legend Some medications are reported with icons to indicate that additional information is available. Consult the RightMed Advisor for more information on speci]c clinical annotations and/or dosing guidelines provided by the Clinical Pharmacogenetics Implementation Consortium (CPIC), the Dutch Pharmacogenomics Working Group (DPWG), the Food and Drug Administration (FDA), and/or other professional guidelines. Increased exposure Total exposure to active compound(s) may be increased. Monitor for adverse effects. Decreased exposure Total exposure to active compound(s) may be decreased. Monitor for lack of therapeutic response. Di_cult to predict Total exposure to active compound(s) is di_cult to predict. Monitor patient response. Response to medication may be lowered due to genetic changes impacting mechanisms other than Reduced response exposure (e.g. receptor function). Additional testing According to FDA labeling, additional laboratory testing may be indicated. Medication has professional guidelines associated with this patient's genetic test results. Avoidance, Professional guideline dose adjustment, or heightened monitoring may be indicated. OneOme order ID: 459CE | Patient name: Jane Doe | Patient date of birth: 1972-07-08 | Report version: 4.0.0 Page 1 / 14 Lab director: Bronwyn R. Hartung, PhD | CLIA: 24D2109855 | NPI: 1669836227 | CAP: 9432670 Making prescriptions personal Personalized medication report summary This list was generated from the medications entered during the order process. Providers can ]nd more information about each medication in the Personalized medication report or in the RightMed Advisor. Note: The associated genes listed for each medication do not imply that a speci]c gene-drug interaction exists, as some genes may only be informative in nature. Medication PGx result Overview Associated gene(s) Predicted carbamazepine metabolism is normal. Genotype suggests a normal exposure to carbamazepine. Carbamazepine Negative for the presence of the HLA-B*15:02 allele. CYP3A5 (Carbatrol, Increased risk of hypersensitivity reactions related to HLA-A Major gene-drug Tegretol) HLA-A*31:01 genotype. HLA-B interaction Professional guidelines exist for the use of carbamazepine in patients with this genotype and/or phenotype. Predicted citalopram metabolism is increased. Genotype suggests a possible decrease in exposure to citalopram. CYP2C19 Citalopram GRIK4 Typical to increased expression of the SLC6A4 (Celexa) HTR2A Major gene-drug transporter. interaction SLC6A4 Professional guidelines exist for the use of citalopram in patients with this genotype and/or phenotype. Predicted phenytoin metabolism is reduced. Genotype suggests a possible increase in exposure to phenytoin. CYP2C9 Phenytoin Negative for the presence of the HLA-B*15:02 allele. HLA-A (Dilantin) Major gene-drug Increased risk of hypersensitivity reactions related to HLA-B interaction HLA-A*31:01 genotype. Professional guidelines exist for the use of phenytoin in patients with this genotype and/or phenotype. Predicted bupropion metabolism is normal. Genotype suggests a normal exposure to bupropion. Bupropion Allele(s) have demonstrated substrate-speci]c function CYP2B6 (Wellbutrin) Minimal gene-drug with bupropion, therefore cytochrome P450 phenotype interaction may differ from bupropion-speci]c phenotype. Genotype suggests a normal exposure to ^uoxetine. CYP2C9 Fluoxetine Typical to increased expression of the SLC6A4 CYP2D6 (Prozac, Sarafem) Minimal gene-drug transporter. SLC6A4 interaction OneOme order ID: 459CE | Patient name: Jane Doe | Patient date of birth: 1972-07-08 | Report version: 4.0.0 Page 2 / 14 Lab director: Bronwyn R. Hartung, PhD | CLIA: 24D2109855 | NPI: 1669836227 | CAP: 9432670 Making prescriptions personal Genotype-derived recommendations for medications Major gene-drug interaction Analgesic/Anesthesiology Immunosuppression Clobazam 1 Psychiatry Morphine 12, 17, 23, 24, 96, 102, Azathioprine 1, 2, 106, 161, 162 Fosphenytoin 1, 2, 6, 18, 26, Amitriptyline 1, 2, 56, 215 164, 180, 181, 194 114, 135 Citalopram 1, 2, 8, 15, 41, 55, Infectious disease Phenytoin 1, 2, 6, 18, 26, 114, 58, 59, 60, 64, 84, 85, 97, 100, 103, 116, 120, Cardiovascular 135 124, 132, 142, 148, 151, 219 Atovaquone/Proguanil 1 Clomipramine 1, 2, 56 Labetalol 21 Voriconazole 1, 2 Oncology Diazepam 1, 66 Doxepin 1, 2, 56 Gastroenterology Mercaptopurine 1, 2, 161, 162 Neurology Escitalopram 1, 2, 8, 15, 41, Thioguanine 1, 2, 161, 162 Esomeprazole 1, 2 55, 59, 60, 64, 97, 103, 116, 124, 132, 151, 219 Brivaracetam 1 Lansoprazole 1, 2, 130 Imipramine 1, 2, 56, 212 Carbamazepine 1, 5, 6, 27, 28, 1, 2, 63, 221 Omeprazole 1, 2 61, 101, 114, 121, 122, 134, 145, 149, 153, 175, Risperidone Pantoprazole 1 228 Trimipramine 1, 2, 56, 91 Moderate gene-drug interaction Analgesic/Anesthesiology Guanabenz 30 Infectious disease Psychiatry Carisoprodol 1, 50 Irbesartan 1 Nel]navir 1 Asenapine 1 Fentanyl 1, 45, 53, 67, 89, 98, 195, Losartan 1 Peginterferon alfa-2a- Duloxetine 1 220, 226, 232, 233, 234 containing regimens 1, Nicotine 31, 36, 75, 126 Ketamine 1, 104, 105, 158, 222 125 Dietary Olanzapine 1, 2, 99, 111 Peginterferon alfa-2b- Selegiline 57, 78, 170 Caffeine 1 containing regimens 1, Anti-in^ammatory Sertraline 1, 2, 40, 42, 55, 107, 125 128, 131, 136, 160, 166, 203, 211 Celecoxib 1 Endocrinology Diclofenac 1 Neurology 1, 179 Flurbiprofen 1, 191 Chlorpropamide Rheumatology Glimepiride 1 Eslicarbazepine 1, 6, 79, 149 Meloxicam 1 Lesinurad 1 1, 88, 92, 198 Frovatriptan 1 Piroxicam 1 Glipizide Glyburide 1 Lamotrigine 1, 6, 114, 149 Sleep medicine Anticoagulant/Antiplatelet Nateglinide 1 Oxcarbazepine 1, 6, 149 Tolbutamide 2 Rasagiline 1 Ramelteon 1 Clopidogrel 1, 172, 173 Selegiline 57, 78, 170 Warfarin 1, 20, 73, 74 Gastroenterology Oncology Cardiovascular Dexlansoprazole 1 Dronabinol 1 Bortezomib 1 Azilsartan 1 Rabeprazole 1 Fluvastatin 1 Minimal gene-drug interaction Allergy Analgesic/Anesthesiology Hydrocodone 1, 32, 33 Midazolam 1, 201 Loratadine 227 Alfentanil 1, 47, 138, 235 Methadone 1 Oxycodone 1, 32, 33 Buprenorphine 1 Tramadol 1, 2, 32, 33, 110, 187, 190, Codeine 1, 2, 9, 17, 32, 33, 182, 196 202 Cyclobenzaprine 1, 214 OneOme order ID: 459CE | Patient name: Jane Doe | Patient date of birth: 1972-07-08 | Report version: 4.0.0 Page 3 / 14 Lab director: Bronwyn R. Hartung, PhD | CLIA: 24D2109855 | NPI: 1669836227 | CAP: 9432670 Making prescriptions personal Minimal gene-drug interaction (cont.) Anticoagulant/Antiplatelet Immunosuppression Docetaxel 1 Lurasidone 1 Apixaban 1 Cyclosporine 1 Enzalutamide 1 Mirtazapine 1, 2, 90, 108, 189, 197 Cilostazol 1, 201 Everolimus 1, 201 Erlotinib 1, 71 Nefazodone 1, 165, 209 Ticagrelor 1 Sirolimus 1 Etoposide 1, 237 Nortriptyline 1, 2, 56, 140, 207 Tacrolimus 1, 14, 201 Everolimus 1, 201 Paroxetine 1, 2, 55, 68, 83, 127, 152, 167, Cardiovascular Exemestane 1 186, 199, 224 Infectious disease Fluorouracil 1, 2, 19 Perphenazine 1, 139 Aliskiren 1 Ge]tinib 1 Pimozide 1, 205 Amiodarone 1 Abacavir 1, 2, 43, 112, 113, 117, 118, 168, 192 Ifosfamide 1, 25 Protriptyline 1 Amlodipine 1 Atazanavir 46, 72 Imatinib 1 Quetiapine 1, 201 Atorvastatin 1 Clarithromycin 1, 201 Irinotecan 1, 48, 93 Thioridazine 1 Carvedilol 1 Darunavir 1 Ixabepilone 1 Trazodone 1 Clonidine 1 Delavirdine 1 Lapatinib 1, 171 Venlafaxine 1, 2, 210 Diltiazem 1, 201 Efavirenz 1 Methotrexate 1, 154, 157, 200, 231 Vilazodone 1 Disopyramide 1 Erythromycin 201 Nilotinib 1, 4 Vortioxetine 1 Dofetilide 1 Fosamprenavir 1 Paclitaxel 1 Dronedarone 1, 201 Indinavir 1, 201 Pazopanib 1 Pulmonary Eplerenone 1 Isavuconazole 1 Ponatinib 1 Felodipine 1 Itraconazole 1 Dextromethorphan 1 Regorafenib 1 Flecainide 1, 2 Ivermectin 1, 230 Indacaterol 1, 76 Ruxolitinib 1 Lidocaine 37, 141 Ketoconazole 1 Salmeterol 1 Sorafenib 1 Lomitapide 1 Maraviroc 1 Sildena]l 1 Sunitinib 1 Lovastatin 1 Me^oquine 1 Tadala]l 1 Tamoxifen 1, 2, 49 Metoprolol 1, 2 Nevirapine 1 Temsirolimus 1 Nifedipine 1, 201 Quinidine 1 Rheumatology Teniposide 95, 163 Nisoldipine 1, 201 Quinine 1, 201 Trabectedin 1 Allopurinol 38, 54, 62, 87, 169 Pravastatin 1, 133 Ritonavir 1 Vemurafenib 1 Cevimeline 1