Medication
Check

powered by My Genomic Health

A quick reference guide
for healthcare professionals

Genetic testing helps identify changes in certain genes that may affect how the body processes, transports, or responds to specific medicines.

If recommendations in the Medication Check propose using alternative medicines not primarily metabolised by a specific enzyme or consider additional information (e.g. concomitant medicines inducing or inhibiting enzymes, statin-associated musculoskeletal side effects, half-life), follow those instructions:

  1.  Select the indicated medicine category
  2.  Explore the table – medicines are grouped by subcategory with decision-relevant information
  3.  Apply filters to focus on relevant information
  4.  Identify alternative medicines and adjust treatment plans

Identify alternative medicines

Identify alternative medicines not primarily metabolised by a specific enzyme. By selecting the affected gene from your patient’s Medication Check report in the drop-down menu, medicines affected by this gene are greyed out.

SSRI
  • Citalopram
    • CYP2C19
  • Escitalopram
    • CYP2C19
  • Fluoxetine
    • CYP2D6
  • Fluvoxamine
    • CYP2D6
  • Paroxetine
    • CYP2D6
  • Sertraline
    • CYP2C19
    • CYP2B6
SNRI
  • Duloxetine
    • No evidence
  • Venlafaxine
    • CYP2D6
TCA
  • Amitriptyline
    • CYP2C19
    • CYP2D6
  • Clomipramine
    • CYP2C19
    • CYP2D6
  • Dosulepin
    • No evidence
  • Doxepin
    • CYP2C19
    • CYP2D6
  • Imipramine
    • CYP2C19
    • CYP2D6
  • Lofepramine
    • No evidence
  • Nortriptyline
    • CYP2D6
  • Trimipramine
    • CYP2C19
    • CYP2D6
TCA like
  • Mianserin
    • No evidence
  • Trazodone
    • No evidence
MAOIs
  • Isocarboxazid
    • No evidence
  • Moclobemide
    • CYP2C19
  • Phenelzine
    • No evidence
  • Tranylcypromine
    • No evidence
Others
  • Agomelatine
    • No evidence
  • Mirtazapine
    • CYP2D6
  • Reboxetine
    • No evidence
  • Vortioxetine
    • CYP2D6
Augmentation
  • Aripiprazole
    • CYP2D6
  • Bupropion
    • No evidence
  • Lamotrigine
    • No evidence
  • Lithium
    • No evidence
  • Mirtazapine
    • CYP2D6
  • Olanzapine
    • No evidence
  • Risperidone
    • CYP2D6
  • Quetiapine
    • CYP3A4
Gene
[...]
Dose
[...] mg
Frequency
[...] x day
Half-life
~ [...] h
Insufficient evidence
No clinically significant pharmacogenetic effect known. Continue prescribing per usual practice or clinical guidelines.


Before switching, combining, or augmenting antidepressants, ensure the current treatment has been taken at an adequate dose and duration with good adherence. These strategies should only be considered after careful assessment of response, side effects, and patient preferences, in line with treatment guidelines.

Sources: Table based on CPIC guidelines (TCA/SSRI/SNRI), Managing treatment-resistant depression (2019), UK (NICE CG91/NG222) and German (S3/NVL) guidelines for depression. Selected content only.
Access date:
07.07.2025

Identify alternative medicines not primarily metabolised by a specific enzyme. By selecting the affected gene from your patient’s Medication Check report in the drop-down menu, medicines affected by this gene are greyed out. Half-life can be considered additionally.

Opioid analgesics
  • Codeine
    • CYP2D6
    • ~ 3 h
  • Hydrocodone
    • CYP2D6
    • ~ 4 h
  • Hydromorphone
    • No evidence
    • ~ 2-3 h
  • Morphine
    • No evidence
    • ~ 2-4 h
  • Oxycodone
    • CYP2D6
    • ~ 3-6 h
  • Tramadol
    • CYP2D6
    • ~ 6 h
  • Oxymorphone
    • No evidence
    • ~ 2-15 h (oral, IV)
  • Fentanyl
    • No evidence
    • ~ 3-12 h (IV)
    • ~ 20-27 h (transd.)
  • Buprenorphine
    • No evidence
    • ~ 20-25 h (subling.)
    • ~ 26-45 h (transd.)
  • Methadone
    • No evidence
    • ~ 8-59 h (variable)
Non-Opioid analgesics
  • Aspirin
    • No evidence
    • ~ 15-20 min
  • Celecoxib
    • CYP2C9
    • ~ 6-16 h
  • Diclofenac
    • No evidence
    • ~ 1-2 h
  • Diflunisal
    • No evidence
    • ~ 5-20 h
  • Etodolac
    • No evidence
    • ~ 6-7 h
  • Fenoprofen
    • No evidence
    • ~ 2 h
  • Flurbiprofen
    • CYP2C9
    • ~ 2-6 h
  • Ibuprofen
    • CYP2C9
    • ~ 2-4 h
  • Indomethacin
    • No evidence
    • ~ 4-6 h
  • Ketoprofen
    • No evidence
    • ~ 2-4 h
  • Ketorolac
    • No evidence
    • ~ 2-9 h
  • Lornoxicam
    • CYP2C9
    • ~ 3-5 h
  • Meclofenamate
    • No evidence
    • ~ 2-3 h
  • Meloxicam
    • CYP2C9
    • ~ 15-20 h
  • Nabumetone
    • No evidence
    • ~ 22-30 h
  • Naproxen
    • No evidence
    • ~ 11-15 h
  • Rofecoxib
    • No evidence
    • ~ 16-18 h
  • Sulindac
    • No evidence
    • ~ 11-16 h
  • Tenoxicam
    • CYP2C9
    • ~ 60 h
  • Tolmetin
    • No evidence
    • ~ 1-2 h (fast)
    • ~ 5 h (slow)
  • Valdecoxib
    • No evidence
    • ~ 8 h
  • Paracetamol
    • No evidence
    • ~ 2-3 h
    • ~ 4-8 h (overdose)
  • Piroxicam
    • CYP2C9
    • ~ 45-50 h
Gene
[...]
Dose
[...] mg
Frequency
[...] x day
Half-life
~ [...] h
Insufficient evidence
No clinically significant pharmacogenetic effect known. Continue prescribing per usual practice or clinical guidelines.


Before switching analgesics, assess key risk factors such as renal or hepatic impairment, older age, polypharmacy, substance misuse history, and pain type. Ensure the current treatment was used at an adequate dose and duration with good adherence. Switching should follow a thorough evaluation of effectiveness, side effects, and patient-specific risks, in line with treatment guidelines.

Sources: Table based on CPIC guidelines (Codeine-CYP2D6/NSAIDs-CYP2C9), UK (NICE NG180) and German (NOPA 001-025) guidelines for Perioperative Care in Adults and SMPCs. Selected content only.
Access date: 
10.07.2025

Identify alternative medicines not primarily metabolised by a specific enzyme. By selecting the affected gene from your patient’s Medication Check report in the drop-down menu, medicines affected by this gene are greyed out.

First Generation Antipsychotics (FGA)
  • Chlorpromazine
    • No evidence
  • Flupentixol
    • No evidence
  • Fluphenazine
    • No evidence
  • Haloperidol
    • CYP2D6
  • Levomepromazine
    • No evidence
  • Pericyazine
    • No evidence
  • Perphenazine
    • CYP2D6
  • Pimozide
    • CYP2D6
  • Sulpiride
    • No evidence
  • Thioridazine
    • CYP2D6
  • Trifluoperazine
    • No evidence
  • Zuclopenthixol
    • CYP2D6
Second Generation Antipsychotics (SGA)
  • Amisulpride
    • No evidence
  • Aripiprazole
    • CYP2D6
  • Brexpiprazole
    • CYP2D6
  • Cariprazine
    • No evidence
  • Clozapine
    • No evidence
  • Iloperidone
    • No evidence
  • Lurasidone
    • No evidence
  • Molindone
    • No evidence
  • Olanzapine
    • No evidence
  • Paliperidone
    • No evidence
  • Quetiapine
    • CYP3A
  • Risperidone
    • CYP2D6
  • Sertindole
    • No evidence
  • Ziprasidone
    • No evidence
Depot Injections
  • Aripiprazole
    • CYP2D6
  • Flupentixol
    • No evidence
  • Fluphenazine
    • No evidence
  • Haloperidol
    • CYP2D6
  • Paliperidone
    • No evidence
  • Pipotiazine
    • No evidence
  • Risperidone
    • CYP2D6
  • Zuclopenthixol
    • CYP2D6
Gene
[...]
Dose
[...] mg
Frequency
[...] x day
Half-life
~ [...] h
Insufficient evidence
No clinically significant pharmacogenetic effect known. Continue prescribing per usual practice or clinical guidelines.


Before switching ensure the current treatment has been taken at an adequate dose and duration with good adherence. These strategies should only be considered after careful assessment of response, side effects, and patient preferences, in line with treatment guidelines.

Sources: Table based on DPWG guidelines (CYP2D6), Maudsley Prescribing Guidelines (2018), drug labels and UK (NICE CG178) and German (S3/NVL) guidelines for schizophrenia
Access date:
07.07.2025

If you encountered concomitant use of inhibitors or inducers in the recommendation, you may select the affected enzyme and strength in the dropdown menu to identify relevant concomitant medicines. Other medicines are greyed out for better visualisation.

Strong Inhibitor
  • Boceprevir
    • CYP3A
  • Bupropion
    • CYP2D6
  • Ceritinib
    • CYP3A
  • Cobicistat
    • CYP3A
  • Clarithromycin
    • CYP3A
  • Conivaptan
    • CYP3A
  • Delaviridine
    • CYP3A
  • Fluoxetine
    • CYP2D6
  • Idelalisib
    • CYP3A
  • Indinavir
    • CYP3A
  • Itraconazole
    • CYP3A
  • Ketoconazole
    • CYP3A
  • Lopinavir
    • CYP3A
  • Mibefradil
    • CYP3A
  • Nefazodone
    • CYP3A
  • Nelfinavir
    • CYP3A
  • Paroxetine
    • CYP2D6
  • Perhexiline
    • CYP2D6
  • Posaconazole
    • CYP3A
  • Quinidine
    • CYP2D6
  • Ribociclib
    • CYP3A
  • Ritonavir
    • CYP3A
  • Saquinavir
    • CYP3A
  • Telaprevir
    • CYP3A
  • Telithromycin
    • CYP3A
  • Tipranavir
    • CYP3A
  • Tucatinib
    • CYP3A
  • Voriconazole
    • CYP3A
Moderate Inhibitor
  • Abiraterone
    • CYP2D6
  • Aprepitant
    • CYP3A
  • Atazanavir
    • CYP3A
  • Cinacalcet
    • CYP2D6
  • Ciprofloxacin
    • CYP3A
  • Clobazam
    • CYP2D6
  • Crizotinib
    • CYP3A
  • Darunavir
    • CYP3A
  • Diltiazem
    • CYP3A
  • Dronedarone
    • CYP2D6
  • Doxepin
    • CYP2D6
  • Duloxetine
    • CYP2D6
  • Erythromycin
    • CYP3A
  • Fluconazole
    • CYP3A
  • Fosamprenavir
    • CYP3A
  • Grapefruit
    • CYP3A
  • Halofantrine
    • CYP2D6
  • Imatinib
    • CYP3A
  • Letermovir
    • CYP3A
  • Lorcaserin
    • CYP2D6
  • Mirabegron
    • CYP2D6
  • Moclobemide
    • CYP2D6
  • Netupitant
    • CYP3A
  • Osamprenavir
    • CYP3A
  • Rolapitant
    • CYP2D6
  • Terbinafine
    • CYP2D6
  • Verapamil
    • CYP3A
Weak Inhibitor
  • Amiodarone
    • CYP2D6
  • Amlodipine
    • CYP3A
  • Atomoxetine
    • CYP3A
  • Celecoxib
    • CYP2D6
  • Cilostazole
    • CYP3A
  • Cimetidine
    • CYP2D6
  • Cimetidine
    • CYP3A
  • Citalopram
    • CYP2D6
  • Clomipramine
    • CYP2D6
  • Entrectinib
    • CYP3A
  • Escitalopram
    • CYP3A
  • Esomeprazole
    • CYP3A
  • Fluvoxamine
    • CYP3A
  • Goldenseal
    • CYP3A
  • Isoniazid
    • CYP3A
  • Ivacaftor
    • CYP3A
  • Lesinurad
    • CYP3A
  • Mifepristone
    • CYP3A
  • Omeprazole
    • CYP3A
  • Quercetin
    • CYP3A
  • Ranitidine
    • CYP3A
  • Ranolazine
    • CYP3A
  • Ritonavir
    • CYP2D6
  • Rucaparib
    • CYP3A
  • Sertraline
    • CYP2D6
  • Simeprevir
    • CYP3A
  • Vemurafenib
    • CYP2D6
Strong Inducer
  • Carbamazepine
    • CYP3A
  • Enzalutamide
    • CYP3A
  • Hypericum
    • CYP3A
    (St. John´s wort)
  • Rifampicin
    • CYP3A
  • Phenobarbital
    • CYP3A
  • Phenytoin
    • CYP3A
  • Rifabutine
    • CYP3A
Gene
[...]
Dose
[...] mg
Frequency
[...] x day
Half-life
~ [...] h
Insufficient evidence
No clinically significant pharmacogenetic effect known. Continue prescribing per usual practice or clinical guidelines.


Before switching ensure the current treatment has been taken at an adequate dose and duration with good adherence. These strategies should only be considered after careful assessment of response, side effects, and patient preferences, in line with treatment guidelines.

Sources: Table based on DPWG guidelines (CYP2D6), The Flockhart Cytochrome P450 Drug-Drug Interaction (2021). Selected content only.
Access date:
 07.07.2025

This table is an overview of all available proton pump inhibitors. Use the recommendation from your patient’s Medication Check report to select proposed dosing recommendations by medicine.

Proton pump inhibitor doses for severe oesophagitis (2019) [CG184]
Proton pump inhibitor doses for H pylori eradication therapy* (2019) [CG184]
PPI
  • Dexlansoprazole
    • CYP2C19
  • Esomeprazole
    • No evidence
  • Lansoprazole
    • CYP2C19
  • Omeprazole
    • CYP2C19
  • Pantoprazole
    • CYP2C19
  • Rabeprazole
    • CYP2C19
Standard dose
  • NA
  • 40 mg
    • 40 mg
    • 1 x day
  • 30 mg
    • 30 mg
    • 1 x day
  • 40 mg
    • 40 mg
    • 1 x day
  • 40 mg
    • 40 mg
    • 1 x day
  • 20 mg
    • 20 mg
    • 1 x day
Low dose (as required - PRN)
  • NA
  • 20 mg
    • 20 mg
    • 1 x day
  • 15 mg
    • 15 mg
    • 1 x day
  • 20 mg
    • 20 mg
    • 1 x day
  • 20 mg
    • 20 mg
    • 1 x day
  • 10 mg
    • 10 mg
    • 1 x day
High/double dose
  • NA
  • 40 mg
    • 40 mg
    • 2 x day
  • 30 mg
    • 30 mg
    • 2 x day
  • 40 mg
    • 40 mg
    • 2 x day
  • 40 mg
    • 40 mg
    • 2 x day
    Off-label dose for GORD disease
  • 20 mg
    • 20 mg
    • 2 x day
    Off-label dose for GORD disease
NA
  • NA
  • 20 mg
    • 20 mg
  • 30 mg
    • 30 mg
  • 20-40 mg
    • 20-40 mg
  • 40 mg
    • 40 mg
  • 20 mg
    • 20 mg
Gene
[...]
Dose
[...] mg
Frequency
[...] x day
Half-life
~ [...] h
Insufficient evidence
No clinically significant pharmacogenetic effect known. Continue prescribing per usual practice or clinical guidelines.

* twice daily along with antibiotics for 7 days (see recommendations 1.9.4–1.9.6 in CG184)


Before switching ensure the current treatment has been taken at an adequate dose and duration with good adherence. These strategies should only be considered after careful assessment of response, side effects, and patient preferences, in line with treatment guidelines.

Source: Table based on CPIC guideline (CYP2C19-PPIs) and NICE CG184 Updated 2019; Appendix A: Dosage information on proton pump inhibitors. Selected content only.
Access date:
07.07.2025

Identify alternative medicines by selecting the affected gene function from your patient’s Medication Check report, choose the medicine and dose by the desired statin intensity level, and filter by acceptable statin-associated musculoskeletal symptoms (SAMS risk) as myopathy or rhabdomyolysis.

Statin intensity a
High
  • Rosuvastatin b
    20 mg
    • SLCO1B1
    • ABCG2
    • Low d SAMs risks
    • 20 mg
  • Atorvastatin
    40-80 mg
    • SLCO1B1
    • High SAMs risks
    • 40-80 mg
  • Rosuvastatin bc
    40 mg
    • SLCO1B1
    • ABCG2
    • High SAMs risks
    • 40 mg
Moderate
  • Atorvastatin
    10-20 mg
    • SLCO1B1
    • Low d SAMs risks
    • 10-20 mg
  • Pitavastatin c
    1 mg
    • SLCO1B1
    • Low d SAMs risks
    • 1 mg
  • Pravastatin​
    40 mg
    • SLCO1B1
    • Low d SAMs risks
    • 40 mg
  • Rosuvastatin b
    5-10 mg
    • SLCO1B1
    • ABCG2
    • Low d SAMs risks
    • 5-10 mg
  • Fluvastatin b
    80 mg
    • CYP2C9
    • SLCO1B1
    • Moderate SAMs risks
    • 80 mg
  • Pravastatin c
    80 mg
    • SLCO1B1
    • Moderate SAMs risks
    • 80 mg
  • Lovastatin c
    40-80mg
    • SLCO1B1
    • High SAMs risks
    • 40-80mg
  • Pitavastatin c
    2-4 mg
    • SLCO1B1
    • High SAMs risks
    • 2-4 mg
  • Simvastatin
    20-40 mg
    • SLCO1B1
    • High SAMs risks
    • 20-40 mg
Low
  • Fluvastatin bc ​
    20-40 mg
    • CYP2C9
    • SLCO1B1
    • Low d SAMs risks
    • 20-40 mg
  • Pravastatin c
    10-20 mg
    • SLCO1B1
    • Low d SAMs risks
    • 10-20 mg
  • Lovastatin c
    20 mg
    • SLCO1B1
    • High SAMs risks
    • 20 mg
  • Simvastatin​
    10 mg
    • SLCO1B1
    • High SAMs risks
    • 10 mg
Gene
[...]
Dose
[...] mg
Frequency
[...] x day
Half-life
~ [...] h
Insufficient evidence
No clinically significant pharmacogenetic effect known. Continue prescribing per usual practice or clinical guidelines.

SAMS: Statin-associated musculoskeletal symptoms ​
a Statin intensity as recommended by current American College of Cardiology/American Heart Association guideline​
b See recommendations for rosuvastatin-ABCG2 and for fluvastatin-CYP2C9​
c Dose recommendations are based solely on pharmacokinetic data​
d Prescribe stated starting dose​


Always consider add-on or other lipid-lowering medicines. These include ezetimibe, bempedoic acid, PCSK9 inhibitors and inclisiran. Follow the valid and up-to-date disease treatment guidelines.

Source: Table based on CPIC guidelines (SLCO1B1, ABCG2, and CYP2C9)
Access date:
 07.07.2025

Identify alternative medicines by selecting the affected gene function from your patient’s Medication Check report, choose the medicine and dose by the desired statin intensity level, and filter by acceptable statin-associated musculoskeletal symptoms (SAMS risk) as myopathy or rhabdomyolysis.

Statin intensity a
High
  • Rosuvastatin b
    20 mg
    • SLCO1B1
    • ABCG2
    • Low d SAMs risks
    • 20 mg
  • Atorvastatin
    40 mg
    • SLCO1B1
    • Moderate SAMs risks
    • 40 mg
  • Rosuvastatin bc
    40 mg
    • SLCO1B1
    • ABCG2
    • Moderate SAMs risks
    • 40 mg
  • Atorvastatin
    80 mg
    • SLCO1B1
    • High SAMs risks
    • 80 mg
Moderate
  • Atorvastatin
    10-20 mg
    • SLCO1B1
    • Low d SAMs risks
    • 10-20 mg
  • Pitavastatin c
    1 mg
    • SLCO1B1
    • Low d SAMs risks
    • 1 mg
  • Pravastatin​
    40 mg
    • SLCO1B1
    • Low d SAMs risks
    • 40 mg
  • Rosuvastatin b
    5-10 mg
    • SLCO1B1
    • ABCG2
    • Low d SAMs risks
    • 5-10 mg
  • Fluvastatin b
    80 mg
    • CYP2C9
    • SLCO1B1
    • Moderate SAMs risks
    • 80 mg
  • Pitavastatin c
    2 mg
    • SLCO1B1
    • Moderate SAMs risks
    • 2 mg
  • Pravastatin
    80 mg
    • SLCO1B1
    • Moderate SAMs risks
    • 80 mg
  • Lovastatin
    40-80 mg
    • SLCO1B1
    • High SAMs risks
    • 40-80 mg
  • Pitavastatin
    4 mg
    • SLCO1B1
    • High SAMs risks
    • 4 mg
  • Simvastatin
    20-40 mg
    • SLCO1B1
    • High SAMs risks
    • 20-40 mg
Low
  • Fluvastatin bc
    20-40 mg
    • CYP2C9
    • SLCO1B1
    • Low d SAMs risks
    • 20-40 mg
  • Pravastatin c
    10-20 mg
    • SLCO1B1
    • Low d SAMs risks
    • 10-20 mg
  • Lovastatin c
    20 mg
    • SLCO1B1
    • Moderate SAMs risks
    • 20 mg
  • Simvastatin​
    10 mg
    • SLCO1B1
    • Moderate SAMs risks
    • 10 mg
Gene
[...]
Dose
[...] mg
Frequency
[...] x day
Half-life
~ [...] h
Insufficient evidence
No clinically significant pharmacogenetic effect known. Continue prescribing per usual practice or clinical guidelines.

SAMS: Statin-associated musculoskeletal symptoms 
a
 Statin intensity as recommended by current American College of Cardiology/American Heart Association guideline​
b
 See recommendations for rosuvastatin-ABCG2 and for fluvastatin-CYP2C9
c
 Dose recommendations are based solely on pharmacokinetic data
d Prescribe stated starting dose​


Always consider add-on or other lipid-lowering medicines. These include ezetimibe, bempedoic acid, PCSK9 inhibitors and inclisiran. Follow the valid and up-to-date disease treatment guidelines.

Source:
Table based on CPIC guidelines (SLCO1B1, ABCG2, and CYP2C9)
Access date: 
07.07.2025

Medicines covered by Bupa Medication Check

Check if an active substance has known pharmacogenetic effects before prescribing.

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Disclaimer: The material provided is for educational purposes only and features selected content from various public sources, including CPIC, UK NICE, and other medical guidelines. It is intended to support healthcare professionals in understanding the pharmacogenetic information included in the Bupa Medication Check and should not be considered clinical guidance or medical advice. All clinical decisions remain the sole responsibility of the treating physician. The physician must consider the full clinical context, patient history and other diagnostic information when making treatment decisions. The information provided is based on generally accepted scientific knowledge and guidelines available at the time of creation and may evolve or change as new evidence emerges.

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