While our DNA does not change over time, clinical guidelines established by the scientific community are continuously refined and expanded to cover a growing number of medications. In order to provide a lifetime of Pillcheck value to our customers, we periodically update reports, incorporating the most up-to-date information and medications.
On page 7 of the Pillcheck report you can find a summary of diplotypes and genotypes. At the bottom of the table, separated by pipes from other information, you will also find the version code of the reference database: GYIAUG212017. The last number in the same pipe string corresponds to the number of reportable medications: 139. The following changes were introduced by the August 2017 update:
- Based on recent recommendation from the Clinical Pharmacogenetics Implementation Consortium (CPIC), the *1/*17 diplotype of the CYP2C19 enzyme has been reclassified from Ultrafast to Rapid Metabolizer and the *17/*17 diplotype was re-categorized as Ultrarapid. Some recommendations and flags for medications metabolized by CYP2C19 have been updated, especially for voriconazole, which now has specific guidelines for children and adults. Flags affecting citalopram, escitalopram, sertraline, diazepam, and proton pump inhibitors were also updated for Rapid Metabolizers carrying the *1/*17 diplotype.
- We added recommendations for apixaban (Eliquis), and rivaroxaban (Xarelto) based on known drug-drug interactions involving the CYP3A4 enzyme to help healthcare providers determine whether these medications can be appropriate alternatives for poor metabolizers of warfarin. Even though there are no specific CPIC or FDA guidelines for factor Xa inhibitors, it is known that co-administration of CYP3A4 substrates increases exposure to these medications and can significantly increase the risk of bleeding. Following the same logic, we added warnings for those with poor and intermediate CYP3A4 metabolic activity.
- Similarly, we expanded the list of new HepC medications that can be considered for patients who are expected to be poor responders to interferon treatment (atazanavir; dolutegravir; elbasvir and grazoprevir; ledipasvir and sofosbuvir; ombitasvir, paritaprevir and ritonavir; sofosbuvir; sofosbuvir and velpatasvir). This information might be pertinent to patients beginning treatment for Hep C when a step therapy option is being considered.
We advise our customers to access their updated reports in the Portal, and share them with attending pharmacist and physicians.
If you have any questions related to the updated Pillcheck report, please send a note to firstname.lastname@example.org. Your feedback is valuable to us and it helps us to improve the Pillcheck Medication Optimization Service.