Pillcheck Update – January 2023
To provide you with a lifetime of value from your Pillcheck, we’ve added a new gene, more medications, and the latest pharmacogenetics (PGx) guidelines. The content of each report depends on when the sample was analyzed.
New gene and related drugs reported
NAT2 gene encodes the N-acetyltransferase enzyme responsible for the metabolism of amifampridine, isoniazid, hydralazine, procainamide and other chemicals. People with significantly reduced activity of the NAT2 enzyme (slow metabolizers) have a higher risk of side effects to these medications. Please note this gene is only included for samples processed after April 2022.
More medications
Up to 9 medications have been added across multiple treatment areas.
| Generic | Brand Name | Treatment Area | Condition |
| Abrocitinib | CIBINQO | Dermatology | Atopic dermatitis (moderate-to-severe eczema) |
| Amifampridine |
RUZURGI FIRDAPSE |
Musculoskeletal | Lambert-Eaton myasthenic syndrome (LEMS) |
| Hydralazine | Apresoline | Cardiovascular | Congestive heart failure, hypertension (high blood pressure) |
| Imatinib | Imatinib | Oncology | Cancer, leukemia |
| Isoniazid | RIFATER | Antibacterial | Tuberculosis |
| Mavacamten | CAMZYOS | Cardiovascular | New drug for the treatment of obstructive hypertrophic cardiomyopathy (HCM) |
| Procainamide | Procainamide | Cardiovascular | Cardiac arrhythmias |
| Remdesivir | VEKLURY |
Antiviral
|
COVID-19
Patients with significantly reduced CYP2C19 metabolism have a higher risk of drug-induced toxicity and hepatitis. |
| Toluidine Blue | Toluidine blue |
Hematology, Oncology
|
Dye used to identify cancer cells, mainly in oral pathology.
People with G6PD deficiency may develop hemolytic anemia as a reaction to this chemical.
|
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Clinical recommendations updated
- New CPIC guidelines being published for antidepressants, including SSRIs and SNRIs, refine dosage recommendations for different metabolizer statuses. Therefore, the alert type (colour) may have changed in your results.
- For sertraline, updated recommendations are based on a combination of two liver enzymes (CYP2C19 and CYP2B6).
- Similarly, recommendations for venlafaxine are now based on two liver enzymes (CYP2C19 and CYP2D6).
- Quetiapine, cyclosporine, temsirolimus, sirolimus and tacrolimus have recommendations based on both CYP3A4 and CYP3A5.
- Recommendations for diazepam are now based on a combination of three enzymes (CYP2C19, CYP3A4 and CYP3A5).
FAQ
- Look up your current medications in the Results tab in your account. Share your results with your healthcare provider.
- If you are experiencing issues with your medications, discuss the Pillcheck Report with your pharmacist or physician.
- Contact us if you have any additional questions or concerns. We can arrange a consultation with a pharmacist to review your medications if you would like us to.
While your DNA does not change, scientific knowledge about the impact of genetics on medication response grows over time. In some cases, the pharmacogenetic guidelines for certain drugs and genetic profiles may be updated by health and regulatory agencies. Pillcheck is dedicated to providing you with the latest evidence-based clinical guidelines established by these organizations. See our Product Information to learn more.
The Pillcheck service includes one Pharmacist Opinion Letter written when your initial Pillcheck test results are generated. If your health situation changes, contact us at support@pillcheck.ca or 1-877-409-3629 to find out if a new pharmacist review and opinion letter would be helpful to your health concerns. Ordering a new medication review and Pharmacist Opinion Letter costs $75 + tax.
New biomarker and related drugs added
The NAT2 gene encodes the N-acetyltransferase enzyme responsible for the activation and/or deactivation of many chemicals and drugs with aromatic amine and hydrazine groups. Variations in the gene define fast (considered normal), intermediate and slow acetylators. Slow acetylators are more susceptible to side effects for amifampridine, isoniazid, hydralazine, procainamide and other chemicals.
New drugs added based on Health Canada, FDA and EMA drug labels
| Generic | Brand Name | Treatment Area | Condition |
| Abrocitinib | CIBINQO | Dermatology | Janus kinase inhibitor medication used for the treatment of atopic dermatitis (moderate-to-severe eczema) |
| Amifampridine |
RUZURGI FIRDAPSE |
Musculoskeletal | Lambert-Eaton myasthenic syndrome (LEMS) |
| Hydralazine | Apresoline | Cardiovascular | Congestive heart failure, hypertension (high blood pressure) |
| Imatinib | Imatinib | Oncology | Cancer, leukemia |
| Isoniazid | RIFATER | Antibacterial | Tuberculosis |
| Mavacamten | CAMZYOS | Cardiovascular |
First-in-class drug for obstructive hypertrophic cardiomyopathy (HCM)
|
| Procainamide | Procainamide | Cardiovascular | Cardiac arrhythmias |
| Remdesivir | VEKLURY |
Antiviral
|
COVID-19
Patients with significantly reduced CYP2C19 metabolism have a higher risk of drug-induced toxicity and hepatitis. |
| Toluidine Blue | Toluidine blue |
Hematology, Oncology
|
Dye used to identify cancer cells, mainly in oral pathology. People with G6PD deficiency may develop hemolytic anemia as a reaction to this chemical. |
Revised recommendations
- New CPIC guidelines being published for SSRIs and SNRIs refine dosage recommendations for different metabolizer statuses for CYP2C19 and CYP2D6 enzymes and introduce recommendations for the CYP2B6 enzyme. Importantly, according to the guidelines, there continues to be insufficient evidence of the serotonin receptor genes SLC6A4 and HTR2A to guide prescribing of antidepressants. Therefore, clinicians should not take this information into consideration until more robust evidence becomes available.
- New guideline recommendations for citalopram and escitalopram for CYP2C19 rapid metabolizers (CYP2C19*1/*17) are less restrictive and are now flagged in yellow. Specifically, they suggest starting with a standard dose, titrating to response and switching to another SSRI for patients with insufficient response. The red flag and a drug switch recommendation remain for ultrarapid metabolizers.
- For sertraline, updated recommendations are based on a combination of CYP2C19 and CYP2B6 enzymes, recognizing the important contribution of the latter to drug clearance.
- A recent large-scale pharmacokinetic study demonstrated the involvement of CYP2C19 in venlafaxine elimination and confirmed the role of CYP2D6 in conversion to the active metabolite O-desvenlafaxine. While the CPIC guideline recommends alternative therapy only for CYP2D6 poor metabolizers, we added comments on the potentially increased risk of side effects or inadequate response in people with altered CYP2C19 and/or CYP2D6 activity.
- Recently published pharmacokinetic studies in ethnically diverse populations highlighted the impact of CYP3A4 and CYP3A5. CYP3A5 is mostly inactive in people of Northern European ancestry, while people of Middle Eastern or African origin commonly have higher activity of this enzyme. Quetiapine, cyclosporine, temsirolimus, sirolimus and tacrolimus have recommendations based on both CYP3A4 and CYP3A5.
- Combinatorial recommendations for diazepam now include CYP2C19, which is responsible for activation, in addition to CYP3A4 and CYP3A5, which are responsible for clearance.