Table 3.

Clinical decision-making process for integrating pharmacogenomics in practice

FactorQuestions
Patient or populationIs the variant likely relevant in the patient or population?
How common is the variant?
Quality of evidenceWhat is the strength of the evidence for the use of data?
Are clinical guidelines or FDA recommendations available?
TestingIs testing available?
Is the coverage appropriate?
What is the turnaround time of results?
Data availabilityDoes pharmacogenomics data already exist?
Is the data quality sufficient to use?
Drug factorsHow important is the gene/variant for the pharmacokinetics or pharmacodynamics of the drug?
Does the drug have a narrow therapeutic index?
Is the drug a prodrug or active?
Will the variant decrease efficacy and/or increase toxicity?
Clinical factorsAre there other factors relevant to the decision, like timing of drug start or previous use of the medication?
How do comorbid clinical conditions affect expected phenotypes?
Are there drug-drug interactions that affect expected phenotypes?
  • FDA, Food and Drug Administration.