Table 2.

Summary of the gene-drug pairs and clinical guidelines relevant to nephrology

DrugGeneClinical Guidance SummaryRef.
WarfarinCYP2C9Use lower dose if a poor or intermediate metabolizer (e.g., *2/*2, *1/*2)23
WarfarinCYP4F2Use lower dose if decreased activity (*3)23
WarfarinVKORC1Use lower dose if increased sensitivity (−1639G>A)23
ClopidogrelCYP2C19Use alternative antiplatelet agent if poor or intermediate metabolizer (e.g., *2/*2, *1/*2); monitor for bleeding if ultrarapid metabolizer (*1/*17, *17/*17)35
SimvastatinSLCO1B1Use lower dose or alternative agent in patients with decreased transporter activity (*5, *15, *17)37
AzathioprineTPMTPatients with decreased TPMT function have higher risk for toxicity39
TacrolimusCYP3A5Carriers of at least one functional (*1) allele may require higher doses13
VoriconazoleCYP2C19Use an alternative agent in CYP2C19 rapid/ultrarapid metabolizer (*1/*17, *17/*17); use alternative agent or lower dose in CYP2C19 poor metabolizer (*2/*2, *3/*3)40
AllopurinolHLA-BUser an alternative uric acid–lowering agent in patients who carry at least one *58:01 allele53
  • TPMT, thiopurine methyltransferase.