CPIC® Guideline for Clopidogrel and CYP2C19

Most recent guideline publication:

Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2C19 Genotype and Clopidogrel Therapy: 2022 update (January 2022)

Updates since publication:

None

Tables in the main manuscript of the guideline:

Table 1. Assignment of Predicted CYP2C19 Phenotype Based on Genotype

Table 2. Antiplatelet therapy recommendations based on CYP2C19 phenotype when considering clopidogrel for cardiovascular indications

Table 3. Antiplatelet therapy recommendations based on CYP2C19 phenotype when considering clopidogrel for neurovascular indications

Supplement to: Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C19 Genotype and Clopidogrel Therapy: 2022 update (January 2022)

Tables and figures included in the supplement^a or referenced in the guideline:

Table S1. Evidence linking CYP2C19 to clopidogrel phenotype-Pharmacokinetics and pharmacodynamics
Table S2. Evidence linking CYP2C19 to clopidogrel phenotype-Cardiovascular indications
Table S3. Evidence linking CYP2C19 to clopidogrel phenotype-Neurovascular indications
Table S4. Evidence linking CYP2C19 to clopidogrel phenotype-Meta-analyses since 2013
Table S5. Comparison of guideline and label recommendations for CYP2C19-clopidogrel
Figure S1. Hepatic metabolism of clopidogrel
CYP2C19 allele definition table
CYP2C19 allele functionality table
CYP2C19 frequency table
CYP2C19 diplotype-phenotype table
Gene resource mapping CYP2C19 gene resource mapping
Drug resource mapping Clopidogrel
Clinical decision supportb: Implementation workflow CYP2C19 consult Clopidogrel pre- and post-test alerts and flow charts

^aSome of the tables included in the guideline may have been updated on-line, particularly to reflect newly described or newly characterized alleles. These include the gene-specific information tables (https://www.pharmgkb.org/page/pgxGeneRef) that support CPIC guidelines by providing information regarding star (*) allele definitions, allele function, allele frequency by major ethnic groups, translations of diplotype to phenotype, and gene resource mappings.

^bThese resources support the adoption of CPIC guidelines into the electronic health record with clinical decision support and provide information that clinical implementers find helpful.

2013 guideline:

• Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C19 Genotype and Clopidogrel Therapy: 2013 update (September 2013)
• 2013 supplement
• March 2017: The FDA-approved label for clopidogrel (Plavix) was recently updated (September 2016) and warns that patients who are CYP2C19 poor metabolizers may have diminished effectiveness of the drug as compared to patients with normal CYP2C19 function. The drug label suggests that a different platelet P2Y12 inhibitor be used in patients identified as CYP2C19 poor metabolizers. The FDA label change does not alter the recommendation from the authors that based on available evidence, the CPIC guideline is most applicable to ACS/PCI patients.

Original publication (August 2011):

• Clinical Pharmacogenetics Implementation Consortium Guidelines for Cytochrome P450-2C19 (CYP2C19) Genotype and Clopidogrel Therapy
• 2011 supplement

This guideline has been endorsed by the American Society of Health-System Pharmacists (ASHP).