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CPIC® Guideline for Clopidogrel and CYP2C19

Most recent guideline publication:

Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C19 Genotype and Clopidogrel Therapy: 2013 update (September 2013)

Updates since publication:

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.

Tables and figure in the main manuscript of the guideline:

Table 1. Assignment of likely CYP2C19 phenotypes based on genotypes
Table 2. Antiplatelet therapy recommendations based on CYP2C19 status when considering clopidogrel for ACS/PCI patients
Figure 1. Algorithm for suggested clinical actions based on CYP2C19 genotype when considering treatment with clopidogrel for ACS patients undergoing PCI

Supplement to: Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C19 Genotype and Clopidogrel Therapy: 2013 update (September 2013)

Tables and figures included in the supplementa or referenced in the guideline:

Supplemental Table S1. Commonly tested CYP2C19 variant alleles and their effect on CYP2C19 protein For an updated version of this table see the CYP2C19 allele definition table .
Supplemental Table S2. Association between CYP2C19 allelic variants and enzyme activity For an updated version of this table see the CYP2C19 allele functionality table .
Supplemental Table S3. Frequencies of CYP2C19 alleles in major race/ethnic groups For an updated version of this table see the CYP2C19 frequency table .
Supplemental Table S4. CYP2C19 minor allele frequencies For an updated version of this table see the CYP2C19 frequency table .
Supplemental Table S5. Predicted metabolizer phenotypes based on CYP2C19 genotype and predicted average frequencies For an updated version of this table see the CYP2C19 frequency table and the CYP2C19 diplotype-phenotype table.
Supplemental Table S6. Evidence linking CYP2C19 genotype with clopidogrel response
Supplemental Table S7. Evidence linking CYP2C19 genotype with clopidogrel response (META-ANALYSES)
Supplemental Table S8. Evidence linking CYP2C19 genotype with phenotype (CLOPIDOGREL DOSE ESCALATION)
Supplemental Figure S1. Hepatic metabolism of clopidogrel or see PharmGKB Clopidogrel Pathway, Pharmacokinetics

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.

Additional Resources Applicable to this guideline:

Drug resource mapping

Gene resource mapping

Original publication (August 2011):

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