Pharmacogenomics

Every patient metabolizes drugs differently — and their genome explains why.

Pharmacogenomics is the only genomic discipline that touches every clinical specialty. Intersect on FHIR™ surfaces gene-drug interaction findings at the point of prescribing — for oncologists, cardiologists, psychiatrists, pain specialists, and primary care physicians alike — built natively on FHIR R6.

1 in 4

Patients carry a CYP2D6 variant that significantly affects how they metabolize a large class of commonly prescribed drugs

200+

FDA-approved drugs have pharmacogenomic information in their labeling — most prescribers never see it at the point of prescribing

Every Specialty

Oncology, cardiology, psychiatry, pain management, and primary care all have high-stakes gene-drug interactions

Why Pharmacogenomics Is Different

Not a specialty tool. A platform-wide capability.

Hereditary cancer panels serve oncologists. Cardiovascular genetics serves cardiologists. Pharmacogenomics serves every prescriber in the organization — because gene-drug interactions do not respect specialty boundaries.

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A patient’s CYP2D6 status matters to their oncologist, their cardiologist, their psychiatrist, and their primary care physician — simultaneously.

A CYP2D6 poor metabolizer taking tamoxifen for breast cancer may also be taking metoprolol for hypertension, codeine for pain, and an antidepressant. Each of those medications is affected by the same genetic variant. Without cross-specialty pharmacogenomic visibility, each prescriber is making decisions in isolation. Intersect surfaces the relevant genomic context to every prescriber who opens a medication order for that patient — regardless of their specialty.

By Clinical Specialty

Gene-drug interactions across every specialty — one platform.

The Intersect pharmacogenomics panel is operational across six clinical areas. Each specialty has its own high-stakes interactions — and a different prescriber who needs to see them at the right moment.

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Oncology

Chemotherapy metabolism and targeted therapy eligibility

DPYD UGT1A1 TPMT NUDT15 CYP2D6

DPYD deficiency — fatal toxicity risk from 5-Fluorouracil; dose reduction required
UGT1A1*28 — severe neutropenia risk from irinotecan
TPMT/NUDT15 — life-threatening myelosuppression from mercaptopurine
CYP2D6 poor metabolizer — tamoxifen to aromatase inhibitor switch recommended
BRCA1/2 — PARP inhibitor eligibility flag at point of treatment planning

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Cardiology

Antiplatelet therapy, anticoagulation, and antiarrhythmics

CYP2C19 VKORC1 CYP2C9 SLCO1B1 CYP2D6

CYP2C19 poor metabolizer — clopidogrel resistance; alternative antiplatelet therapy recommended
VKORC1 + CYP2C9 — warfarin dose adjustment for bleeding risk vs. thrombosis
SLCO1B1 — statin-induced myopathy risk; dose or drug change recommended
CYP2D6 — metoprolol and other beta-blocker metabolism variation
SCN5A, KCNQ1 — drug-induced arrhythmia risk stratification

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Psychiatry & Behavioral Health

Antidepressants, antipsychotics, and anxiolytics

CYP2D6 CYP2C19 HTR2A SLC6A4 CYP3A4

CYP2D6 — affects metabolism of most SSRIs, TCAs, antipsychotics, and stimulants
CYP2C19 — escitalopram, citalopram, sertraline dose optimization
HTR2A — antidepressant response and side effect prediction
SLC6A4 — serotonin transporter variation affecting SSRI response
Ultrarapid metabolizers — therapeutic failure risk for standard doses

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Pain Management

Opioid metabolism, efficacy, and overdose risk

CYP2D6 OPRM1 CYP3A4 COMT

CYP2D6 ultrarapid metabolizer — codeine to morphine conversion risk; potentially fatal in children
CYP2D6 poor metabolizer — codeine and tramadol therapeutic failure
OPRM1 A118G — reduced opioid efficacy; higher dose requirement
CYP3A4 — fentanyl and oxycodone metabolism variation
Integrated with MME calculation and CDC 2022 CDS alerts

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Primary Care

Statins, PPIs, anticoagulants, and common prescriptions

SLCO1B1 CYP2C19 CYP2C9 G6PD

SLCO1B1 — statin myopathy risk (simvastatin, atorvastatin, rosuvastatin)
CYP2C19 — PPI dose optimization (omeprazole, pantoprazole)
CYP2C9 + VKORC1 — warfarin starting dose guidance
G6PD deficiency — hemolysis risk from rasburicase, dapsone, nitrofurantoin
Findings visible across the full care team in the shared record

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Infectious Disease & Hospital Medicine

Antivirals, antimalarials, and inpatient medications

HLA-B*57:01 HLA-B*15:02 G6PD CYP2B6

HLA-B*57:01 — abacavir hypersensitivity; contraindicated without negative test
HLA-B*15:02 — carbamazepine-induced Stevens-Johnson syndrome risk
G6PD — hemolysis risk from antimalarials (chloroquine, primaquine)
CYP2B6 — efavirenz and other antiretroviral metabolism variation
Alerts surfaced at point of inpatient medication ordering

High-Stakes Interactions

The gene-drug interactions that matter most.

These are not edge cases. They are common medications prescribed daily across every type of practice — where a patient’s genetic variant can mean the difference between therapeutic benefit and serious harm.

Drug	Key Gene	Specialty	Clinical Consequence & Platform Action
5-Fluorouracil (5-FU)	DPYD	Oncology	Poor metabolizer — potentially fatal toxicity. Alert fires before order is placed; dose reduction protocol triggered.
Clopidogrel (Plavix)	CYP2C19	Cardiology	Poor metabolizer — drug resistance; increased MI/stroke risk. Alternative antiplatelet therapy recommended at prescribing.
Codeine	CYP2D6	Pain	Ultrarapid metabolizer — toxic morphine accumulation, potentially fatal. Poor metabolizer — no analgesic effect.
Tamoxifen	CYP2D6	Oncology	Poor metabolizer — reduced conversion to active endoxifen; compromised efficacy. Aromatase inhibitor switch recommended.
Warfarin	VKORC1 / CYP2C9	CardiologyPrimary Care	Combined variant profile determines optimal starting dose. Alerts fire with specific dose guidance based on patient genotype.
Simvastatin	SLCO1B1	Primary CareCardiology	SLCO1B1*5 — high myopathy risk at standard doses. Dose reduction or alternative statin recommended.
Abacavir	HLA-B*57:01	Infectious Disease	Positive HLA-B*57:01 — contraindicated; severe hypersensitivity reaction risk. Alert fires with contraindication flag.
Irinotecan	UGT1A1	Oncology	*28 homozygous — severe neutropenia and diarrhea; dose reduction required before first cycle.
Antidepressants (SSRIs/TCAs)	CYP2D6 / CYP2C19	PsychiatryPrimary Care	Poor or ultrarapid metabolizer — therapeutic failure or toxicity across the most commonly prescribed drug class in the U.S.

Platform Integration

One test. Every prescriber. Every encounter.

A patient’s pharmacogenomic panel is tested once and stored as structured FHIR R6 resources — visible to every clinician who cares for that patient, surfaced automatically when a relevant medication is ordered.

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Point-of-Prescribing CDS

When a clinician opens a medication order for any drug with a pharmacogenomic interaction, the relevant finding is surfaced automatically. No manual lookup. No separate system. The alert appears in the clinical workflow before the order is signed.

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Cross-Specialty Visibility

Pharmacogenomic results are not siloed in the ordering department. A CYP2D6 result ordered by oncology is immediately visible to the cardiologist, the pain specialist, and the primary care physician — all through the same shared FHIR record.

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FHIR R6 GenomicStudy Resources

All pharmacogenomic findings are stored as structured FHIR R6 GenomicStudy, MolecularSequence, and DiagnosticReport resources — not PDF attachments. Structured data enables automated CDS, longitudinal tracking, and research data extraction.

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Integrated with All Five Genomic Panels

The pharmacogenomics panel works alongside the hereditary cancer, cardiovascular genetics, cardiac arrhythmia, and Lynch syndrome panels — sharing the same patient record, the same FHIR infrastructure, and the same clinical workflow.

Bring pharmacogenomics to every prescriber in your organization.

Whether you are a health system looking to standardize PGx CDS across specialties or an academic medical center seeking to build a pharmacogenomics program from the ground up, Intersect on FHIR™ provides the FHIR-native infrastructure. Let’s talk.

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