Click below to learn more about the use of CYP2C19 genetics in the prescribing of proton pump inhibitors (PPIs), including omeprazole, pantoprazole, lansoprazole, and deslansoprazole.
Omeprazole, pantoprazole, lansoprazole, and deslansoprazole are metabolized by the liver to inactive metabolites. The protein in the liver responsible for the majority of this metabolism is the cytochrome p450 enzyme CYP2C19 (pronounced "sip two see nineteen").
Across populations, CYP2C19 protein alleles can have different genetic variants that impact its ability to metabolize PPIs and other medications. The different alleles can produce five different metabolism phenotypes: ultrarapid, rapid, normal, intermediate and poor metabolism. Of these, the ultrarapid and rapid metabolizer phenotypes have been shown to have lower drug levels and therefore, risk of treatment failure. The intermediate and poor metabolizer phenotypes have been shown to have higher drug levels and risk of dose-related adverse effects with long-term use.
At UCHealth the use of pharmacogenetics when prescribing omeprazole, pantoprazole, lansoprazole, or deslansoprazole will occur in patients who meet the following conditions:
1) Provided a blood or saliva sample to the Colorado Biobank and this sample has undergone genotyping. 2) Have consented for the return of their results. 3) Are prescribed omeprazole, pantoprazole, lansoprazole, or deslansoprazole.
This process takes a minimum of 4-6 weeks, but may take several years. Therefore, results will not be available at initial presentation if a patient has not previously enrolled in the Biobank.
If you are a provider AND your patient is a CYP2C19 ultrarapid, rapid, intermediate or poor metabolizer, an in-line medication warning will appear if you attempt to prescribe or refill omeprazole, pantoprazole, lansoprazole, or dexlansoprazole in the UCHealth's EHR. If the in-line medication warning is visible, links to resources will be listed for your reference.
Frequently Asked Questions
Yes. After a participant signs a consent to return results to their UCHealth EHR, CYP2C19 genotype results will be placed into the EHR and sent to the participant via the MyHealthConnection electronic patient portal. There are patient education texts available for UCHealth providers to use in discharge paperwork or the after visit summary (AVS) when using CYP2C19 genotype results to impact prescribing.
No. There is a minimum of a 4-6 week turnaround time from blood draw to genotype results being available. However, this time could be much longer, several months to years. Thus, genotyping results will not be returned in a clinically meaningful time frame.
If a patient presents with H.Pylori, GERD or upper GI bleeding and has previously consented to both the biobank research study AND for his or her results to be returned to the EHR, then CYP2C19 genotyping may be available for this patient.
The Biobank Research study is open to all UCHealth patients ages 18 and over, who are able to consent for themselves. This program is available to patients throughout the UCHealth system, including North, Metro and South. The program is not available outside the UCHealth system.
Several alternative agents are on formulary for many insurance plans; however, if your patient is not provided with coverage, please contact the pharmacogenetics pager at 303-266-4510 for assistance with prior authorization.
Genotype is not the only factor governing drug response or side effects. If your patient is taking omeprazole, pantoprazole, lansoprazole, or deslansoprazole and now has CYP2C19 results available, the next step would be to evaluate whether the patient is having an adequate therapeutic response or if he or she is experiencing side effects. In cases of inadequate therapeutic response or bothersome side effects, a dose adjustment may be appropriate.
The in-line medication warning will appear when omeprazole, pantoprazole, lansoprazole, or deslanzoprazole is renewed or refilled, in addition to appearing for new prescriptions for these medications.
For questions regarding direct patient care, please page the pharmacogenetics pager at 303-266-4510.