MedEvidence Medication Reference & Personal Records

Published Reference Evidence & Discussion Packet Organizer

BE
Benjamin Bathen (0BC7C) OneOme ID: 0BC7C DOB: 1977-11-30 • Age: 48 yrs • Male 2 Contraindicated

Ordering Provider: Dr. Selma Eikelenboom-Schieveld, M.D., Ph.D. Facility: Independent Forensic Services (IFS) LLC. Report Date: 2019-08-11. OneOme RightMed Comprehensive PGx Panel.

Patient Records Updated

Records organized for Benjamin Bathen (0BC7C). Active medications: 4.

Active Patient: Benjamin Bathen (0BC7C)•DOB: 1977-11-30•Age: 48 yrs•Gender: Male
BE

Benjamin Bathen (0BC7C)

OneOme ID: 0BC7C DOB: 1977-11-30 • Age: 48 yrs • Male

Clinical History: Generalized Anxiety Disorder (GAD) diagnosed 2003-2004; Hypertension / High Blood Pressure (mildly compensated on Norvasc); Fatigue and situational anxiety/depression (2016); Tobacco use (occasional / attempted cessation). History of severe drug-induced agitation and akathisia.

Active Records In Use (2):OneOme RightMed Comprehensive PGx Report (Order 0BC7C).pdfIndependent Forensic Services Medical Records Review (Dr. Selma Eikelenboom-Schieveld).pdf
Live Databases Synchronized:
FDA ADE Database (FAERS):Connected(0 reports scanned)
PharmGKB / ClinPGX:Connected(0 profile annotations loaded)

Visual Pharmacogenomic Safety Heatmap

OneOme × Rx Clearance Matrix

Maps patient genetic variants across prescribed medications to identify clearance bottlenecks, impaired metabolic pathways, and pharmacodynamic receptor collisions.

TOTAL CONFLICTS
11pathways
CRITICAL BOTTLENECKS
4severe
HIGH RISK PATHWAYS
7impaired
ALTERED DNA ENZYMES
8genes
COMPATIBLE PATHWAYS
0normal
Filter Genes:
Prescription Drug Regimen
4 Rx
CYP3A4
*1/*22
Intermediate
CYP2C19
*1/*3
Intermediate
CYP2D6
*4+*68/*41
Poor to Intermediate
CYP2B6
*1/*6
Intermediate
SLC6A4
L/S (La/Sa)
Reduced
CYP1A2
*1F/*1F
Rapid
CYP3A5
*3/*3
Poor
HTR2A
rs7997012
Reduced
VKORC1
*1/*1
Normal
SLCO1B1
*1/*1
Normal
DPYD
*1/*1
Normal
TPMT
*1/*1
Normal
Escitalopram
Active
Lexapro • 10 mg
Fatigue, situational anxiety and depression
2 Critical2 High
35%
Severe Bottleneck
Intermediate
37%
Severe Bottleneck
Intermediate
28%
Impaired Route
Poor to Intermediate
-
No Interaction
Intermediate
PD Target
Impaired Route
Reduced
-
No Interaction
Rapid
-
No Interaction
Poor
PD Target
Altered Rate
Reduced
-
No Interaction
Normal
-
No Interaction
Normal
-
No Interaction
Normal
-
No Interaction
Normal
Amlodipine
Active
Norvasc • 10 mg
Essential Hypertension
1 Critical
90%
Severe Bottleneck
Intermediate
-
No Interaction
Intermediate
-
No Interaction
Poor to Intermediate
-
No Interaction
Intermediate
-
No Interaction
Reduced
-
No Interaction
Rapid
10%
Altered Rate
Poor
-
No Interaction
Reduced
-
No Interaction
Normal
-
No Interaction
Normal
-
No Interaction
Normal
-
No Interaction
Normal
Triamterene / Hydrochlorothiazide
Active
Maxzide-25 • 25 mg / 37.5 mg
Systolic blood pressure augmentation
1 High
-
No Interaction
Intermediate
-
No Interaction
Intermediate
-
No Interaction
Poor to Intermediate
-
No Interaction
Intermediate
-
No Interaction
Reduced
55%
Altered Rate
Rapid
-
No Interaction
Poor
-
No Interaction
Reduced
-
No Interaction
Normal
-
No Interaction
Normal
-
No Interaction
Normal
-
No Interaction
Normal
Bupropion
Discontinued
Wellbutrin • 150 mg
Anxiety / Smoking cessation
1 Critical2 High
-
No Interaction
Intermediate
15%
Impaired Route
Intermediate
Inhibitor
Impaired Route
Poor to Intermediate
70%
Severe Bottleneck
Intermediate
-
No Interaction
Reduced
-
No Interaction
Rapid
-
No Interaction
Poor
-
No Interaction
Reduced
-
No Interaction
Normal
-
No Interaction
Normal
-
No Interaction
Normal
-
No Interaction
Normal
Escitalopram (10 mg) × CYP3A4 CRITICAL CONFLICT 35% Elimination Route

Critical Clearance Bottleneck (35% pathway)

1. PATIENT GENETIC PROFILE
Gene Locus:CYP3A4
Genotype:*1/*22
Phenotype:Intermediate

Critical Clearance Bottleneck (35% pathway)

2. PHARMACOKINETIC MECHANISM

Escitalopram relies heavily (35%) on CYP3A4 for hepatic phase I clearance. Serum surge + genotype *1/*22 (Intermediate Metabolizer), causing severe accumulation.

Clinical & Toxicological Risk: Close at A. Toxicological Risk: 300%+ surge in steady-state AUC plasma concentrations; elimination half-life prolonged 3-fold. Severe risk of akathisia, QTc prolongation, and neurotoxicity.
3. CLINICAL GUIDELINES & NEXT STEPS
CPIC / DPWG Consensus:

CPIC Level A / Marked dose reduction (50%-75%) or switch to non-CYP450 alternative (e.g. Desvenlafaxine), TDM strongly advised.

Physician Mitigation:

Reduce starting dose by 50% or replace with alternative metabolized via non-compromised pathways. Daily akathisia monitoring mandatory.

PAN-PHARMACOPEIA DRUG-DRUG SCREEN: FAVORABLE 5 Active Drugs • 10 Pairs Evaluated

No Category X contraindications or Category D major interactions detected across active prescribed medications.

Medication Evidence Reference Deliberately Bounded Scope

This summary organizes information already present in user medical and laboratory records and pairs it with published reference sources. It is prepared solely as an information packet for discussion with a qualified healthcare professional. It does not diagnose conditions, predict adverse event likelihood, determine clinical appropriateness, or recommend medication changes.

Does not diagnoseDoes not infer phenotypeNo probability predictionsNo dose recommendations
Factual Status Designations:
Source AvailableSource UnavailableUser-Entered InformationExtracted Awaiting ConfirmationNot Assessed (Not Safe)Conflicting Source Information

Critical Clinical Red Flag: 2 Contraindicated Medications

Contraindicated due to patient inability to metabolize the drug (enzyme defect/phenotype), excessively high adverse event reporting ratio (PRR ≥ 2.0), or both.

Clinical Precaution Mandated
Escitalopram DUAL HIGH RISK (METABOLISM + PRR)

Dual Contraindication: Impaired CYP2C19 (Intermediate Metabolizer) Metabolism + Disproportionate PRR (5x)

FAERS PRR Ratio: 5xχ²: 94
Bupropion HIGH PRR SIGNAL

Critical Safety Signal: Disproportionate PRR of 3.9x (χ²: 70.6)

FAERS PRR Ratio: 3.9xχ²: 70.6

Patient Level of Metabolism & Enzyme Activity Profile

Current metabolic clearance phenotype governing drug metabolism contraindications. Select any enzyme phenotype to simulate clinical scenarios.

Live PGx Evaluation
CYP2C19
*1/*3Contraindicates
CYP2D6
*4+*68/*41Contraindicates
CYP2C9
*1/*1Functional
SLCO1B1
*1/*1Functional
DPYD
*1/*1Functional
TPMT
*1/*1Functional

Organized Medications & Published Source Material

Documented openFDA product labels, CPIC guideline publications, and explicitly recorded laboratory findings.

CONTRAINDICATED • DUAL HIGH RISK (METABOLISM + PRR)
Strict Clinical Red Flag

Escitalopram Contraindicated

[10 mg • Oral • Morning daily]
Indication: Fatigue, situational anxiety and depression
ContraindicatedUser-Entered Information
Contraindication Analysis:
Dual Risk (Metabolism + PRR)

Dual Contraindication: Impaired CYP2C19 (Intermediate Metabolizer) Metabolism + Disproportionate PRR (5x)

Escitalopram is strongly contraindicated: the patient cannot properly metabolize this drug due to their CYP2C19 (Intermediate Metabolizer) status, and the drug demonstrates a disproportionately high reporting ratio (PRR 5x, χ²: 94).

Identified Risk Factors:
Critical Disproportionality Signal: Moore/Glenmullen/Furberg PRR 5x (χ²: 94) for adverse events/violence.Impaired CYP2C19 Metabolism (Intermediate Metabolizer): Patient is unable to metabolize Escitalopram at standard levels, causing toxic drug accumulation or therapeutic failure.
Suggested Discussion Points with Prescribing Clinician:
  • Review dosage and schedule for EscitalopramContraindicated (10 mg) in context of patient clinical history.
  • Discuss published FDA package insert warnings and relevant laboratory findings.

Amlodipine

[10 mg • Oral • Once daily]
Indication: Essential Hypertension
User-Entered Information
Suggested Discussion Points with Prescribing Clinician:
  • Review dosage and schedule for Amlodipine (10 mg) in context of patient clinical history.
  • Discuss published FDA package insert warnings and relevant laboratory findings.

Triamterene / Hydrochlorothiazide

[25 mg / 37.5 mg • Oral • Once daily morning]
Indication: Systolic blood pressure augmentation
User-Entered Information
Suggested Discussion Points with Prescribing Clinician:
  • Review dosage and schedule for Triamterene / Hydrochlorothiazide (25 mg / 37.5 mg) in context of patient clinical history.
  • Discuss published FDA package insert warnings and relevant laboratory findings.
CONTRAINDICATED • HIGH PRR SIGNAL
Strict Clinical Red Flag

Bupropion Contraindicated

[150 mg • Oral • Discontinued after 15 days]
Indication: Anxiety / Smoking cessation
ContraindicatedUser-Entered Information
Contraindication Analysis:
Disproportionate PRR Signal

Critical Safety Signal: Disproportionate PRR of 3.9x (χ²: 70.6)

Bupropion is contraindicated and red-flagged due to a disproportionately high adverse event reporting ratio (PRR 3.9x, χ²: 70.6) in pharmacovigilance benchmarks.

Identified Risk Factors:
Critical Disproportionality Signal: Moore/Glenmullen/Furberg PRR 3.9x (χ²: 70.6) for adverse events/violence.
Suggested Discussion Points with Prescribing Clinician:
  • Review dosage and schedule for BupropionContraindicated (150 mg) in context of patient clinical history.
  • Discuss published FDA package insert warnings and relevant laboratory findings.