Medical and Medicare-Paid Pharma and Cancer genetic tests

For Medical and Medicare Paid Pharma and Cancer genetic tests in the USA , contact Connie at motherhealth@gmail.com or text 408-854-1883

Medicare coverage of genetic services. Under Medicare’s guidelines, BRCA1 and BRCA2 genetic testing is covered for people with: A personal history of breast cancer, with one or more of the following: … a close relative with a known BRCA1 or BRCA2 gene mutation.

Medicare coverage of genetic services

Under Medicare’s guidelines, BRCA1 and BRCA2 genetic testing is covered for people with:

  1. A personal history of breast cancer, with one or more of the following:
    • diagnosed at or before age 45, with or without family history
    • diagnosed at or before age 50 or two breast primaries, with 1 or more close blood relative(s) with breast cancer diagnosed at or before age 50 or 1 or more close blood relative(s) with ovarian cancer/fallopian tube/primary peritoneal cancer
    • two breast primaries when first breast cancer diagnosis occurred prior to age 50
    • diagnosed at any age, with 2 or more close blood relatives with breast and/or epithelial ovarian/fallopian tube/primary peritoneal cancer, at any age
    • close male blood relative with breast cancer
    • personal history of epithelial ovarian/fallopian tube/primary peritoneal cancer
    • of a certain ethnicity associated with higher mutation frequency, (eg, founder populations of Ashkenazi Jewish, Icelandic, Swedish, Hungarian or other) no additional family history required
    • a close relative with a known BRCA1 or BRCA2 gene mutation
  2. Personal history of epithelial ovarian/fallopian tube/primary peritoneal cancer.
  3. Personal history of male breast cancer.

Medicare operates on a regional system in which Medicare Area Contractors (MACs) manage the provision of health services for a specific jurisdiction. In the spring of 2015, four MACs expanded their coverage to better align their services with National Comprehensive Cancer Network (NCCN) guidelines in a number of important areas, including:

  • Expanding coverage of genetic testing for individuals who have or had cancer consistent with hereditary cancer syndromes, including men diagnosed with prostate cancer and men and women diagnosed with pancreatic cancer,
  • Coverage of multigene testing panels if more than one mutation may be indicated, and
  • Clarification of the BRCA testing policy for use of the targeted therapyLynparza (olaparib).

It is important to note that these policy changes apply only to states covered by the four MACs:
Arkansas, Arizona, California, Hawaii, Idaho, Kentucky, Montana, Nevada, North Carolina, North Dakota, Ohio, Oregon, South Carolina, South Dakota, Utah, Virginia, Washington, West Virginia and Wyoming

Medicare does not currently cover the cost of genetic testing in individuals who do not have a personal history of cancer.

Genetic Testing

Genetic Testing

The CDC Office of Public Health Genomics ranks the following list for levels of evidence of genomic tests and family health history in practice . This approach was based on a paper by KhouryExternal Web Site Icon and updated in accordance with criteria presented by a 2014 paper in Clinical Pharmacology and TherapeuticsExternal Web Site Icon. The criteria are  shown in the following figure to provide additional information to our readers.This list is updated on an ongoing basis andprovided only for informational purposes to researchers, healthcare providers, public health programs and others.

Green

  • FDA label requires use of test to inform choice or dose of a drug
  • CMS covers testing
  • Clinical practice guidelines based on systematic review supports testing

Yellow

  • FDA label mentions biomarkers*
  • CMS coverage with evidence development
  • Clinical practice guideline, not based on systematic review, supports use of test
  • Clinical practice guideline finds insufficient evidence but does not discourage use of test
  • Systematic review, without clinical practice guideline, supports use of test
  • Systematic review finds insufficient evidence but does not discourage use of test
  • Clinical practice guideline recommends dosage adjustment, but does not address testing

Red

  • FDA label cautions against use
  • CMS decision against coverage
  • Clinical practice guideline recommends against use of test
  • Clinical practice guideline finds insufficient evidence and discourages use of test
  • Systematic review recommends against use
  • Systematic review finds insufficient evidence and discourages use
  • Evidence available only from published studies without systematic reviews, clinical practice guidelines, FDA label or CMS labels coverage decision

*Can be reassigned to Green of Red of one or more conditions in these categories apply

Tier 1/Green category: represents genomic and family health history applications which have a base of synthesized evidence supporting implementation into practice.
Gene, Gene/Drug, Test, or Family History Disorder/Indication Use* Synthesized Evidence Sources
Cancer—Breast/Ovarian
family history of breast/ovarian or other types of BRCA-related cancer hereditary breast and ovarian cancer in women risk prediction for referral for BRCA genetic counseling USPSTFExternal Web Site Icon (2013)

NCCN Guideline Adobe PDF file [PDF 836.97 KB]External Web Site Icon(2013)

NCCN Task ForceExternal Web Site Icon (2011)

first-degree family history of breast cancer chemoprevention of breast cancer risk prediction USPSTFExternal Web Site Icon (2013)
family history of known breast/ovarian cancer with deleterious BRCA mutation hereditary breast and ovarian cancer in women risk prediction; referral to counseling for BRCA genetic testing USPSTFExternal Web Site Icon (2013)
HER2/trastuzumab invasive breast cancer PGx NICE Adobe PDF file [PDF 2.00 MB]External Web Site Icon (2009)

ASCOExternal Web Site Icon (2007)

FDA-DeviceExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon (2013)

HER2/pertuzumab invasive breast cancer PGx FDA-DeviceExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon (2013)

HER2/ado-trastuzumab emtansine metastatic breast cancer PGx FDA-PGx Drug InformationExternal Web Site Icon (2013)
HER2/everolimus advanced HR+ HER2- breast cancer PGx FDA-PGx Drug InformationExternal Web Site Icon (2013)
HER2/lapatinib (in combination with capecitabine or letrozole) advanced or metastatic breast cancer PGx FDA-PGx Drug InformationExternal Web Site Icon (2013)
HER2 invasive breast cancer PGx ASCO/CAPExternal Web Site Icon (2007)

NICE Adobe PDF file [PDF 178.88 KB]External Web Site Icon (2009)

ER /fulvestrant metastatic breast cancer PGx FDA-PGx Drug InformationExternal Web Site Icon (2012)
ER/exemestane ER+ early breast cancer PGx FDA-PGx Drug InformationExternal Web Site Icon (2013)

NICE Adobe PDF file [PDF 178.88 KB]External Web Site Icon (2009)

ER/anastrozole or letrozole ER+ early invasive breast cancer PGx NICE Adobe PDF file [PDF 178.88 KB]External Web Site Icon (2009)

FDA-PGx Drug Information [anastrozole]External Web Site Icon (2013)

FDA-PGx Drug Information [letrozole]External Web Site Icon (2011)

ER and PgR invasive breast cancer, breast cancer recurrences PGx ASCO/CAPExternal Web Site Icon (2010)

NCCN Task ForceExternal Web Site Icon (2011)

Oncotype DX® adjuvant chemotherapy ER+/LN-/HER2- breast cancer, intermediate risk of recurrence prognostic; guiding decision-making: adjuvant chemotherapy NICEExternal Web Site Icon (2013)

NCCN Task ForceExternal Web Site Icon (2011)

Cancer—Colorectal
Testing for Lynch syndrome newly diagnosed colorectal cancer screening, cascade testing of relatives EGAPP (2009)
Testing for Lynch syndrome known Lynch syndrome in family diagnostic, screening EGAPP (2009)

NCCNExternal Web Site Icon: Genetic/Familial High-Risk Assessment – Colorectal  (2014)

KRAS/cetuximab, panitumumab metastatic colorectal cancer PGx EGAPP Adobe PDF file [PDF 456.16 KB]External Web Site Icon (2013)

NCCNExternal Web Site Icon (2011)

ASCOExternal Web Site Icon (2009)

FDA-DeviceExternal Web Site Icon

FDA-PGx Drug InformationExternal Web Site Icon (2013)

Carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5 or CEA) invasive colorectal cancer prognostic ASCO/CAPExternal Web Site Icon (2006)

NCCN Adobe PDF file [PDF 1.27 MB]External Web Site Icon (2013)

NCCN Task ForceExternal Web Site Icon (2011)

Cancer—Gastric
HER2/trastuzumab gastric or gastroesophageal junction adenocarcinoma PGx FDA-DeviceExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon (2013)

c-Kit protein (CD 117)/imatinib gastrointestinal stromal tumors PGx FDA-DeviceExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon (2013)

Cancer—Leukemia/lymphoma
Philadelphia chromosome, T315I mutation/dasatinib chronic myeloid leukemia, acute lymphoblastic leukemia PGx; diagnostic FDA-PGx Drug InformationExternal Web Site Icon (2013)
Philadelphia chromosome/imatinib chronic myeloid leukemia, acute lymphoblastic leukemia PGx; diagnostic FDA-PGx Drug InformationExternal Web Site Icon (2013)
Philadelphia chromosome/bosutinib chronic myelogenous leukemia PGx; diagnostic FDA-PGx Drug InformationExternal Web Site Icon (2013)
Philadelphia chromosome/nilotinib chronic myeloid leukemia PGx; diagnostic FDA-PGx Drug InformationExternal Web Site Icon (2013)
PML/RARα/tretinoin acute promyelocytic leukemia PGx FDA-PGx Drug InformationExternal Web Site Icon (2004)
PML/RARα/arsenic trioxide acute promyelocytic leukemia PGx FDA-PGx Drug InformationExternal Web Site Icon (2010)
PDGFRB/imatinib myelodysplastic/ myeloproliferative diseases PGx FDA-PGx Drug InformationExternal Web Site Icon (2013)
CD25/denileukin diftitox persistent or recurrent cutaneous T-cell  lymphoma PGx FDA-PGx Drug InformationExternal Web Site Icon (2011)
CD20/tositumomab Non-Hodgkin’s lymphoma PGx FDA-PGx Drug InformationExternal Web Site Icon (2012)

Alberta Health Services Adobe PDF file [PDF 792.34 KB]External Web Site Icon (2013)

G6PD/rasburicase leukemia, lymphoma, solid tumor malignancies PGx, pretreatment screening in patients at higher risk for G6PD deficiency (e.g., African or Mediterranean ancestry) FDA-PGx Drug InformationExternal Web Site Icon (2009)

CPICExternal Web Site Icon (2014)

Chromosome 5q deletion/lenalidomide transfusion-dependent anemia due to low-or intermediate-1-risk myelodysplastic syndromes associated with a deletion 5q PGx FDA-PGx Drug InformationExternal Web Site Icon (2013)
Cancer—Lung
EGFR (exon 19 deletions and exon 21 (L858R) substitution mutations)/afatinib metastatic non-small-cell lung cancer PGx FDA-DeviceExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon (2013)

EGFR (exon 19 deletions and exon 21 (L858R) substitution mutations)/erlotinib locally advanced or metastatic non-small-cell lung cancer PGx NICE Adobe PDF file [PDF 189.11 KB]External Web Site Icon (2012)

NCCN Task ForceExternal Web Site Icon (2011)

FDA-DeviceExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon (2013)

ALK gene rearrangement/crizotinib non-small cell lung cancer PGx FDA-DeviceExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon (2013)

NCCN Task ForceExternal Web Site Icon (2011)

NCCN Guideline Adobe PDF file [PDF 1.61 MB]External Web Site Icon(2013)

Cancer—Melanoma
BRAF V600E/K /trametinib unresectable or metastatic melanoma PGx FDA-PGx Drug InformationExternal Web Site Icon (2013)

FDA-DeviceExternal Web Site Icon (2013)

BRAF V600E/dabrafenib unresectable or metastatic melanoma PGx FDA-PGx Drug InformationExternal Web Site Icon (2013)

FDA-DeviceExternal Web Site Icon (2013)

BRAFV600E/vemurafenib unresectable or metastatic melanoma PGx NICEExternal Web Site Icon (2012)

FDA-PGx Drug InformationExternal Web Site Icon (2013)

FDA-DeviceExternal Web Site Icon (2013)

Cardiovascular disease
DNA testing and LDL-C concentration measurement familial hypercholesterolemia cascade testing of relatives of people diagnosed with FH NICEExternal Web Site Icon (2008)
family history of cardiovascular disease before age 50 years in male relatives and age 60 years in female relatives cholesterol screening risk prediction USPSTFExternal Web Site Icon  (2008)
Infectious disease
HLA-B*5701/abacavir HIV PGx DHHS Advisory Committee Adobe PDF file [PDF 1.46 MB]External Web Site Icon (2013)

CPICExternal Web Site Icon (2014)

FDA-PGx Drug InformationExternal Web Site Icon (2013)

CCR5-tropic HIV-1 /maraviroc HIV PGx FDA-PGx Drug InformationExternal Web Site Icon (2013)

HHS Panel Adobe PDF file [PDF 1.46 MB]External Web Site Icon(2013)

Other
CFTR (G551D)/ivacaftor cystic fibrosis PGx FDA-PGx Drug InformationExternal Web Site Icon (2012)
HLA-B*1502/carbamazepine epilepsy, trigeminal neuralgia; pretreatment screening for those with ancestry in populations  genetically at-risk for certain serious dermatologic reactions PGx, pretreatment screening for those with ancestry in populations  genetically at-risk for certain serious dermatologic reactions FDA-PGx Drug InformationExternal Web Site Icon (2013)
CYP2D6/pimozide Tourette’s disorder PGx-dose FDA-PGx Drug InformationExternal Web Site Icon (2011)
CYP2D6/tetrabenazine chorea associated with Huntington’s disease PGx-dose FDA-PGx Drug InformationExternal Web Site Icon (2011)
G6PD/pegloticase chronic gout in adults refractory to conventional therapy PGx, pretreatment screening in patients at higher risk for G6PD deficiency (e.g., African or Mediterranean ancestry) FDA-PGx Drug InformationExternal Web Site Icon (2012)
Parental history of hip fracture

osteoporosis screening in women risk prediction USPSTFExternal Web Site Icon (2011)
family history, especially siblings, with hereditary hemochromatosis hereditary hemochromatosis risk prediction; counseling for genetic testing among asymptomatic people USPSTFExternal Web Site Icon (2006)
newborn screening panel 31 core conditions screening SACHDNCExternal Web Site Icon (2013)

*Pharmacogenomic applications have been classified in the Use column as either PGx (which may relate to drug choice, prevention of adverse events, or other uses of the information gained through testing), or PGx-dose (when specific dosing-related guidance is provided, or mention of a potential effect on dose is noted in the evidence sources cited). Additional Use categories include: screening, cascade testing, risk prediction, diagnostic, and prognostic.

Source Abbreviations: Agency for Healthcare Research and Quality (AHRQ), American College of Medical Genetics and Genomics (ACMG), American Society of Clinical Oncology (ASCO), Centers for Medicare and Medicaid Services (CMS), Clinical Pharmacogenetics Implementation Consortium (CPIC), Evaluation of Genomic Applications in Practice and Prevention (EGAPP), National Comprehensive Cancer Network (NCCN), National Institute for Health and Care Excellence (NICE), National Institutes of Health (NIH), Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC), US Department of Health and Human Services (DHHS), US Food and Drug Administration (FDA), United States Preventive Services Task Force (USPSTF)

Tier 2/Yellow category: represents genomic and family health history applications have synthesized evidence that is insufficient to support routine implementation in practice; however, existing evidence may provide information for informed decision making by providers and patients.
Gene, Gene/Drug, Test, or Family History Disorder/Indication Use* Synthesized Evidence Sources
Cancer—Breast
gene expression profiles breast cancer Recurrence:  risk prediction; prognostic EGAPPExternal Web Site Icon (2009)
ER-alpha and PgR status/ER-alpha (ESR1)-modulating agents invasive breast cancer and breast cancer PGx – recurrence risk prediction; prognostic NCCN Task ForceExternal Web Site Icon (2011)

NCCN Task ForceExternal Web Site Icon (2009)

ASCO/CAPExternal Web Site Icon (2010)

CYP2D6/tamoxifen risk for primary breast cancer or breast cancer recurrence PGx – informing therapeutic choice BCBSA TECExternal Web Site Icon (2014)
Cancer—Colorectal
first-degree family history of colorectal cancer at a younger age or multiple affected first-degree relatives colorectal cancer screening risk prediction USPSTFExternal Web Site Icon (2008)
BRAF c.1799T>A (p.V600E) colon cancer prognostic NCCN Task ForceExternal Web Site Icon (2011)

NCCN Guideline Adobe PDF file [PDF 1.30 MB]External Web Site Icon (2013)

BRAF V600E/cetuximab, panitumumab metastatic colorectal cancer PGx EGAPP Adobe PDF file [PDF 456.16 KB]External Web Site Icon(2013)

NCCN Task ForceExternal Web Site Icon (2011)

UGT1A1/irinotecan Metastatic carcinoma of the colon or rectum PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)

EGAPPExternal Web Site Icon (2009)

testing for Lynch syndrome patients meeting revised Bethesda guidelines or Amsterdam criteria diagnostic, screening NCCNExternal Web Site Icon: Genetic/Familial High-Risk Assessment – Colorectal  (2014)
testing for Lynch syndrome endometrial cancer in women under 50 years of age diagnostic, screening NCCNExternal Web Site Icon: Genetic/Familial High-Risk Assessment – Colorectal  (2014)
consideration of testing for Lynch syndrome people with 5% or higher risk of Lynch syndrome based on any prediction model diagnostic, screening NCCNExternal Web Site Icon: Genetic/Familial High-Risk Assessment – Colorectal  (2014)
testing for Lynch syndrome colorectal cancer diagnosed under 70 years of age, and those 70 and older who meet Bethesda guidelines diagnostic, screening NCCNExternal Web Site Icon: Genetic/Familial High-Risk Assessment – Colorectal  (2014)
testing for Lynch syndrome colorectal cancer in patients younger than 50 years diagnostic, screening NCCNExternal Web Site Icon: Genetic/Familial High-Risk Assessment – Colorectal  (2014)
testing for Lynch syndrome synchronous or metachronous colorectal or other Lynch syndrome-related tumors, at any age diagnostic, screening NCCNExternal Web Site Icon: Genetic/Familial High-Risk Assessment – Colorectal  (2014)
testing for Lynch syndrome MSI-H histology in colorectal cancer patients younger than 60 years diagnostic, screening NCCNExternal Web Site Icon: Genetic/Familial High-Risk Assessment – Colorectal  (2014)
testing for Lynch syndrome colorectal cancer in patient with relative (one or more first-degree) with Lynch syndrome related cancer that was diagnosed under age 50 years diagnostic, screening NCCNExternal Web Site Icon: Genetic/Familial High-Risk Assessment – Colorectal  (2014)
testing for Lynch syndrome colorectal cancer in patient with relatives (two or more first- or second-degree) with Lynch syndrome related cancer at any age diagnostic, screening NCCNExternal Web Site Icon: Genetic/Familial High-Risk Assessment – Colorectal  (2014)
Cancer—Leukemia
FLT3-ITD acute myeloid leukemia predictive; prognostic NCCN Task ForceExternal Web Site Icon (2011)

NCCN Guideline Adobe PDF file [PDF 852.75 KB]External Web Site Icon (2013)

CEBPA mutation acute myeloid leukemia predictive; prognostic NCCN Task ForceExternal Web Site Icon (2011)

NCCN Guideline Adobe PDF file [PDF 852.78 KB]External Web Site Icon (2013)

NPM1 mutation acute myeloid leukemia predictive; prognostic NCCN Task ForceExternal Web Site Icon (2011)

NCCN Guideline Adobe PDF file [PDF 852.80 KB]External Web Site Icon (2013)

KIT mutation acute myeloid leukemia predictive; prognostic NCCN Task ForceExternal Web Site Icon (2011)

NCCN Guideline Adobe PDF file [PDF 852.70 KB]External Web Site Icon (2013)

Philadelphia chromosome/busulfan chronic myelogenous leukemia PGx FDA-PGx Drug InformationExternal Web Site Icon(2003)
UGT1A1*28homozygotes/nilotinib Philadelphia chromosome positive chronic myeloid leukemia PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
FIP1L1-PDGFRα kinase/imatinib hypereosinophilic syndrome and/or chronic eosinophilic leukemia PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2013)
TPMT/thiopurines (mercaptopurine) acute lymphatic leukemia PGx-dose CPICExternal Web Site Icon (2011)

FDA-PGx Drug InformationExternal Web Site Icon(2011)

TPMT/thiopurines (thioguanine) acute, non-lymphocytic leukemias PGx-dose CPICExternal Web Site Icon (2011)

FDA-PGx Drug InformationExternal Web Site Icon(2004)

Cancer—Lung
KRAS mutations [except c38G>A]/anti-EGFR therapy non–small cell lung cancer predictive; prognostic NCCN Task ForceExternal Web Site Icon (2011)
Cancer—Melanoma
G6PD/dabrafenib unresectable or metastatic melanoma PGx FDA-PGx Drug InformationExternal Web Site Icon(2014)
family history of skin cancer skin cancer screening in adults risk prediction USPSTFExternal Web Site Icon (2009)
Cancer—Other
DPD testing/5-FU (capecitabine) Dukes’ C colon cancer, metastatic colorectal cancer, metastatic breast cancer PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
family history of bladder cancer bladder cancer screening risk prediction USPSTFExternal Web Site Icon (2011)
c-Kit D816V/imatinib aggressive systemic mastocytosis PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
TPMT/cisplatin metastatic testicular tumors, metastatic ovarian tumors, advanced bladder cancer PGx FDA-PGx Drug InformationExternal Web Site Icon(2011)
Cardiovascular
family history relevant to dyslipidemia (otherwise undefined) lipid screening in  infants, children, adolescents, or young adults (up to age 20) risk prediction USPSTFExternal Web Site Icon (2007)
first-degree family history of abdominal aortic aneurysm requiring surgical repair abdominal aortic aneurysm screening risk prediction USPSTFExternal Web Site Icon (2005)
SLCO1B1/simvastatin dyslipidemia PGx-dose CPICExternal Web Site Icon (2012)
CYP2C9, VKORC1/warfarin venous thrombosis, pulmonary embolism, thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement, myocardial infarction PGx-dose CMS CEDExternal Web Site Icon (2009)

ACMGExternal Web Site Icon (2008)

FDA-PGx Drug InformationExternal Web Site Icon

CPICExternal Web Site Icon (2011)

CYP2D6/metoprolol hypertension, angina pectoris, heart failure PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)
CYP2D6/carvedilol chronic heart failure, left ventricular dysfunction following myocardial infarction, hypertension PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)
CYP2D6/carvedilol chronic heart failure, left ventricular dysfunction following myocardial infarction, hypertension PGx FDA-PGx Drug InformationExternal Web Site Icon(2011)
CYP2D6/propafenone atrial fibrillation PGx FDA-PGx Drug InformationExternal Web Site Icon(2011)
CYP2C19/clopidogrel non-ST-segment elevation acute coronary syndrome, ST-elevation myocardial infarction, myocardial
infarction, stroke, peripheral arterial disease
PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)

CPICExternal Web Site Icon (2013)

AHRQExternal Web Site Icon (2013)

CYP2C19/prasugrel acute coronary syndrome managed with percutaneous coronary intervention PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2C19/tricagrelor acute coronary syndrome PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
LDLR/pravastatin hypercholesterolemia PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)
F5, SERPINC1/eltrombopag thrombocytopenia PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)
Endocrine disorders
G6PD/chlorpropamide glycemic control, type 2 diabetes in adults PGx FDA-PGx Drug InformationExternal Web Site Icon(2011)
G6PD/glimepiride glycemic control, type 2 diabetes in adults PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
G6PD/glipizide glycemic control, type 2 diabetes in adults PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
G6PD/glyburide glycemic control, type 2 diabetes in adults PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
Gastroenterology
CYP2C19/pantoprazole gastroesophageal reflux disease, pathological hypersecretory conditions PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2C19/omeprazole duodenal ulcer, gastric ulcer, gastroesophageal reflux disease PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2C19/esomeprazole gastroesophageal reflux disease, NSAID-associated gastric ulcer, duodenal ulcer recurrence, pathological hypersecretory
conditions
PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)
CYP2C19/rabeprazole gastroesophageal reflux disease, duodenal ulcers, pathological hypersecretory conditions PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2C19, CYP1A2/dexlansoprazole erosive esophagitis, heartburn PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
Infectious Disease
G6PD/chloroquine phosphate malaria, extraintestinal amebiasis PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
G6PD/dapsone (tablet) leprosy PGx FDA-PGx Drug InformationExternal Web Site Icon

DailyMedExternal Web Site Icon (2011)

G6PD/mafenide acetate (for 5% topical solution) bacterial infections PGx FDA-PGx Drug InformationExternal Web Site Icon(1998)
G6PD/nitrofurantoin antibacterial, specific urinary tract infections PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
G6PD/primaquine vivax malaria, radical cure (prevention of relapse) PGx FDA-PGx Drug InformationExternal Web Site Icon(2008)
G6PD/quinine sulfate uncomplicatedPlasmodium falciparum malaria PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
G6PD/sulfamethoxazole & trimethoprim bacterial infections PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
IL28B/boceprevir chronic hepatitis C genotype 1 PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
IL28B/telaprevir chronic hepatitis C genotype 1 PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
IL28B/peginterferon alfa-2b chronic hepatitis C PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2C19/voriconazole invasive aspergillosis, candidemia and disseminated candidiasis, esophageal candidiasis,Scedosporium apiospermum andFusarium spp. infection PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2011)
Neurology
CYP2C19/clobazam seizures associated with Lennox-Gastaut syndrome PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2013)
HLA-B*1502/phenytoin generalized tonic-clonic status epilepticus and for seizures that occur during neurosurgery; testing pertains to risk for certain serious dermatologic reactions, which may be higher in patients of Chinese or Asian ancestry PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
HLAB*1502/ carbamazepine epilepsy, other seizure disorders, trigeminal neuralgia, bipolar disorder PGx-dose CPICExternal Web Site Icon (2013)
CYP2D6, CYP2C19/diazepam epilepsy PGx FDA-PGx Drug InformationExternal Web Site Icon(2005)
CYP2D6/dextromethorphan and quinidine pseudobulbar affect PGx, PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2010)
Psychiatry
parental history of depression major depressive disorder screening in adolescents risk prediction USPSTFExternal Web Site Icon (2009)
family history of depression depression screening in adults risk prediction USPSTFExternal Web Site Icon (2009)
CYP2D6/amitriptyline depression PGx-dose CPICExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon

CYP2D6/desipramine depression PGx-dose CPICExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon(2012)

CYP2D6/fluoxetine major depressive disorder, obsessive compulsive disorder, bulimia nervosa, panic disorder PGx FDA-PGx Drug InformationExternal Web Site Icon(2009)
CYP2D6/imipramine depression PGx-dose CPICExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon(2012)

CYP2D6/nortriptyline depression PGx-dose CPICExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon(2012)

CYP2D6/trimipramine depression PGx-dose CPICExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon(2012)

CYP2D6/venlafaxine major depressive disorder, social anxiety disorder PGx, PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2012)
CYP2C19, CYP2D6/citalopram depression PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2012)
CYP2D6/aripiprazole schizophrenia, bipolar I disorder, major depressive disorder, autistic disorder PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2D6/clozapine schizophrenia, schizoaffective disorder PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2D6/iloperidone schizophrenia PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2D6/risperidone schizophrenia, bipolar I disorder, autistic disorder PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2012)
CYP2D6/atomoxetine attention-deficit/hyperactivity disorder PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2D6/clomipramine obsessive-compulsive disorder PGx-dose CPICExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon(2012)

CYP2D6, CYP2C19/fluvoxamine obsessive compulsive disorder PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)
CYP2D6, CYP2C19/doxepin insomnia PGx-dose CPICExternal Web Site Icon (2013)

FDA-PGx Drug InformationExternal Web Site Icon(2010)

CYP2D6/modafinil narcolepsy, obstructive sleep apnea, and shift work disorder PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2010)
Rheumatology
CYP2C19/carisoprodol musculoskeletal conditions PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2C9/celecoxib osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, acute pain, primary dysmenorrhea PGx-dose FDA-PGx Drug InformationExternal Web Site Icon(2011)
CYP2C9/flurbiprofen rheumatoid arthritis, osteoarthritis PGx FDA-PGx Drug InformationExternal Web Site Icon(2010)
TPMT/thiopurines (azathioprine) renal homotransplantation, rheumatoid arthritis PGx-dose CPICExternal Web Site Icon (2011)

FDA-PGx Drug InformationExternal Web Site Icon(2011)

Other
family history of developmental dysplasia of the hip developmental dysplasia of the hip screening in infants risk prediction USPSTFExternal Web Site Icon (2006)
family history of diabetes gestational diabetes screening risk prediction USPSTFExternal Web Site Icon (2008)
family history of neonatal jaundice Hyberbilirubinemia screening in infants; prevention of chronic bilirubin encephalopathy risk prediction USPSTFExternal Web Site Icon (2009)
family history of age-related macular degeneration visual acuity screening in older adults risk prediction USPSTFExternal Web Site Icon (2009)
family history of chronic kidney disease chronic kidney disease screening risk prediction USPSTFExternal Web Site Icon (2012)
family history for common diseases common diseases risk prediction NIH State of the ScienceExternal Web Site Icon (2009)
CYP2D6/tolterodine overactive bladder PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)
HPRT1/mycophenolic acid organ rejection PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2C19/drospirenone and ethinyl estradiol pregnancy prevention, premenstrual dysphoric disorder, moderate acne PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)
UGT1A1/indacaterol chronic obstructive pulmonary disease, including chronic bronchitis and/or emphysema PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)
CYP2D6/codeine pain PGx-dose CPICExternal Web Site Icon (2012)

FDA-PGx Drug InformationExternal Web Site Icon(2013)

CYP2D6/tramadol and acetaminophen acute pain PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
CYP2D6/cevimeline dry mouth in patients with Sjögren’s Syndrome PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
DPD/fluorouracil cream multiple
actinic or solar keratoses
PGx FDA-PGx Drug InformationExternal Web Site Icon(2003)
G6PD/dapsone (gel) acne vulgaris PGx FDA-PGx Drug InformationExternal Web Site Icon(2009)
G6PD/dapsone (tablet) dermatitis herpetiformis PGx FDA-PGx Drug InformationExternal Web Site Icon

DailyMedExternal Web Site Icon (2011)

G6PD/(polyethylene glycol 3350, sodium sulfate, sodium chloride, potassium chloride, sodium ascorbate, & ascorbice acid for oral solution) laxative, preparation for colonoscopy in adults PGx FDA-PGx Drug InformationExternal Web Site Icon(2013)
G6PD/sodium nitrite life-threatening, acute cyanide poisoning PGx FDA-PGx Drug InformationExternal Web Site Icon(2012)
G6PD/succimer lead poisoning, pediatric PGx FDA-PGx Drug InformationExternal Web Site Icon(2007)
next generation sequencing/whole genome sequence various rare familial diseases diagnostic BCBS TEC Adobe PDF file [PDF 210.52 KB]External Web Site Icon(2013)
various molecular, cytogenetic biochemical and other tests** single gene disorders and chromosomal abnormalities where diagnosis and management may require use of genetic tests even without formal evidence synthesis and reviews by evidence panels diagnosis, management, carrier testing NIH GTRExternal Web Site Icon (2013)

*Pharmacogenomic applications have been classified in the Use column as either PGx (which may relate to drug choice, prevention of adverse events, or other uses of the information gained through testing), or PGx-dose (when specific dosing-related guidance is provided, or mention of a potential effect on dose is noted in the evidence sources cited). Additional Use categories include: screening, cascade testing, risk prediction, diagnostic, and prognostic.

**This entry includes many genetic disorders for which there are no evidence-based recommendations, clinical guidelines or systematic reviews. However, a systematic search for evidence-based recommendations and reviews has not been conducted to date by our office. We expect further refinements in this classification in the near future.

Source Abbreviations: Agency for Healthcare Research and Quality (AHRQ), American College of Medical Genetics and Genomics (ACMG), American Society of Clinical Oncology (ASCO), Centers for Medicare and Medicaid Services (CMS), Clinical Pharmacogenetics Implementation Consortium (CPIC), Evaluation of Genomic Applications in Practice and Prevention (EGAPP), National Comprehensive Cancer Network (NCCN), National Institute for Health and Care Excellence (NICE), National Institutes of Health (NIH), Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC), US Department of Health and Human Services (DHHS), US Food and Drug Administration (FDA), United States Preventive Services Task Force (USPSTF)

Tier 3/Red category: represents genomic and family health history applications either have synthesized evidence culminating in recommendations against use (or discouraging use), OR no relevant synthesized evidence was identified. Such applications are not ready for routine practice, but may be considered in clinical and population research.
Gene, Gene/Drug, Test, or Family History Disorder/Indication Use* Synthesized Evidence Sources
HFE hereditary hemochromatosis population screening USPSTFExternal Web Site Icon (2006)
routine BRCA genetic counseling, routine BRCA testing Hereditary breast/ovarian cancer, in women whose family history is not associated with an increased risk of BRCA mutations population screening USPSTFExternal Web Site Icon (2013)
panels for various genetic risk factors common diseases risk assessment, disease prevention Multiple sources, for example:EGAPPExternal Web Site Icon (2010)
next generation sequencing/whole genome sequence various common diseases risk prediction Rapidly evolving landscape; gaps in knowledge exist for analytic validity, clinical validity and clinical utility
SNP panels type 2 diabetes risk prediction EGAPP Adobe PDF file [PDF 242.05 KB]External Web Site Icon (2013)
TCF7L2 genotyping type 2 diabetes risk prediction EGAPP Adobe PDF file [PDF 242.05 KB]External Web Site Icon (2013)
NRAS or PIK3CA mutation analysis and/or testing for loss of PTEN or AKT protein expression/anti-EGFR therapy metastatic colorectal cancer PGx EGAPP Adobe PDF file [PDF 456.16 KB]External Web Site Icon (2013)

Systematic reviewExternal Web Site Icon (2011)

CYP450 testing/SSRIs non-psychotic depression PGx, PGx-dose EGAPPExternal Web Site Icon (2007)
tumor gene expression analysis (Prolaris®, Oncotype Dx® Prostate prostate cancer prognostic, management BCBS TECExternal Web Site Icon (2014)
emerging genomic tests in the CDC’sGAPP FinderExternal Web Site Icon of theGAPP Knowledge BaseExternal Web Site Icon various disorders various uses Almost all of these applications (except when listed above) have insufficient information on analytic or clinical validity, or clinical utility

*Pharmacogenomic applications have been classified in the Use column as either PGx (which may relate to drug choice, prevention of adverse events, or other uses of the information gained through testing), or PGx-dose (when specific dosing-related guidance is provided, or mention of a potential effect on dose is noted in the evidence sources cited). Additional Use categories include: screening, cascade testing, risk prediction, diagnostic, and prognostic.

Source Abbreviations: Agency for Healthcare Research and Quality (AHRQ), American College of Medical Genetics and Genomics (ACMG), American Society of Clinical Oncology (ASCO), Centers for Medicare and Medicaid Services (CMS), Clinical Pharmacogenetics Implementation Consortium (CPIC), Evaluation of Genomic Applications in Practice and Prevention (EGAPP), National Comprehensive Cancer Network (NCCN), National Institute for Health and Care Excellence (NICE), National Institutes of Health (NIH), Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC), US Department of Health and Human Services (DHHS), US Food and Drug Administration (FDA), United States Preventive Services Task Force (USPSTF)

Other Abbreviations: estrogen receptor (ER), progesterone receptor (PgR), pharmacogenomics (PGx), single-nucleotide polymorphism (SNP)

Connie Dello Buono

Prevent vascular disease, manage inflammation, get GYV health caps to boost ATP cells performance and speedy repair of your body, email connie to get the caps and join in spreading the benefits with extra income for you at motherhealth@gmail.com and text 408-854-1883

Physician assistants, growing service professionals for patient safety

  • A physician assistant (or PA) is a nationally certified and state-licensedmedical professional. PAs practice medicine on healthcare teams withphysicians and other providers. They practice and prescribemedication in all 50 states, the District of Columbia and all U.S. territories, with the exception of Puerto Rico.
  • Dear PA,
  • Your service is very important to promote patient safety
  • Please contact me at 408-854-1883 motherhealth@gmail.com for toxicology and pharmacogenetic tests (now FDA approved and insurance covered) to promote patient safety and prevent adverse drug reactions.

Regards,

  • Connie Dello Buono,
  • Certified rep for pactox and medxprime.com/clubalthea
  • vistaprint business card
  • PA

Toxicology test for pregnant women

A toxicology screen is a test used to determine if an individual has been exposed to certain legal or illegal drugs. Toxicology screens are usually ordered to see if a patient has taken drugs that could endanger his or her health. If a patient is suspected of taking illegal drugs, a screen for specific drugs that are commonly abused may be ordered.

Toxicology screens are often ordered by hospital emergency department personnel when a patient appears to be impaired or is unconscious. Testing is also done in patients who have a change in mental status, in cases of seizures, and onset of dementia. Toxicology testing can also be useful in cases of suspected sexual assault.

In some cases, a patient may have been exposed to a prescription drug accidentally or overdose may be suspected. Some employers require random drug screening. Employees who test positive for illegal drug abuse may be suspended or fired.

The test can be performed fairly quickly. Results can help doctors treat the patient effectively and safely.

 Types of Toxicology Screens

There are several types of toxicology screens. Most screening methods use a sample of urine to test for the presence of illegal narcotics or prescription drugs. Some, like the blood alcohol test, can determine the precise concentration of a particular drug. Others, like the urine screen, can indicate if a person has been exposed to drugs or poisons. Drug screens can also be performed on saliva.

One common type of toxicology test looks for evidence of alcohol abuse by a mother during pregnancy. Her newborn’s first stool is examined to predict a condition called fetal alcohol syndrome.

Most screens provide limited information about how much or how often a patient has taken a drug. Once the presence of a drug has been identified by screening, the doctor may order a more specific test, which will show exactly how much of the drug is present in the patient’s system.

The contents of the stomach may also be screened when doctors suspect a patient may have taken a drug orally.

How Samples for Toxicology Screens Are Obtained

Some toxicology screens are obtained by doing blood tests, which involve drawing one or more small tubes of blood. A medical professional inserts a needle into a vein and removes enough blood to perform the necessary tests.

If a urine sample is required, the patient may be asked to urinate into a small sample cup in the presence of law enforcement or medical personnel. This prevents the patient from tampering with the sample.

Types of Drugs Screened

Many types of drugs can be identified by toxicology screens. Depending on the drug, it may show up in the blood or urine hours or weeks after exposure to the drug. For example, alcohol is eliminated from the body relatively rapidly. It’s necessary to draw blood within about three hours of an automobile accident to accurately reflect a patient’s blood alcohol status at the time of the incident.

Other drugs, such as THC, a component of marijuana, may show up in urine for months after exposure. How long THC remains detectable depends on whether the patient is a heavy user.

Common classes of drugs that may be detected by toxicology screens include:

  •  alcohol (including ethanol and methanol)
  • amphetamines (such as Adderall)
  • barbiturates
  • benzodiazepines
  • methadone
  • cocaine
  • opiates (including codeine, oxycodone, heroin)
  • phencyclidine (PCP)
  • tetrahydrocannabinol (THC)

———–

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acog org mortality

Chemicals taking a toll on reproductive health

Chemicals from a variety of sources are having an increasingly negative effect on human health—especially in children—so ob-gyns need to step up efforts to reverse this trend through advocacy and education, said Linda C. Giudice, MD, PhD, during the Donald F. Richardson Memorial Lecture on Monday, May 6, at the Annual Clinical Meeting.

Dr. Giudice presented “Environmental Chemical Effects on Reproductive Health Outcomes: Strength of the Evidence and What We Can Do for Our Patients, Learners, and Communities.” She is the Robert B. Jaffe, MD, Endowed Professor in the Reproductive Sciences at the University of California, San Francisco.

“Our scientists are taking a good look at the data and are finding trends that are disconcerting. We now have an opportunity to do something,” she said, pointing out that since lead was phased out of gasoline in 1973, blood lead levels have plummeted. “We can transform exposures.”

In the past 20 years, impaired fecundity in the US has increased from 8% to 12%, and 90% of that change has come in the 15–24 age group. In males, sperm counts and testosterone levels have declined about 1% per year in recent decades, Dr. Giudice said. At the same time, hypospadias and testicular germ cell tumors have increased.

“Malformations of the male reproductive system are among the most common birth defects today,” she said.

In adults, unhealthy trends have also developed. Prostate and breast cancers are increasing, and aggressive breast cancer has increased 36%.

Today, 80,000 chemical substances are registered for use in US commerce, and 700 new industrial chemicals are introduced into commerce each year. However, these chemicals are not monitored closely. “It is only when something happens and there are questions that this product or chemical is looked into in more depth,” Dr. Giudice said.

Evidence for adverse reproductive outcomes from exposure to endocrine-disrupting chemicals is strong, she said. “What can we as health professionals do? I think we can strengthen professional education in reproductive and environmental health at the undergraduate and medical education levels and at the graduate medical education level,” Dr. Giudice said. “I think we should share what we know with our patients. We should together advocate for chemical policy reform.”

Call to Action

Those who attend the Edith Louise Potter Memorial Lecture will be left with a challenge. Presenters Mary E. D’Alton, MD, New York, NY, and Sarah J. Kilpatrick, MD, PhD, Los Angeles, are hoping attendees are moved to action after hearing the lecture, “Maternal Morbidity and Mortality in the US: Time to Wake Up and Take the Lead,” from 11:15 am to 12:15 pm Tuesday in Skyline Ballroom (ABC).

“What I’m going to present is a plan that we believe every birthing center, hospital, and facility that delivers babies in the US should have within three years,” Dr. D’Alton said. “It’s going to focus on efforts that we believe will have a significant impact on reducing maternal mortality and morbidity.”

Dr. D’Alton said data suggest that maternal mortality has been increasing in the US during the last decade and serious maternal morbidity has increased even more so.

“We believe this is for several reasons, but some of it is related to the increased age of mothers as they become pregnant, so they have higher incidence of comorbidities such as diabetes and hypertension, and also the national epidemic of obesity,” she said.

As a result of these increases, ACOG is joining several other societies to form the National Partnership for Maternal Safety.

“We felt because of there being no minimal progress in this area that all societies that deliver care to women needed to come together to make a plan,” Dr. D’Alton said. “The energy behind this is palpable right now. … The challenge before us is implementation.”

Dr. D’Alton knows not all maternal mortalities and morbidities are preventable, but the partnership’s goal is to reduce those that are preventable by 50% in five years.

Future of Patient Safety

Today, Joanna M. Cain, MD, will take her ACM attendees on a journey six years into the future for a unique, forward-thinking look at patient safety.

Dr. Cain’s one-hour presentation is this year’s Morton and Diane Stenchever Lecture. “Keeping Our Patients Safe: Key Actions for Ob-Gyn for All Stages and Sites of Patient Care,” begins at 4 pm in Ballroom ABC. It will examine the direction patient safety is going—and what it could look like in the year 2020.

Dr. Cain’s presentation will cover actions that ob-gyns need to take to change how they educate students and residents and how they manage their own practice, taking into consideration the effects of all the new technology. How does that influence patient safety and how ob-gyns deliver care in the future?

Dr. Cain said present day is a tumultuous time in medicine because of technological innovations such as electronic medical records, and even Google Glass, the computerized eyewear. These technologies may affect students’ education and help train and evaluate ob-gyn surgical competence.

“How we teach is changing,” Dr. Cain said. “The cost of education is probably too high, so how we structure our future will make a difference in making sure we have a pipeline for the future.”

Dr. Cain will emphasize education that equips residents to be leaders in safety education and will discuss restructuring ambulatory practices. She’ll also look at what role ACOG’s Safety Certification in Outpatient Practice Excellence for Women’s Health Program (SCOPE) might play down the road.

The look ahead offers the chance for several intriguing “what-if” questions.

“What if, instead of seeing students as sort of a burden to practice, what if they came with skills that we could leverage to make practices safer?” Cain said. “What if they knew those skills from early on? What if medical schools worked together in the first years and shared a similar national curriculum with flipped classrooms?

“And what would it look like if there were students in almost every practice in the country and that’s how we educated students—and they were the front line of making sure we continue to improve safety and quality?”


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200 top prescribed meds and pharmacogenetic tests to prevent reactions

Avail of pharmacogenetic and toxicology tests to reduce adverse drug reactions and to promote patient safety for the following 200 top prescribed meds. Contact Connie Dello Buono if you are a doctor or med rep at motherhealth@gmail.com 408-854-1883.

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Top 200 Drugs

  1. Misoprostol  325
  2. Oxycodone  3461
  3. Hydrocodone  1936
  4. Xanax Alprazolam  1674
  5. Percocet Acetaminophen + Oxycodone  1187
  6. Tramadol  818
  7. Methamphetamine  210
  8. Suboxone Buprenorphine  1429
  9. Viagra Sildenafil  257
  10. Methadone  1568
  11. Acetaminophen  2081
  12. Morphine  1384
  13. OxyContin Oxycodone  1003
  14. Cytotec Misoprostol  269
  15. Alprazolam  665
  16. Adderall Amphetamine + Dextroamphetamine  641
  17. Subutex Buprenorphine  376
  18. Gabapentin  578
  19. Clonazepam  680
  20. Dilaudid Hydromorphone  512
  21. Norco Acetaminophen + Hydrocodone  541
  22. Priligy Dapoxetine  5
  23. Cyclobenzaprine  322
  24. Vicodin Acetaminophen + Hydrocodone  750
  25. Amphetamine  350
  26. Amoxicillin  702
  27. Roxicodone Oxycodone  254
  28. Opana Oxymorphone Hydrochloride  450
  29. Cocaine  205
  30. Diazepam  369
  31. Valium Diazepam  504
  32. MiraLax Polyethylene Glycol  26
  33. Neurontin Gabapentin  166
  34. Naproxen  549
  35. Diclofenac  392
  36. Klonopin Clonazepam  383
  37. Sulfamethoxazole  422
  38. Phentermine  375
  39. Methocarbamol  215
  40. Ibuprofen  609
  41. Fentanyl  445
  42. Metoprolol  620
  43. Hydroxyzine  260
  44. Amitriptyline  308
  45. Lorazepam  349
  46. Citalopram  349
  47. Progesterone  239
  48. Vyvanse Lisdexamfetamine Dimesylate  182
  49. Metronidazole  199
  50. Escitalopram  179
  51. Meloxicam  205
  52. Lupron Leuprolide  4
  53. Aspirin  705
  54. Prednisone  379
  55. Lyrica Pregabalin  415
  56. Dinintel Clobenzorex  72
  57. Etoshine Etoricoxib  37
  58. Metformin  625
  59. Promethazine  197
  60. Trazodone  266
  61. Cephalexin  201
  62. Lortab Acetaminophen + Hydrocodone  585
  63. Amlodipine  409
  64. Drixoral Cold & Allergy Dexbrompheniramine + Pseudoephedrine  39
  65. Doxycycline  284
  66. Tizanidine  133
  67. Hydromorphone  188
  68. Ciprofloxacin  208
  69. Lisinopril  483
  70. Acetaminophen + Hydrocodone  18
  71. Buprenorphine  78
  72. Soma Carisoprodol  288
  73. Pregabalin  174
  74. Butalbital  60
  75. Penicillin  294
  76. Diphenhydramine  152
  77. Quetiapine  88
  78. Pantoprazole  189
  79. Cyproheptadine  81
  80. Paracetamol Acetaminophen  288
  81. Baclofen  136
  82. Oxytocin  11
  83. Sertraline  213
  84. Buspirone  113
  85. Codeine  259
  86. Falmina Ethinyl Estradiol + Levonorgestrel  1
  87. Zolpidem  270
  88. Folic Acid  286
  89. Clonidine  178
  90. Augmentin Amoxicillin + Clavulanic Acid  185
  91. Nidol Nimesulide  1
  92. Vitamin E  172
  93. Azithromycin  133
  94. Oxymorphone  74
  95. ECASA Aspirin
  96. Atorvastatin  214
  97. Omeprazole  238
  98. Tylenol Acetaminophen  545
  99. Dexamethasone  90
  100. Cheratussin AC Codeine + Guaifenesin  19
  101. Doxytetracycline Doxycycline  10
  102. Seroquel Quetiapine  199
  103. Clindamycin  127
  104. Montelukast  99
  105. Carisoprodol  110
  106. Mirtazapine  169
  107. Guaiatussin AC Codeine + Guaifenesin  1
  108. Butesin Picrate Butamben Picrate  11
  109. Ativan Lorazepam  205
  110. Aceclofenac  108
  111. Zubsolv Buprenorphine + Naloxone  27
  112. Propranolol  180
  113. Bupropion  196
  114. Levothyroxine  363
  115. Methylphenidate  126
  116. Dextroamphetamine  55
  117. Lo Loestrin Fe Norethindrone Acetate + Ethinyl Estradiol and Ethinyl Estradiol + Ferrous Fumarate  304
  118. Wellbutrin Bupropion  119
  119. Cetirizine  119
  120. Sildenafil  76
  121. Endocet Acetaminophen + Oxycodone  113
  122. Chlordiazepoxide  63
  123. Sibutramine  143
  124. Opcon-A Naphazoline + Pheniramine
  125. Rabeprazole  107
  126. Losartan  262
  127. Telmisartan  158
  128. Ranitidine  204
  129. Flexeril Cyclobenzaprine  99
  130. Arthrexin Indomethacin  10
  131. Dicyclomine  103
  132. Loperamide  63
  133. Concerta Methylphenidate  99
  134. Chlorpheniramine  113
  135. Ambien Zolpidem  221
  136. Acetylcysteine  38
  137. Chlorzoxazone  57
  138. Fluoxetine  172
  139. Brintellix Vortioxetine  14
  140. MS Contin Morphine  133
  141. Histamine Dihydrochloride  1
  142. Bactrim Sulfamethoxazole + Trimethoprim, SMX-TMP  204
  143. Pseudoephedrine  107
  144. Oxymetazoline  2
  145. Spasmoctyl Otilonium Bromide  7
  146. Nitrofurantoin  204
  147. Acid Mantle Creme Aluminum Acetate, Burow’s Solution  1
  148. Clopidogrel  98
  149. Niacin Niacinamide  37
  150. Temazepam  117
  151. Nimesil Nimesulide  3
  152. Phenylephrine  75
  153. Ondansetron  75
  154. Cefixime  87
  155. Levetiracetam  60
  156. BuSpar Buspirone  43
  157. Adderall XR Amphetamine + Dextroamphetamine  27
  158. Hydroxychloroquine  43
  159. Acetaminophen + Oxycodone  12
  160. Purbac Sulfamethoxazole + Trimethoprim, SMX-TMP  79
  161. Guaifenesin  196
  162. Cymbalta Duloxetine  212
  163. Fioricet Acetaminophen + Butalbital + Caffeine  94
  164. Topiramate  55
  165. Furosemide  149
  166. Lexapro Escitalopram  214
  167. Darvocet Acetaminophen + Propoxyphene  176
  168. Trimethoprim  141
  169. Phendimetrazine  39
  170. Lamotrigine  85
  171. Hypotears Artificial Tears  4
  172. Ephedrine  88
  173. Levofloxacin  67
  174. Hyoscyamine  73
  175. Sudafed Pseudoephedrine  65
  176. Buro-Sol Aluminum Acetate, Burow’s Solution  2
  177. Ampicillin  76
  178. Colistimethate Colistimethate Sodium
  179. Xanax XR Alprazolam XR  2
  180. Codeine + Promethazine
  181. Urimax Hyoscyamine + Methenamine + Methylene Blue + Phenyl Salicylate + Sodium Biphosphate  41
  182. Testosterone  78
  183. Domperidone  59
  184. Atenolol  186
  185. Ofloxacin  63
  186. Robaxin Methocarbamol  44
  187. Dextromethorphan  64
  188. Biphetamine Amphetamine + Dextroamphetamine  2
  189. Borofax Boric Acid  13
  190. Sprintec Ethinyl Estradiol + Norgestimate  214
  191. Ritalin Methylphenidate  152
  192. Aspergum Aspirin  11
  193. Methylprednisolone  84
  194. Melatonin  62
  195. Propoxyphene  103
  196. Cialis Tadalafil  87
  197. Biotin  66
  198. Asthalin Salbutamol  23
  199. Benadryl Diphenhydramine  108
  200. Quinine  70