Pharmacogenomics is playing an increasingly important role in clinical practice, and pharmacists are uniquely positioned to lead the way in integrating pharmacogenomics testing to improve medication-related outcomes. With the incorporation of pharmacogenomics data into drug development, approval processes, and labeling, the need to integrate pharmacogenomics into clinical practice is becoming more evident.

The Clinical Pharmacogenetics Implementation Consortium (CPIC), established in 2009 by the National Institutes of Health (NIH) and the Pharmacogenomics Knowledge Base, has been at the forefront of providing guidelines for clinical care incorporating pharmacogenomics testing. CPIC has published over 28 guidelines summarizing evidence and recommendations for pharmacogenomics testing, including guidance related to cardiovascular medications such as clopidogrel, statins, and beta-blockers.

Clopidogrel, a commonly used P2Y12 inhibitor, requires hepatic biotransformation to its active metabolite by the enzyme CYP2C19. Patients with a CYP2C19 loss-of-function (LOF) genotype may experience reduced antiplatelet effects and clinical outcomes due to their inability to metabolize clopidogrel effectively. Recent updates in CPIC guidelines strongly recommend avoiding clopidogrel in patients with acute coronary syndrome (ACS) and those undergoing percutaneous coronary intervention (PCI) who are CYP2C19 intermediate metabolizers and poor metabolizers (PMs).

Furthermore, CPIC provides a moderate recommendation to consider alternative antiplatelet therapy over clopidogrel in patients with stroke or transient ischemic attack for treatment or prevention. The benefits of using alternative medications such as prasugrel or ticagrelor over clopidogrel have been highlighted in various clinical trials, especially in patients with CYP2C19 LOF genotype.

Pharmacists’ involvement in integrating pharmacogenomics testing into cardiology clinical practice holds significant potential to optimize medication therapy and improve patient outcomes. As pharmacogenomics continues to shape the future of personalized medicine, the role of pharmacists in this field is expected to expand, ultimately benefiting patients through tailored medication management.