Alzheimer’s Disease

Alzheimer’s disease is the most common type of dementia. Dementia is a progressive neurological disease which includes declines in multiple brain functions, including memory. It is a progressive condition, which means the symptoms develop gradually and become more severe over the course of several years. As the condition develops, memory problems become more severe and further symptoms can develop, such as confusion, difficulty planning or making decisions, problems with speech and language, problems with moving around and self-care tasks, personality changes, hallucinations and delusions, and low mood or anxiety. The exact cause of Alzheimer’s disease is unknown. 

TREATMENT 

There is no cure for Alzheimer’s disease, but medication is available that can help relieve some of the symptoms and slow down the progression of the condition in some people.  

The TreatGx algorithm for Alzheimer’s type dementia includes pharmacotherapy options for the treatment of cognitive symptoms for adults with a diagnosis of Alzheimer’s type dementia. It does not include treatment options for co-morbid conditions, or behavioural or psychological symptoms associated with Alzheimer’s disease. It does not include medication options for those who are pregnant or breastfeeding. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.  

Medications* for the treatment of Alzheimer’s type dementia include:

• Donepezil (Aricept, generics)
• Galantamine (Razadyne, Razadyne ER, generics)
• Rivastigmine (Exelon, generics)
• Memantine (Ebixa, Namenda, Namenda XR, generics)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Anxiety Disorders

There are several different types of anxiety disorders including generalized anxiety disorder, social anxiety disorder, and post-traumatic stress disorder. Feelings of anxiety can interfere with daily activities such as job performance, school work, and relationships.

TREATMENT

Treatment options vary based on type and severity of anxiety and can include psychotherapy, guided self-help, medication or a combination of treatments. These algorithms do not include treatment options for acute anxiety attacks or other types of anxiety such as panic disorder or obsessive-compulsive disorder. After the decision has been made to initiate a medication, these algorithms can be used to help health care providers select the safest and most effective medications for the individual. These algorithms are not developed for use with children, adolescents, or those who are pregnant or breastfeeding. Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is a long-term condition that can make you feel anxious about a wide range of situations and issues, rather than one specific event. Symptoms may include feeling restless, being irritable, getting tired easily, difficulty in concentrating or feeling your mind goes blank, difficulty sleeping, or experiencing tense muscles. The TreatGx algorithm for Anxiety – Generalized Anxiety Disorder includes pharmacotherapy options for adults with generalized anxiety disorder.

Medications* for the treatment of general anxiety disorder include:

• Buspirone
• Clonazepam (Rivotril, Klonopin)
• Diazepam (Valium)
• Duloxetine (Cymbalta, Drizalma)
• Escitalopram (Cipralex, Lexapro)
• Fluoxetine (Prozac)
• Hydroxyzine (Atarax, Vistaril)
• Imipramine (Tofranil)
• Mirtazapine (Remeron)
• Paroxetine (Paxil)
• Pregabalin (Lyrica)
• Quetiapine (Seroquel)
• Sertraline (Zoloft)
• Venlafaxine (Effexor XR)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Social Anxiety Disorder

Social anxiety disorder (SAD), also called social phobia, is a long-lasting and overwhelming fear of social situations. It is a common problem that usually starts during the teenage years. For some people, it gets better as they get older, although for many it does not go away on its own. The TreatGx algorithm for Anxiety – Social Anxiety Disorder includes pharmacotherapy options for adults with social anxiety disorder.

Medications* for the treatment of social anxiety disorder include:

• Clonazepam
• Citalopram (Celexa)
• Escitalopram (Cipralex, Lexapro)
• Fluvoxamine (Luvox)
• Moclobemide (Manerix)—CAN only
• Paroxetine (Paxil)
• Phenelzine
• Pregabalin
• Sertraline (Zoloft)
• Venlafaxine (Effexor XR)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) may develop after being involved in or witnessing traumatic events such as combat, natural disasters, serious accidents, terrorist attacks, or physical or sexual assault. PTSD can cause a variety of symptoms including flashbacks to the traumatic event, avoidance of triggering situations, hypervigilance, abnormal fear, feeling of numbness, irritability, anger, difficulty concentrating, feeling overwhelmed by small tasks, isolating from other people, and is also associated with co-morbidities such as depression, anxiety, sleep disturbances, and panic attacks. The TreatGx algorithm for Anxiety – Post-Traumatic Stress Disorder includes psychotherapy and pharmacotherapy options for adults diagnosed with chronic PTSD. Psychotherapy is the preferred treatment option for most patients using trauma-focused cognitive behavioral therapy (TFCBT) or eye movement desensitization and reprocessing (EMDR), and pharmacotherapy options are available if psychotherapy is not feasible.

Medications* for the treatment of post-traumatic stress disorder include:

• Amitriptyline
• Imipramine (Tofranil)
• Fluoxetine (Prozac)
• Mirtazapine (Remeron)
• Nefazodone—USA only
• Paroxetine (Paxil)
• Phenelzine (Nardil)
• Risperidone (Risperdal)
• Sertraline (Zoloft)
• Venlafaxine (Effexor XR)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Asthma

Asthma is a common lung condition that causes occasional breathing difficulties. It affects people of all ages and often starts in childhood, although it can also develop for the first time in adults. There’s currently no cure, but there are simple treatments that can help keep the symptoms under control. The main symptoms of asthma are wheezing, breathlessness, a feeling of tightening around the chest, and coughing. The symptoms can sometimes get temporarily worse; this is known as an asthma attack.

TREATMENT

Asthma is usually treated by using an inhaler, which is a small device that lets you breathe in medicines. Some people also need to take tablets. The main types of inhaler are:

• • reliever inhalers – used when needed to quickly relieve asthma symptoms for a short time
  • preventer inhalers – used every day to prevent asthma symptoms from occurring

The TreatGx algorithm for Asthma – Adults & Adolescents includes stepwise pharmacotherapy options for maintenance therapy in persons who are 12 years of age or older with a diagnosis of asthma. It does not include treatment options for status asthmaticus or severe acute exacerbations. This algorithm is not developed for use with children under the age of 12, or those who are pregnant or breastfeeding.
The TreatGx algorithm for Asthma – Pediatric includes pharmacotherapy options for maintenance therapy in children aged 1 to 11 years with a diagnosis of asthma. It does not include treatment options for children under 1 year of age, for status asthmaticus or for asthma exacerbations.
Any decision about you or your child’s medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* for the treatment of asthma include:

• Albuterol (Accuneb, Proair, Proventil, Ventolin) – USA only
• Beclomethasone Dipropionate (Qvar)
• Budesonide (Pulmicort)
• Budesonide/Formoterol Fumarate (Symbicort)
• Ciclesonide (Alvesco)
• Dupilumab (Dupixent)
• Fluticasone Furoate (Arnuity)
• Fluticasone Furoate/Vilanterol (Breo)
• Fluticasone Propionate (Flovent, Armonair)
• Fluticasone Propionate/Salmeterol (Advair)
• Formoterol Fumarate (Foradil)
• Formoterol Fumarate Dihydrate (Oxeze) – CAN only
• Levalbuterol (Xopenex) – US only
• Mometasone Furoate (Asmanex)
• Mometasone Furoate/Formoterol Fumarate (Zenhale, Dulera)
• Montelukast (Singulair)
• Omalizumab (Xolair)
• Prednisone
• Salbutamol (Airomir, Ventolin) – CAN only
• Salmeterol (Serevent) only children
• Terbutaline (Bricanyl) – CAN only
• Theophylline (Theo-ER, Uniphyl)
• Tiotropium (Spiriva)
• Zafirlukast (Accolate) – USA only

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Atrial Fibrillation

Atrial fibrillation is a heart condition that causes an irregular heart rate or rhythm. In some cases, the heart rate can be considerably faster than normal and over 100 beats a minute. This can cause feelings of dizziness, shortness of breath, and tiredness. Other symptoms may include noticeable heart palpitations, where the heart feels like it’s pounding, fluttering or beating irregularly, often for a few seconds or, in some cases, a few minutes.

TREATMENT

Treatment of atrial fibrillation is aimed at decreasing symptoms and reducing complications, but not everyone may require medication therapy. Medications may be prescribed to control your heart rate, control the rhythm of your heart or to reduce your chance of having a stroke.
The TreatGx algorithm for Atrial Fibrillation – Anticoagulation includes pharmacotherapy options for reducing the risk of stroke in adults with atrial fibrillation. Anticoagulants are medicines that help prevent blood clots, thereby reducing the risk having a stroke or heart attack. It does not include therapy recommendations for persons currently taking antiplatelet agents or who require anticoagulation prior to undergoing cardioversion.
The TreatGx algorithm for Atrial Fibrillation – Rate Control includes pharmacotherapy options for adults using a long-term rate control strategy to reduce the symptoms of atrial fibrillation. It does not include therapy recommendations for acute management of rate control or cardioversion. It does not include therapy recommendations for rhythm control. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
The TreatGx algorithm for Atrial Fibrillation – Rhythm Control includes pharmacotherapy options for adults using a long-term rhythm control strategy to maintain sinus rhythm. It does not include therapy recommendations for acute rhythm control or for intermittent (pill-in-the-pocket) rhythm control. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
After the decision has been made to initiate a medication, these algorithms can be used to help health care providers select the safest and most effective medications for the individual.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness. Most cases are diagnosed when children are 6 to 12 years old. The symptoms usually improve with age but may persist into adulthood. People with ADHD may have additional problems, such as sleep and anxiety disorders.

TREATMENT

Although there is no cure for ADHD it can be managed with appropriate support and advice, and where necessary medication. Medicine is often the first treatment offered to adults with ADHD, although psychological therapies such as cognitive behavioral therapy may also help.
The TreatGx algorithm for ADHD includes pharmacotherapy options for persons who are 6 years of age or older with a diagnosis of ADHD. It does not include medication options for children under 6 years old, those who are pregnant or breastfeeding, or for persons with comorbid tics, Tourette syndrome, or autism. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* for the treatment of ADHD include:

• Atomoxetine (Strattera)
• Amphetamine/Dextroamphetamine (Adderall)
• Clonidine (Kapvay)
• Dextroamphetamine (Dexedrine)
• Guanfacine (Intuniv, Intuniv XR)
• Lisdexamfetamine (Vyvanse)
• Methylphenidate (Adhansia XR, Aptensio XR, Biphentin, Concerta, Contempla XR-ODT, Daytrana, Foquest, Jornay PM, Metadate CD, Methylin, Methylin ER, Quillichew ER, Quillivant XR, Ritalin)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Bipolar 1 Disorder

Bipolar 1 disorder is a disabling mental illness characterized by extreme mood swings that can cause substantial impairment in a patient’s interpersonal relationships. Symptoms depend on which mood you are experiencing. During a depressive episode, symptoms may include overwhelming feelings of worthlessness, low energy, sadness, hopelessness, irritability, and lack of motivation or interest in things. During a manic phase of bipolar disorder, you may feel very happy, have lots of energy, talk very quickly, not feel like eating or sleeping, spend large amounts of money on things you cannot afford and would not normally want, and become annoyed easily.

TREATMENT

The goal of therapy is to reduce the severity and number of high and low episodes a person with bipolar disorder will experience. Treatment options depend on the type and frequency of episodes. Psychological treatment in combination with medication can help control symptoms and reduce the frequency of mood swings.
The TreatGx algorithm for Bipolar 1 Disorder includes pharmacotherapy options for adults with mild to moderate acute manic episodes, major depressive episodes, and maintenance therapy. It does not include treatment options for bipolar II disorder, cyclothymia, hypomania, or mixed episodes. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual.  This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Chronic Pain

Fibromyalgia

Fibromyalgia has many symptoms that tend to vary from person to person. The main symptom is widespread pain. Other common symptoms include fatigue, stiffness, poor sleep quality, cognitive problems (“fibro-fog”), headaches, depression and digestive problems. 

TREATMENT

Because the presence and severity of symptoms can vary between people with fibromyalgia, a tailored approach to treatment is ideal. Treatment for fibromyalgia tries to ease symptoms and improve quality of life, but there’s currently no cure. Treatments that work for some people will not necessarily work for others. Education, exercise, and psychological therapies are often part of the management strategy in addition to medications which can be given to reduce pain and manage other symptoms. 

The TreatGx algorithm for Fibromyalgia includes pharmacotherapy options for adults who are experiencing chronic pain due to fibromyalgia. It does not include treatment options for other symptoms of fibromyalgia, such as fatigue or insomnia. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding. 

Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional. 

Medications* used for fibromyalgia include: 

• Amitriptyline (Elavil)
• Cyclobenzaprine (Flexeril)
• Duloxetine (Cymbalta, Drizalma Sprinkle)
• Gabapentin (Neurontin)
• Milnacipran (Savella)
• Pregabalin (Lyrica)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Low Back Pain

Chronic non-specific low back pain is constant or fluctuating back pain that persists for more than 3 months. It can lead to difficulty with normal daily activities and psychological distress.

TREATMENT

Staying active and doing back exercises and stretches are fundamental parts of therapy for the management of chronic low back pain. Exercise classes, manual therapy and psychological support may be recommended. Trying to relax is a crucial part of easing the pain as muscle tension caused by worrying about your condition may make things worse. Medications may be given to reduce pain and enable participation in activity.
The TreatGx algorithm for Low Back Pain includes pharmacotherapy options for adults who are experiencing chronic low back pain. It does not include treatment options for acute pain from a recent injury or for specific causes of low back pain, which should be addressed in addition to pain management. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* used for low back pain include:

• Capsaicin (Low-dose transdermal patch)
• Celecoxib (Celebrex)
• Codeine (Codeine Contin)
• Diclofenac (Voltaren)
• Diflunisal—USA only
• Duloxetine (Cymbalta, Drizalma Sprinkle)
• Etodolac—USA only
• Flurbiprofen
• Hydrocodone (Hysingla ER)—USA only
• Hydromorphone (Dilaudid, Exalgo, Hydromorph Contin)
• Ibuprofen (Advil, Ibu-Tab, Motrin)
• Indomethacin
• Ketoprofen
• Meloxicam (Mobic, Vivlodex)
• Morphine (Kadian, M-Eslon, Morphabond ER, Morphine SR, MS Contin, MS-IR, Statex)
• Nabumetone
• Naproxen (Aleve, Anaprox, Maxidol, Naprelan, Naprosyn)
• Oxycodone (Oxaydo, OxyContin, Oxy IR, OxyNeo, Roxicodone, Supeudol, Xtampza ER)
• Oxymorphone—USA only
• Piroxicam (Feldene)
• Sulindac
• Tapentadol (Nucynta)
• Tramadol (Conzip, Durela, Ralivia, Ultram, Zytram)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Neuropathic Pain

Chronic neuropathic pain stems from damage to, or dysfunction of, the nervous system. It includes conditions such as diabetic neuropathy, postherpetic neuralgia, phantom limb pain amongst others. The pain often appears out of proportion to the tissue injury and may be described as burning, stabbing, or shooting pain and is often associated with numbness, “pins and needles” and itching. Pain may also be deep and aching. Symptoms are long-lasting, typically persisting after resolution of the primary cause (if one was present).

TREATMENT

The symptoms and intensity of neuropathic pain can vary thus a tailored approach including for example, psychologic treatments, physical methods, antidepressants or anticonvulsants, and sometimes surgery may be used.
The TreatGx algorithm for Neuropathic Pain includes pharmacotherapy options for adults with chronic neuropathic pain. It does not include specific treatment options for nerve pain caused by trigeminal neuralgia. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* used for neuropathic pain include:

• Amitriptyline (Elavil)
• Capsaicin (Qutenza)—USA only
• Desipramine (Norpramin)
• Duloxetine (Cymbalta, Drizalma Sprinkle)
• Gabapentin (Neurontin)
• Hydromorphone (Dilaudid, Exalgo, Hydromorph Contin)
• Imipramine (Tofranil)
• Lidocaine (Lidoderm)—USA only
• Morphine (Kadian, M-Eslon, Statex, MS-IR, MS Contin, Morphabond)
• Nortriptyline (Aventyl, Pamelor)
• Oxycodone (Oxy IR, Oxycontin, Oxyneo, Supeudol, Targin, Roxicodone, Xtampza)
• Pregabalin (Lyrica)
• Tapentadol (Nucynta)
• Tramadol (Conzip, Durela, Ralivia, Ultram, Zytram)
• Venlafaxine (Effexor XR)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Trigeminal Neuralgia

Trigeminal neuralgia is sudden, severe facial pain. In most cases, only one side of the face is affected, usually the lower parts of the face near the jaw, teeth or gums. It is often described as a sharp, shooting or electric shock-like pain that can occur suddenly or can be triggered by movement or touch. It usually happens in short, unpredictable attacks that can last from a few seconds to about 2 minutes. The attacks stop as suddenly as they start.

TREATMENT

Trigeminal neuralgia is usually a long-term condition and the periods of remission often get shorter over time. However, the treatments available do help most cases to some degree.
The TreatGx algorithm for Trigeminal Neuralgia includes pharmacotherapy options for adults with chronic trigeminal neuralgia pain, either for primary or secondary trigeminal neuralgia. It does not include treatment options for other types of neuropathic pain or acute pain exacerbations. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* used for trigeminal neuralgia include:

• Botulinum Toxin A (Botox) 
• Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, Teril)
• Gabapentin (Neurontin) 
• Lamotrigine (Lamictal)
• Oxcarbazepine (Trileptal)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Crohn’s Disease

Crohn’s disease is one type of inflammatory bowel disease (IBD). It affects people of all ages, with the symptoms usually starting in childhood or early adulthood. The main symptoms of Crohn’s disease are diarrhea, stomach aches and cramps, blood in your faeces, tiredness (fatigue), and weight loss. The symptoms may be constant or may come and go every few weeks or months.

TREATMENT

Although there is no cure for Crohn’s disease, treatment can help reduce or control symptoms. The main treatments are i) medicines to reduce inflammation in the digestive tract, ii) medicines to stop the inflammation coming back, and iii) surgery to remove a small part of the digestive tract.

The TreatGx algorithm for Crohn’s disease includes pharmacotherapy options for adults who have been diagnosed with Crohn’s disease. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding. Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* for the treatment of Crohn’s disease include:

• Adalimumab (Humira)
• Azathioprine (Azasan, Imuran)
• Budesonide (Entocort, Ortikos)
• Certolizumab (Cimzia)
• Hydrocortisone (Solu-Cortef)
• Infliximab (Remicade)
• Mercaptopurine (Purinethol)
• Methotrexate (Metoject, Otrexup, Rasuvo, Reditrex)
• Methylprednisolone sodium succinate (Solu-Medrol)
• Metronidazole (Flagyl)
• Natalizumab (Tysabri)
• Prednisolone
• Prednisone (Winpred)
• Sulfasalazine (Salazopyrin, Azulfidine)
• Ustekinumab (Stelara)
• Vedolizumab (Entyvio)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Depression

Major depressive disorder (MDD) is a common mental disorder characterized by depressed mood, loss of interest or pleasure in regular activities, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, psychomotor changes, and poor concentration. Major depressive disorder is the most prevalent and disabling form of depression. In addition to the immediate symptoms of depression, MDD precipitates overall poor quality of life, decreased productivity, increased obesity and sedentary behavior, and increased risk of mortality from suicide and other causes. Social difficulties potentially emerge from the condition, including stigma, loss of employment, and relationship conflict. (from VA/DoD 2022 guidelines)

TREATMENT

The TreatGx algorithm for Depression includes pharmacotherapy options for adults who have been diagnosed with major depressive disorder. It does not include specific treatment options for bipolar depression, psychotic depression, post-partum depression, peri-menopausal disorder, seasonal affective disorder, or dysthymia. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.

Medications* for the treatment of depression include:

• Amitriptyline (Elavil)
• Bupropion (Aplenzin, Forfivo, Wellbutrin)
• Citalopram (Celexa)
• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta, Drizalma Sprinkle)
• Escitalopram (Cipralex, Lexapro)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox) – CAN only
• Levomilnacipran (Fetzima)
• Mirtazapine (Remeron)
• Moclobemide (Manerix) – CAN only
• Paroxetine (Paxil, Pexeva)
• Phenelzine (Nardil)
• Selegiline transdermal (Emsam) – US only
• Sertraline (Zoloft)
• Tranylcypromine (Parnate)
• Trazodone
• Venlafaxine (Effexor)
• Vilazodone (Viibryd)
• Vortioxetine (Trintellix)

Adjunctive medications:

• Aripiprazole (Abilify)
• Brexpiprazole (Rexulti)
• Esketamine nasal spray (Spravato) 
• Lithium (Carbolith, Lithane, Lithmax, Lithobid)
• Modafinil (Alertec) – CAN only
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Triiodothyronine (T3)/Liothyronine (Cytomel)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Diabetes Mellitus Type 2

Type 2 diabetes is a common condition that causes the level of sugar (glucose) in the blood to become too high. It can cause symptoms such as tiredness, frequent urination (peeing), unusual feelings of thirst, or unexpected weight loss. Having high levels of glucose in the blood can lead to complications such as damage to the heart, eyes, and kidneys. It’s caused by problems with a chemical in the body (hormone) called insulin.

TREATMENT

The goal of treatment is to lower the level of sugar in the blood and thereby prevent complications. Treatment of diabetes depends on your glucose levels and medication is not always necessary. Lifestyle changes, including eating a healthy diet and being active, are very important for people with Type 2 diabetes.
The TreatGx algorithm for Diabetes Mellitus Type 2 includes pharmacotherapy options for glycemic control in adults diagnosed with type 2 diabetes, including patients with atherosclerotic cardiovascular disease, heart failure, and chronic kidney disease. It does not address other agents for macrovascular or microvascular disease prevention (i.e. aspirin, lipid lowering agents, ACE inhibitors/ARBs), Type 1 diabetes, diabetic coma, or diabetic ketoacidosis. TreatGx does not include treatment options for patients under 18 years of age, those who are planning pregnancy, pregnant, or breastfeeding. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications and doses for the individual.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* for the treatment of Type 2 Diabetes include:

• Acarbose (Glucobay, Precose)
• Alogliptin (Nesina)
• Alogliptin/Metformin (Kazano)
• Canagliflozin (Invokana)
• Canagliflozin/Metformin (Invokamet)
• Dapagliflozin (Forxiga)
• Dapagliflozin/Metformin (Xigduo)
• Dulaglutide (Trulicity)
• Empagliflozin (Jardiance)
• Empagliflozin/Metformin (Synjardy)
• Empagliflozin/Linagliptin (Glyxambi)
• Exenatide (Bydurion, Byetta)
• Gliclazide (Diamicron) – CAN only
• Glimepiride (Amaryl)
• Glyburide (Diabeta, Glynase)
• Insulin Aspart (Fiasp, Novolog, Novorapid)
• Insulin Aspart/Insulin Aspart Protamine (Novolog, NovoMix)
• Insulin Detemir (Levemir)
• Insulin Degludec (Tresiba)
• Insulin Glargine (Basaglar, Lantus, Toujeo)
• Insulin Glulisine (Apidra)
• Insulin Lispro (Admelog, Humalog)
• Insulin Lispro/Insulin Lispro Protamine (Humalog)
• Insulin NPH (Humulin, Novolin)
• Insulin Regular (Afrezza, Entuzity, Humulin, Novolin)
• Insulin Regular/Insulin NPH (Humulin, Novolin)
• Linagliptin (Tradjenta, Trajenta)
• Linagliptin/Dapagliflozin (Qtern)
• Linagliptin/Empagliflozin (Glyxambi)
• Linagliptin/Metformin (Jentadueto)
• Liraglutide (Saxenda, Victoza)
• Lixisenatide (Adlyxin)
• Metformin (Fortamet, Glucophage, Glumetza)
• Pioglitazone (Actos)
• Repaglinide (GlucoNorm, Prandin)
• Rosiglitazone (Avandia)
• Saxagliptin (Onglyza)
• Saxagliptin/Metformin (Komboglyze)
• Semaglutide (Ozempic)
• Sitagliptin (Januvia)
• Sitagliptin/Ertugliflozin (Steglujan)
• Sitagliptin/Metformin (Janumet)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Dyspepsia

Dyspepsia or indigestion describes several different symptoms including stomach pain, bloating, nausea, burping, or loss of appetite. Dyspepsia can have many different causes, including ulcers, lactose intolerance, anxiety, food, or medication.

TREATMENT

Treatment for dyspepsia depends on the cause and can include changing what you eat or drink, using medications to reduce symptoms, or using psychological therapies.
The TreatGx algorithm for Dyspepsia includes pharmacotherapy options for adults diagnosed with dyspepsia in the absence of peptic ulcer disease, structural abnormalities or H. pylori infection. It does not include treatment options for other gastrointestinal conditions such as gastroesophageal reflux disease, H. pylori eradication, or Zollinger-Ellison syndrome. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* used for treatment of dyspepsia include:

• Amitriptyline (Elavil)
• Dexlansoprazole (Dexilant)
• Domperidone (Motilium) – CAN only
• Esomeprazole (Nexium)
• Famotidine (Pepcid)
• Lansoprazole (Prevacid)
• Metoclopramide (Metonia, Reglan)
• Nizatidine (Axid)
• Omeprazole (Losec, Prilosec)
• Pantoprazole (Pantoloc, Protonix, Tecta)
• Rabeprazole (Aciphex, Pariet)
• Ranitidine (Zantac)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Epilepsy

Epilepsy is a common condition that affects the brain and causes frequent seizures. Seizures are bursts of electrical activity in the brain that temporarily affect how the brain works. They can cause a wide range of symptoms. Possible symptoms include uncontrollable jerking or shaking (a “fit”), losing awareness and staring into space, becoming stiff, collapsing, strange sensations such as unusual smells or tastes, or tingling in the arms or legs. More information on epilepsy can be found on the Epilepsy Canada website.

TREATMENT

Treatment can help most people with epilepsy have fewer seizures or stop having seizures completely.
The TreatGx algorithm for Epilepsy includes pharmacotherapy options for adults diagnosed with seizures classified as focal, generalized tonic-clonic, absence, myoclonic, tonic or atonic. It does not include therapy recommendations for other types of seizure disorders or when there is diagnostic doubt as to the nature of the seizures. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* for the treatment of epilepsy include:

• Carbamazepine (Carbatrol, Epitol, Equetro, Tegreto, Teril)
• Divalproex Sodium (Depakote, Epival)
• Ethosuximide (Zarontin)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Oxcarbazepine (Oxtellar, Trileptal)
• Topiramate (Topamax, Trokendi XR, Qudexy XR)
• Valproic Acid (Depakene)
• Zonisamide (Zonegran)—USA only

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Gastroesophageal Reflux Disease (GERD)

Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). If it keeps happening, it’s called gastroesophageal reflux disease (GERD). Other symptoms can include an unpleasant sour taste in your mouth, a cough, recurring hiccups, a hoarse voice, bad breath, bloating and feeling nauseous. Symptoms are usually worse after eating, when lying down and when bending down.

TREATMENT

In some cases, you can improve your GERD symptoms with dietary changes, such as avoiding fatty or spicy foods that make your acid reflux worse. Eating smaller meals, not eating close to bedtime, avoiding alcohol, and losing weight if needed may also improve symptoms for some people. Over-the-counter antacids or medications that reduce acid production in the stomach may be needed if lifestyle modifications do not improve symptoms.
The TreatGx algorithm for Gastroesophageal Reflux Disease (GERD) includes pharmacotherapy options for adults with mild/intermittent or moderate-severe GERD symptoms, and options for GERD in pregnancy. It does not include treatment options for other gastrointestinal conditions such as dyspepsia, peptic ulcer disease, H. pylori eradication, or Zollinger-Ellison syndrome. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Gout

Gout causes sudden severe joint pain. It is a form of inflammatory arthritis that develops in people who have high levels of uric acid in the blood. Crystals form within joints causing pain, tenderness, redness, warmth, and swelling. For many people the first symptom of gout is excruciating pain and swelling in the big toe, but it may also appear in the fingers, wrists, elbows or knees.

TREATMENT

There are two aims of gout treatment. The first is to relieve the symptoms of gout during an attack (acute gout), and the second is to prevent more attacks occurring (chronic gout treatment).
Treatment for acute gout includes taking any prescribed medicines as soon as possible, resting and raising the limb, and keeping the joint cool.
Treatment for chronic gout includes eating a healthy diet, reducing alcohol intake, drinking plenty of fluids, stopping smoking, managing your weight and being physically active.
The TreatGx algorithm for Gout – Acute includes pharmacotherapy options for adults diagnosed with an acute attack of gout. It does not include treatment options for urate-lowering therapy or for prevention of gout attacks. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
The TreatGx algorithm for Gout – Chronic includes pharmacotherapy options for prophylactic and urate-lowering therapy in adults with recurrent gout attacks. It does not include treatment options for acute gout attacks. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease, also known as COPD, is the name for a group of lung conditions that cause breathing difficulties. It includes emphysema (damage to the air sacs in the lungs), and chronic bronchitis (long-term inflammation of the airways). The main symptoms of COPD include increasing breathlessness, persistent chesty cough with mucus, frequent chest infections, and wheezing.

TREATMENT

Treating COPD and changing your lifestyle can help you feel better, stay more active, and slow the progress of the disease. People with COPD sometimes experience a sudden worsening of their symptoms, called an “acute exacerbation” of COPD. People are defined as having “stable” COPD if their symptoms are either staying the same or gradually getting worse.
Treatments include stopping smoking, inhalers and medications, and pulmonary rehabilitation (a specialised program of exercise and education).
The TreatGx algorithm for COPD – Acute Exacerbation includes pharmacotherapy options for adults experiencing a mild or moderate exacerbation requiring short-acting bronchodilators, with consideration for a corticosteroid and/or empiric antibiotic therapy. This does not include treatment options for patients with severe exacerbations who require hospitalization or with acute respiratory failure.
The TreatGx algorithm for persons with COPD – Stable for adults with a diagnosis of Chronic Obstructive Pulmonary Disease includes pharmacotherapy options for initial maintenance therapy or adjustments to current maintenance therapy. TreatGx does not include treatment options for patients under 18 years of age, those who are planning pregnancy, pregnant, or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

H. Pylori Eradication

Helicobacter pylori (H. pylori) is a bacterium that infects your stomach. Most people don’t realize they have this infection until they develop a peptic ulcer (stomach or intestinal ulcer). Peptic ulcers occur when the layer that protects the stomach lining from stomach acid breaks down, which allows the stomach lining to become damaged. Ulcers commonly cause burning pain that occurs either with eating or when the stomach is empty, and typically lasts from a few minutes to a few hours. Other symptoms can include nausea, loss of appetite, bloating, or unintentional weight loss.

TREATMENT

With treatment, most stomach ulcers will heal within a month or two. Treatment involves a short course of a combination of antibiotics and acid-reducing medications. The antibiotics kill the H. pylori bacteria and the acid-reducing medications help heal the ulcer.
The TreatGx algorithm for H. pylori Eradication includes pharmacotherapy options for adults who have tested positive for H. pylori infection, with or without endoscopy confirmation. It does not include treatment options for symptoms not related to the H. pylori infection or for ongoing symptom treatment after eradication of the infection. After the decision has been made to initiate treatment, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Heart Failure

Heart failure occurs when the heart becomes damaged and is unable to pump enough blood to meet the body’s demand. There are many conditions that can damage or weaken the heart, such as a heart attack or high blood pressure. The main symptoms of heart failure are breathlessness, feeling tired most of the time and finding exercise exhausting, and swollen ankles and legs. Some people also experience other symptoms e.g. a persistent cough, wheezing, bloating, loss of appetite, fast heart rate, palpitations and dizziness.

TREATMENT

For most people, heart failure is a long-term condition that can’t be cured. But treatment can help keep the symptoms under control. Treatment plans may include lifestyle changes, medications, devices and surgical procedures. Persons with heart failure may need multiple medications. Each one treats a different symptom or contributing factor and comes with its own instructions and rules.

The TreatGx algorithm for Heart Failure – Chronic includes pharmacotherapy options for adults diagnosed with Stage C heart failure: Structural heart disease with current or previous symptoms of heart failure. It does not include therapy options for fluid retention in heart failure or acute decompensated heart failure. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.

The TreatGx algorithm for Heart Failure – Fluid Retention includes pharmacotherapy options for adults diagnosed with heart failure who are experiencing volume overload or fluid retention. It does not include treatment options for chronic heart failure or other causes of fluid retention. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Hyperlipidemia

Hyperlipidemia is the term used to describe the condition of having too much fat in the blood. It’s mainly caused by eating fatty food, not exercising enough, being overweight, smoking, drinking alcohol, and genetics (family history). Too much cholesterol can block your blood vessels. It makes you more likely to have heart problems or a stroke.

TREATMENT

Eating a healthy diet, stopping smoking, cutting down on alcohol and increasing your level of activity are important in lowering high cholesterol. For some people lifestyle changes may not be enough to lower the risk of having a heart attack or stroke. If so, your health care professional will probably recommend medication.
The TreatGx algorithm for Hyperlipidemia includes pharmacotherapy options for the primary prevention of cardiovascular events in adults without established cardiovascular disease. It does not include treatment options for secondary causes of hyperlipidemia, familial hypercholesterolemia, or secondary prevention of cardiovascular events. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* for the treatment of hyperlipidemia include:

• Alirocumab (Praluent)
• Atorvastatin* (Lipitor)
• Cholestyramine (Olestyr,Prevalite)
• Colesevelam (Lodalis, Welchol)
• Colestipol (Colestid)
• Evolocumab (Repatha)
• Fenofibrate (Antara, Fenoglide, Lipidil, Lipofen, Tricor, Triglide, Trilpilix)
• Fluvastatin* (Lescol)
• Gemfibrozil (Lopid)
• Lovastatin* (Altoprev)
• Pitavastatin* (US Only) (Livalo, Zypitamag)
• Pravastatin* (Pravachol)
• Rosuvastatin* (Crestor, Ezallor)
• Simvastatin* (Flolipid, Zocor)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Hypertension

People with high blood pressure (hypertension) are often unaware of it and they rarely have noticeable symptoms.
Blood pressure is recorded with 2 numbers. The systolic pressure (higher number) is the force at which your heart pumps blood around your body. The diastolic pressure (lower number) is the resistance to the blood flow in the blood vessels. Everyone’s blood pressure will be slightly different. What’s considered low or high for you may be normal for someone else.
If your blood pressure is too high, it puts extra strain on your blood vessels, heart, and other organs such as the brain, kidneys and eyes. This can lead to serious conditions such as heart attack, heart failure, kidney disease, or stroke. If you have high blood pressure, reducing it even a small amount can help lower your risk of these health conditions.

TREATMENT

Treatment for hypertension includes changes to your lifestyle and medication. Lifestyle changes can include eating a healthy diet, reducing salt intake, cutting down on caffeine, managing your weight, stopping smoking, reducing alcohol intake and being physically active.
The TreatGx algorithm for Hypertension includes treatment options for adults when pharmacotherapy is required for reaching blood pressure targets. Although the Hypertension algorithm does account for some common co-morbidities, if another condition is present (e.g. atrial fibrillation, heart failure, left ventricular hypertrophy, post-myocardial infarction, secondary stroke prevention), its treatment should be optimized first before treating hypertension, and if additional BP control is required then this algorithm may be used. TreatGx does not account for multiple co-morbidities. TreatGx does not include treatment options for patients aged 18 or under, those who are planning pregnancy, pregnant, or breastfeeding, or for treatment of hypertensive crisis or secondary hypertension (e.g. hyperaldosteronism, pheochromocytoma).
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* for the treatment of hypertension include:

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Insomnia

Insomnia is a sleep disorder in which you have difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning. Occasional episodes of insomnia may come and go without causing any serious problems, but for some people it can last for months or even years at a time. Persistent insomnia can have a significant impact on your quality of life. It can limit what you’re able to do during the day, affect your mood, and lead to relationship problems with friends, family and colleagues. 

Insomnia can be secondary to mental health conditions (e.g. depression, schizophrenia), physical health conditions (e.g. heart problems, chronic pain), or certain medications (e.g. antidepressants, epilepsy or steroid medications).  

TREATMENT 

Treatment for insomnia is focused on identifying and treating the reasons for not sleeping well. If the insomnia is secondary to an underlying problem, treating that problem should be considered first. The most effective treatment for insomnia is cognitive behavioural therapy. If this alone is not effective, some people may need to add a medicine for a while to help them sleep. Doctors often prescribe medicine for a short time if other treatment isn’t working. But medicine doesn’t work as well over time as lifestyle and behaviour changes do. Sleep medicine can also become habit-forming. Medicine works best as a short-term treatment combined with lifestyle and behaviour changes. 

The TreatGx algorithm for Insomnia includes pharmacotherapy options for adults who have been diagnosed with primary insomnia. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. 

The medication treatment options are ranked into two lines of therapy according to evidence for efficacy, and each medication includes the sleep parameter(s) it has been shown to improve.   

The insomnia algorithm does not include specific treatment options for older adults or secondary insomnia, and is not developed for use with children, adolescents, or those who are pregnant or breastfeeding. Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional. 

Medications* for the treatment of insomnia include:

• Doxepin (Silenor, generics)
• Eszopiclone (Lunesta, generics) – USA only
• Flurazepam (generics)
• Melatonin (generics)
• Ramelteon (Rozerem, generics) – USA only
• Suvorexant (Belsomra) – USA only
• Temazepam (Restoril, generics)
• Trazodone (generics)
• Triazolam (Halcion, generics)
• Zaleplon (Sonata, generics) – USA only
• Zolpidem (Sublinox, Ambien, Ambien CR, Intermezzo, generics)
• Zopiclone (Imovane, generics) – CAN only

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Migraine

A migraine is usually a moderate or severe headache felt as a throbbing pain. A migraine may be accompanied by nausea, vomiting and increased sensitivity to light or sound. There are several types of migraine, including:

• • Migraine with aura: There are warning signs before the migraine begins, such as seeing flashing lights
  • Migraine without aura: The migraine occurs without warning signs.
  • Migraine aura without headache, also known as silent migraine: An aura or other migraine symptoms are experienced, but a headache does not develop.

Some people have migraines frequently, up to several times a week. Other people only have a migraine occasionally.

TREATMENT

If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines. It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.
There is no cure for migraines, but medication can be used to help reduce the symptoms.
Medication is also available to help prevent migraines, known as migraine prophylaxis. You may be prescribed these medications if you experience frequent or very severe migraine attacks.
The TreatGx algorithm for Migraine includes outpatient pharmacotherapy options for treatment of adults with acute migraine headaches. It does not include recommendations for other headache types, medication overuse headaches, migraine prophylaxis, or acute migraine treatment in an emergency department setting. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
The TreatGx algorithm for Migraine Prophylaxis includes pharmacotherapy options for prophylaxis of adults with episodic migraines and menstrual migraine. It does not include invasive therapies such as nerve blocks, non-pharmacologic therapies such as acupuncture or CBT, or recommendations for chronic migraine with or without medication overuse. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Osteoarthritis

Osteoarthritis is a common condition that causes joints to become stiff and painful. Almost any joint can be affected, but the condition most commonly causes problems in the knees, hips and hands. The main symptoms of osteoarthritis are joint pain and stiffness, and problems moving the joint. Some people also have symptoms such as swelling, tenderness, and a grating or crackling sound when moving the affected joints.

TREATMENT

Osteoarthritis is a long-term condition and cannot be cured, but it doesn’t necessarily get any worse over time and it can sometimes gradually improve. A number of treatments are available to reduce the symptoms.
The main treatments for osteoarthritis include lifestyle changes, medication to relieve your pain, and supportive therapies to help make everyday activities easier. Lifestyle changes can include regular exercise, weight management, wearing suitable footwear, structured exercise plan, using special devices to reduce strain on your joints.
Due to the long-term nature of the condition, medication may be taken over many months. Certain pain-relieving medications when taken long-term may have adverse effects on your stomach, therefore gastro-protective (stomach protecting) medications may also be suggested.
The TreatGx algorithm for Osteoarthritis includes pharmacotherapy options for adults with pain due to osteoarthritis. It does not include treatment options for joint pain due to other causes. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Osteoporosis

Losing bone strength is a normal part of the ageing process, but for some people it can lead to osteoporosis. This is a condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break (fracture). The most common type of injuries in people with osteoporosis are broken wrist, hip or spinal (vertebral) bones. However, breaks can also happen in other bones, such as in the arm or pelvis. Sometimes a cough or sneeze can cause a broken rib or the partial collapse of one of the bones of the spine.

TREATMENT

Treatment for osteoporosis is based using medication to strengthen bones and prevent fractures.
Staying active and healthy – for example, through exercise and diet – is likely to keep you independent and reduce your risk of falling.

The TreatGx algorithm for Osteoporosis includes treatment options for adults with a diagnosis of osteoporosis, mainly based on treatment guidelines for post-menopausal women. It does not include treatment options for preventative therapy (including glucocorticoid-induced osteoporosis prevention, or prevention of postmenopausal osteoporosis), Paget’s disease, or hypercalcemia of malignancy. This algorithm does not include treatment options related to hormone-replacement therapy for osteoporosis and/or vasomotor menopausal symptoms. All medication options have Health Canada and FDA indications for treatment of osteoporosis in postmenopausal women, and are indicated for use in men with osteoporosis unless noted otherwise within drug dosing notes. TreatGx does not recommend treatment options for patients under 18, or who are pregnant or breastfeeding.

After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* used in the treatment of osteoporosis include:

• Abaloparatide – USA only
• Alendronate (Binosto, Fosamax)
• Calcitonin nasal spray – USA only
• Calcium
• Denosumab (Prolia)
• Ibandronate (Boniva) – USA only
• Raloxifene (Evista)
• Risedronate (Actonel, Atelvia)
• Romosozumab (Evenity)
• Teriparatide (Bonsity, Forteo, Osnuvo)
• Vitamin D3
• Zoledronic Acid (Aclasta, Reclast)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Overactive Bladder

Overactive bladder is characterized by urinary urgency, urinary frequency, and nocturia (interruption of sleep one or more times because of the need to void urine), with or without urge urinary incontinence, in the absence of urinary tract infection or other pathology. Risk factors can include older age, previous vaginal birth delivery, obesity, chronic constipation, other medical conditions, or taking medications such as diuretics. There can be a significant impact on quality of life, which should be considered when deciding on treatment options. The significant negative impact on daily activities, mental health (including a link to depression), and sexual function has been highlighted by several studies. 

TREATMENT

Non-drug evidence-based measures should be implemented as the first-line treatment for overactive bladder, which include behavioral therapy (e.g. bladder training and pelvic floor muscle therapy such as Kegel exercises) and/or lifestyle changes (e.g. reduction of fluid and caffeine intake, weight control, dietary modifications to avoid bladder irritants, management of bowel regularity, treating other medical conditions, and smoking cessation). Medication therapy can be combined with these measures if needed. The TreatGx algorithm for Overactive Bladder includes pharmacotherapy options for adults with overactive bladder, including symptoms of urge urinary incontinence, frequency, and/or urgency. If no medication options are available due to contraindications or past ineffective trials, referral can be considered for neuromodulative therapies such as peripheral tibial nerve stimulation (PTNS) or sacral neuromodulation (SNS). 

Medications* used for overactive bladder include: 

• Botulinum Toxin A (OnabotulinumtoxinA) injection (Botox)
• Conjugated estrogens (Premarin Cream)
• Darifenacin (Enablex)
• Estradiol (Estring, Vagifem)
• Fesoterodine (Toviaz)
• Mirabegron (Myrbetriq)
• Oxybutynin (Ditropan XL, Gelnique, Oxytrol)
• Propiverine (Mictoryl)—CAN only
• Solifenacin (Vesicare)
• Tolterodine (Detrol)
• Trospium (Trosec)
• Vibegron (Gemtesa)—USA only

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Peptic Ulcer Disease

A peptic ulcer is a sore in the inner lining of the stomach or upper small intestine. Ulcers form when the intestine or stomach’s protective layer is broken down. When this happens, digestive juices can damage the intestine or stomach tissue. Symptoms include a burning, aching or gnawing pain between the belly button and breastbone, or occasionally back pain. The pain can last from a few minutes to a few hours and may come and go for weeks. The pain usually goes away after taking an antacid or acid reducer. Other symptoms can include loss of appetite and weight loss, bloating or nausea after eating, vomiting, vomiting blood or material that looks like coffee grounds, or passing black stools that contain dark red blood.

TREATMENT

To treat peptic ulcers, most people need to take medicines that reduce the amount of acid in the stomach. You can help speed the healing of your ulcer and prevent it from coming back if you quit smoking and limit your alcohol consumption. Continued use of medicines such as aspirin, ibuprofen, or naproxen may increase the chance of your ulcer coming back.
The TreatGx algorithm for Peptic Ulcer Disease includes pharmacotherapy options for adults diagnosed with peptic ulcer disease in the absence of structural abnormalities or H. pylori infection. It does not include treatment options for other gastrointestinal conditions such as gastroesophageal reflux disease, H. pylori eradication, or Zollinger-Ellison syndrome. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* used for treatment of peptic ulcer disease include:

• Dexlansoprazole (Dexilant)
• Esomeprazole (Nexium)
• Famotidine (Pepcid)
• Lansoprazole (Prevacid)
• Misoprostol (Cytotec)
• Nizatidine (Axid)
• Omeprazole (Losec, Prilosec)
• Pantoprazole (Pantoloc, Protonix, Tecta)
• Rabeprazole (Aciphex, Pariet)
• Ranitidine (Zantac)
• Sucralfate (Sulcrate, Carafate)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Peripheral Artery Disease

Peripheral artery disease (PAD) is a condition where a build-up of fatty deposits in the arteries restricts blood supply, often to leg muscles (lower extremity artery disease), or to the heart muscle (carotid artery stenosis). Many people with PAD have no symptoms. However, some develop a painful ache in their legs when they walk. The pain can range from mild to severe, and usually goes away after a few minutes when you rest your legs. Other symptoms of PAD can include hair loss on your legs and feet, numbness or weakness in the legs, brittle toenails that grow slowly, ulcers (open sores) on your feet and legs, changing or shiny skin colour on your legs. 

TREATMENT

There is no cure for PAD, but lifestyle changes and medication can help reduce the symptoms and reduce cardiovascular risk. Lipid-lowering medications such as statins are recommended, in addition to blood pressure and blood sugar control. Exercise and smoking cessation/avoidance are also recommended. Antithrombotic therapy (to prevent clotting) is recommended for most people with PAD depending on symptoms and type of PAD. 

The TreatGx Peripheral Artery Disease (PAD) algorithm includes antithrombotic therapy options for asymptomatic lower extremity artery disease, symptomatic lower extremity artery disease, and carotid artery stenosis. A treatment option for improving pain-free walking distance is also offered in symptomatic lower extremity artery disease (US only). TreatGx does not provide options post-revascularization, post-stenting, or for those with established coronary artery disease or cerebrovascular disease. Follow specific guidelines for antithrombotic treatment if the patient has had an acute cardiovascular event. TreatGx does not provide treatment options for acute limb ischemia or other PAD subtypes.  

After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional. 

Medications* used for peripheral artery disease include:

• Acetylsalicylic acid (Aspirin)
• Cilostazol – USA only
• Clopidogrel (Plavix)
• Rivaroxaban (Xarelto)
• Ticagrelor (Brilinta)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Post-Myocardial Infarction

A myocardial infarction (MI) is also known as a heart attack. Recovering from a heart attack can take several months. During your recovery period, you’ll receive help and support from a range of healthcare professionals. The 2 most important aims of the recovery process are 1) to gradually restore your physical fitness so you can resume normal activities (known as cardiac rehabilitation), 2) to reduce your risk of another heart attack.

TREATMENT

The TreatGx algorithm for Post-Myocardial Infarction includes pharmacotherapy options for secondary prevention of cardiovascular events in adults who have experienced a non-ST-elevation or ST-elevation myocardial infarction. It does not include treatment for acute treatment of a myocardial infarction. This algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* for Post-MI include:

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Prevention of NSAID-Induced Gastrotoxicity

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat pain and inflammation (swelling). Many people take NSAIDs without having any side effects, but there is a risk the medication could cause problems, such as stomach ulcers or bleeding, particularly if taken for a long time or at high doses. If people are at high risk of this happening (due to prior history, taking medications that increase their risk such as antiplatelet medications or certain antidepressants, and other factors), there are medications available to protect the stomach.

TREATMENT

The TreatGx algorithm for Prevention of NSAID-Induced Gastrotoxicity includes pharmacotherapy options to lower the risk of developing an ulcer or gastrointestinal bleeding for adults who are taking NSAIDs regularly and are at risk of gastrointestinal complications. It does not include options for treatment of a current ulcer or gastrointestinal bleed and does not provide assessment on the safety of the use of an NSAID for an individual. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* to prevent ulcers include:

• Dexlansoprazole (Dexilant)
• Esomeprazole (Nexium)
• Famotidine (Pepcid)
• Lansoprazole (Prevacid)
• Misoprostol (Cytotec)
• Omeprazole (Losec, Prilosec)
• Pantoprazole (Pantoloc, Protonix, Tecta)
• Rabeprazole (Aciphex, Pariet)
• Ranitidine (Zantac)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Rheumatoid Arthritis

Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. There may be periods where symptoms become worse, known as flare-ups or flares. A flare can be difficult to predict, but with treatment it’s possible to decrease the number of flares and minimise or prevent long-term damage to the joints. Some people with rheumatoid arthritis also experience problems in other parts of the body, or more general symptoms such as tiredness and weight loss.
Rheumatoid arthritis mainly affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.

TREATMENT

Treatments for rheumatoid arthritis can help reduce inflammation in the joints, relieve pain, prevent or slow down joint damage, reduce disability and enable you to be as active as possible.
Although there’s no cure for rheumatoid arthritis, early treatment and support (including medicine, lifestyle changes, supportive treatments and surgery) can reduce the risk of joint damage and limit the impact of the condition.
There are medicines available to help stop rheumatoid arthritis from getting worse and reduce your risk of further problems. These are often divided into main 2 types: disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments. Biological treatments are a newer form of treatment for rheumatoid arthritis. They are usually taken in combination with methotrexate or another DMARD, and are usually only used if DMARDs have not been effective on their own.
The TreatGx algorithm for Rheumatoid Arthritis includes pharmacotherapy options for adults who have been diagnosed with rheumatoid arthritis and who are being cared for by a specialist. It does not include treatment options for other types of arthritis and the medications included in the algorithm should not be prescribed by anyone who is not experienced with their use and monitoring requirements. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* used for rheumatoid arthritis include:

• Abatacept (Orencia)
• Adalimumab (Biosimilars, Humira)
• Baricitinib (Olumiant)
• Certolizumab (Cimzia)
• Etanercept (Biosimilars, Enbrel)
• Golimumab (Simponi)
• Hydroxychloroquine (Plaquenil)
• Infliximab (Biosimilars, Remicade)
• Leflunomide (Arava)
• Methotrexate (Metoject, Otrexup, Rasuvo, Reditrex, Xatmep, Trexall)
• Rituximab (Biosimilars, Rituxan)
• Sarilumab (Kevzara)
• Sulfasalazine (Azulfidine, Salazopyrin)
• Tocilizumab (Actemra)
• Tofacitinib (Xeljanz)
• Upadacitinib (Rinvoq)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Schizophrenia

Schizophrenia is a serious and chronic mental illness with diverse symptoms.  It is characterized by distortions in thinking, perception and emotions.  Hallucinations (hearing voices or seeing things that are not there) and delusions (fixed, false beliefs) are commonly experienced in those with schizophrenia.  

TREATMENT

There is no cure for schizophrenia, but it can be managed with antipsychotic medications and psychotherapy.  The goal of treatment for schizophrenia is to achieve relief from the symptoms of psychosis especially in the acute phase and to minimize relapse in the maintenance phase.
The TreatGx algorithm for Schizophrenia includes pharmacotherapy options for the treatment of acute episodes of psychosis and for maintaining remission in adults who have been diagnosed with schizophrenia. It does not include treatment options for those with severe psychosis who required in-patient treatment, or treatment for other forms of psychosis. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional. 

Medications* for the treatment of schizophrenia include:

• Aripiprazole (Abilify, Abilify Maintena, Aristada)
  
• Asenapine (Saphris, Secuado)
• Brexpiprazole (Rexulti)
• Cariprazine (Vraylar) – USA only
• Chlorpromazine
• Clozapine (Clozaril)
• Flupentixol (Fluanxol)
• Fluphenazine – CAN only
• Haloperidol (Haldol)
• Iloperidone (Fanapt) – USA only
• Loxapine (Loxapac, Xylac)
• Lurasidone (Latuda)
• Methotrimeprazine (Methoprazine, Nozinan) – CAN only
• Molindone – USA only
• Olanzapine (Zyprexa)
• Paliperidone (Invega)
• Perphenazine
• Pimozide
• Quetiapine (Seroquel)
• Risperidone (Perseris, Risperdal)
• Thioridazine – USA only
• Thiothixene – USA only
• Trifluoperazine
• Ziprasidone (Geodon, Zeldox)
• Zuclopenthixol (Clopixol) – CAN only

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Smoking Cessation

Stopping smoking lets you breathe more easily, gives you more energy, feel less stressed, have better sex, improves fertility, improves smell and taste, have younger-looking skin, have whiter teeth and sweeter breath, live longer, and protects your loved one’s health. It is never too late to stop.

TREATMENT

If you want to stop smoking, several different treatments are available from shops, pharmacies and on prescription to help you beat your addiction and reduce withdrawal symptoms. The best treatment for you will depend on your personal preference, your age, whether you’re pregnant or breastfeeding and any medical conditions you have.
The TreatGx algorithm for Smoking Cessation includes pharmacotherapy options for adults who are currently smoking and wish to use medication to help reduce nicotine withdrawal symptoms. It does not include non-pharmacological treatment options, which should be included as part of a comprehensive smoking cessation program. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

Medications* used to help quit smoking include:

• Bupropion (Zyban)
• Clonidine
• Nicotine Gum (Nicorette, Thrive)
• Nicotine Inhaler (Nicorette, Nicotrol)
• Nicotine Lozenge (Nicorette, Thrive)
• Nicotine Mouth Spray (Nicorette)– CAN only
• Nicotine Patch (Habitrol, Nicoderm)
• Nortriptyline (Aventyl, Pamelor)
• Varenicline (Champix, Chantix)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Ulcerative Colitis (UC)

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). It affects people of all ages, with symptoms usually starting between the ages of 15 and 30 years. The main symptoms of ulcerative colitis are diarrhea, abdominal pain or cramping, rectal bleeding, and an inability to defecate despite urgency. Disease activity is typically described as relapsing and remitting, with periods of active symptoms alternating with periods of remission.  

TREATMENT 

Ulcerative colitis is a chronic condition and therapy is aimed at inducing and maintaining remission. Treatments include medication therapy to reduce intestinal inflammation to allow mucosal healing, or surgery. The selection of medications used to treat ulcerative colitis will depend on the severity of the disease and whether the patient is in remission or not. 

The TreatGx algorithm for Ulcerative Colitis includes pharmacotherapy options for adults who have been diagnosed with ulcerative colitis. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding. Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional. 

Medications* for the treatment of Ulcerative Colitis include:

• Adalimumab (Humira)
• Azathioprine (Azasan, Imuran)
• Balsalazide (Colazal)—USA only
• Budesonide (Cortiment, Uceris)
• Golimumab (Simponi)
• Infliximab (Remicade)
• Mesalazine (Apriso, Asacol, Delzicol, Lialda, Mezavant, Pentasa)
• Olsalazine (Dipentum)
• Prednisolone
• Prednisone
• Sulfasalazine (Salazopyrin, Azulfidine)
• Tofacitinib (Xeljanz)
• Ustekinumab (Stelara)
• Vedolizumab (Entyvio)

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol

Urinary Tract Infection

Urinary tract infections (UTIs) can affect different parts of your urinary tract, including your bladder (cystitis), urethra (urethritis) or kidneys (kidney infection / pyelonephritis). Symptoms include needing to urinate suddenly or more often than usual, pain or a burning sensation when urinating, smelly or cloudy urine, blood in your urine, pain in your lower belly, feeling tired and unwell, and in older people confusion or agitation.

TREATMENT

Urinary tract infections are treated with antibiotics to resolve symptoms and prevent complications. A urine test may be needed to identify the infecting organism and to ensure that the prescribed antibiotic will work.

The TreatGx algorithm for Urinary Tract Infections & Pyelonephritis includes pharmacotherapy options for adults who have been diagnosed with uncomplicated or complicated urinary tract infection or pyelonephritis. It does not include treatment options for prostatitis or prophylaxis of recurrent infections. After the decision has been made to initiate a medication, this algorithm can be used to help health care providers select the safest and most effective medications for the individual. This algorithm is not developed for use with children, adolescents, or those who are pregnant or breastfeeding.
Any decision about your medication(s) and healthcare should be made in consultation with a qualified healthcare professional.

The TreatGx algorithm for Urinary Tract Infections – Cystitis (Empiric therapy) includes empiric pharmacotherapy options for adults who have been diagnosed with uncomplicated or complicated cystitis (lower urinary tract infection). It does not include treatment options for pyelonephritis (upper urinary tract infection), prostatitis or prophylaxis of recurrent infections. Once culture and sensitivity results are available therapy should be tailored.

The TreatGx algorithm for Urinary Tract Infections – Pyelonephritis (Empiric therapy) includes empiric pharmacotherapy options for adults who have been diagnosed with uncomplicated or complicated pyelonephritis (upper urinary tract infection). It does not include treatment options for cystitis (lower urinary tract infection), prostatitis or prophylaxis of recurrent infections. Once culture and sensitivity results are available therapy should be tailored. TreatGx does not include treatment options for patients under 18 years of age, those who are planning pregnancy, pregnant, or breastfeeding.

Medications* for Urinary Tract Infections – Cystitis (Empiric therapy) include:

Medications* for Urinary Tract Infections – Pyelonephritis (Empiric therapy) include:

*Medications that may have an altered response based on pharmacogenetic results are highlighted and include the symbol