Pharmacogenomic topic · dashboard states: NM · PM · IM · RM · UM
PGx describes inherited differences in drug handling. AUC measures total exposure, not benefit or toxicity by itself. Ask whether the pathway clears a drug or activates it: slower clearance can raise exposure; slower activation can reduce benefit. Lower inactive-metabolite exposure does not imply lost efficacy.
Dashboard vocabulary: NM = Normal metabolizer; PM = Poor metabolizer; IM = Intermediate metabolizer; UM = Ultrarapid metabolizer. RM = Rapid metabolizer appears only under CYP2C19; EXP = Expresser appears only under CYP3A5. These interface labels do not establish clinical phenotypes for every gene. Prescribing uses the laboratory report, current guidance and monitoring.
IMs and PMs form less clopidogrel active thiol metabolite, weakening platelet inhibition. Alternative therapy may be appropriate, particularly after coronary stenting.
Practical pearls
Reduced clearance raises exposure to PPIs such as omeprazole; faster clearance can reduce their effect.
RM and UM are distinct states on this dashboard.
Safety / monitoring
Clobazam's active metabolite, N-desmethylclobazam, can accumulate: watch for sedation.
Follow drug-specific guidance; do not stop antiplatelet treatment from a dashboard estimate.
Self-check
Why may clopidogrel work less well in a PM? Less active metabolite is formed.
Does PM always mean lower exposure? No. Omeprazole exposure can rise.