CPIC and ClinPGx

CPIC is now part of ClinPGx. The standalone CPIC site will retire soon, but all its content will move to ClinPGx. Visiting cpicpgx.org will redirect you to the corresponding ClinPGx page.

We’re not planning any changes to the CPIC database or API. The database stays on GitHub at the releases page, and the API remains at https://api.cpicpgx.org. If we need to make major changes, we’ll give you plenty of notice.

CPIC Data Changes

That being said, the next release of the CPIC database and API will include some small changes to the schema that may affect you.

PharmGKB has been subsumed by ClinPGx. There are many references to PharmGKB in the CPIC data and schema. We will be updating all "PharmGKB" references to ClinPGx. This means every place we used to refer to "PharmGKB" in the codebase or schema we will change to "ClinPGx". We are also updating some guideline information for the change.

Here are the specific changes you will see in the database and the API:

• The guideline table now has a clinpgxid column instead of the pharmgkbid column. The pharmgkbid held an array of one or more IDs to PharmGKB Guidline Annotations. However, this new clinpgxid column contains one ID to an overall Guideline entity that is a better one-to-one match for this table.
• The pair table and pair_view view changed the column name of pgkbcalevel to clinpgxlevel. The contents are logically the same, only the name is changed.
• The drug table changed pharmgkbid to clinpgxid. The contents are logically the same, only the name is changed.
• The gene table changed pharmgkbid to clinpgxid. The contents are logically the same, only the name is changed.

All of these changes will also be reflected in the gene and drug information files that are exported with every release and made available on ClinPGx.org.

If you have a local copy of the database we recommend grabbing a fresh DB export from the latest release when it is available and replacing your local copy.

The release will be available on March 13, 2026. The changes will be available on the development branch before then. Contact feedback@clinpgx.org if you have questions or feedback.

Update 3/13/2026: The CPIC DB and API have been updated to v1.55.0 with all the aforementioned changes.

CPIC experts are closely evaluating the evidence on antipsychotics and the metabolizing enzymes CYP2D6, CYP3A4, and CYP2C19 as they work toward developing a new PGx guideline. To support this effort, ClinPGx scientists have expanded our antipsychotic pharmacokinetic (PK) pathway collection; updating several existing pathways and adding brand-new ones.

Explore them here:
Aripiprazole PK updated
Brexpiprazole PK updated
Cariprazine PK updated
Clozapine PK
Haloperidol PK
Iloperidone PK new
Olanzapine PK
Pimozide PK
Quetiapine PK updated
Risperidone and Paliperidone PK updated
Thioridazine PK new
Zuclopenthixol PK new

We’d love to hear your feedback! Tell us what you find most helpful, what may be missing, and what you’d like to see next at feedback@clinpgx.org

Do you use ClinPGx Pathways in your research, clinical work, or teaching? If so, would you be willing to answer a few questions or participate in a focus group about pathways? Please let us know at at feedback@clinpgx.org

The guideline manuscript, supplement, all supporting tables including allele definition, allele function, gene CDS, pre- and post-test alerts, etc., and links to ClinPGx guideline annotations with the accompanying genotype/phenotype selection tool to retrieve specific recommendations, can be found on the ClinPGx website on the guideline page. Updated information is also available in the CPIC DB.

As part of the guideline process, CPIC's TPMT and NUDT15 PCEP groups re-evaluated and updated the function assignments for the respective star alleles, with each gene having at least one allele assigned decreased function. Previously all TPMT and NUDT15 alleles were normal function, no function or unknown/uncertain function. The addition of decreased function alleles required updated mapping from allele function to phenotype for both TPMT and NUDT15.

During the function evaluation process, PharmVar's NUDT15 expert panel determined that NUDT15*2 and *3 should be consolidated under the same star number as both have c.415C>T (p.R139C) which eliminates enzymatic activity. The NUDT15*2 allele has been removed from ClinPGx and CPIC materials and DB reflect the transition of *2 to a *3 suballele.

The c.415C>T variant can occur without (*3.001) and with (*3.002) the 6 base pair GAGTCG insertion (also referred to as c.50_55dup), and the insertion can also occur without c.415C>T (*6). The figure below provides a graphical overview of these NUDT15 star alleles. Because the single nucleotide variant and the insertion variant can be found in different combinations on the same gene copy or different gene copies, the phase of the variants (i.e., whether the variants are in cis or in trans) is important. As shown in the bottom panel of the figure, for a patient with a heterozygous test result for both c.415C>T and c.50_55dup without any information regarding variant phase, the genotype is ambiguous. The patient has either a NUDT15*1/*3 (intermediate metabolizer) or *3/*6 (poor metabolizer) diplotype with the former having a *3.002 suballele and the latter having a *3.001 suballele. As the predicted phenotypes for NUDT15*1/*3 and *3/*6 differ, it is important to be aware of this ambiguity. Currently, there is no standardized approach to reporting ambiguous diplotypes when phase is unknown. Additionally, if a pharmacogenetic test does not interrogate the GAGTCG repeat, NUDT15*6 and *9 alleles are not detected and are ‘defaulted’ to *1, while *3.002 will be identified as *3 due to having c.415C>T. Please refer to the PharmVar NUDT15 Read Me document for more information.

• CPIC function and phenotype assignments are used to provide genotype-level guidance from all sources including DPWG and FDA. For a detailed blog see, Genotype-Phenotype Mapping for Guideline and Drug Label Curation.
• Allele definitions are up to date to PharmVar’s  Version 6.2.17.2, which adds new alleles for NAT2, CYP2C19, CYP2C9, SLCO1B1.
• Recommendation updates (see full list of gene and drugs included in PharmCAT)
  • Addition of new DPWG recommendation for CYP2C19-mavacamten and UGT1A1-atazanavir. Updates to several existing DPWG recommendations, e.g. SLCO1B1-statin pairs, TPMT/NUDT15 guidelines
  • Addition of the CPIC NAT2-hydralazine guideline, which also enables the translation of NAT2 genotypes into phenotypes
  • Addition of NAT2-FDA content
• The preprocessor now supports BCF files, although PharmCAT still only supports VCF.
• Ability to call a single gene with the -g flag.
• PharmCAT is now a part of ClinPGx and has a new logo

The latest version is available on PharmCAT.org, GitHub, and DockerHub.

Previously, we attempted to use DPWG mappings for DPWG guideline annotations. We received feedback that this caused confusion when using PharmDOG and GSI when the CPIC/ClinPGx and DPWG assignments differed. In these cases, two different metabolizer statuses were shown for the same diplotype - one phenotype was used to retrieve CPIC and FDA guidance while another was used to retrieve the DPWG guideline recommendation. Another source of confusion was that the alleles listed in the DPWG documents and guideline publications are often a smaller set than what is available on PharmVar, resulting in a number of diplotypes with a CPIC phenotype assignment and guidance but without a DPWG phenotype assignment and guidance. Additionally, the gene documentation on the KNMP website moves over time and our team is not always able to find the same source documents as these website changes occur; updates are not readily apparent and might only be in found in the DPWG guideline publications and supplements. Due to these issues, we will use CPIC/ClinPGx assignments for genotype-phenotype translation going forward for all guideline annotations.

The guideline annotation includes an interactive interface for retrieving specific recommendations based on user-entered genotypes or phenotypes. The NAT2 resources created to support this guideline enable us to map genotypes to FDA-approved drug label annotations and annotated Table of Pharmacogenetic Associations entries for NAT2 and "Nonspecific (NAT)". Annotations for amifampridine, amifampridine phosphate, hydralazine, isoniazid, procainamide, sulfamethoxazole/trimethoprim and sulfasalazine are now included in our precision guidance tools PharmDOG/GSI and are coming soon to PharmCAT.

This publication covers the results of the PGxIC’s two needs assessment surveys targeting both the pharmacogenomics and genomic medicine communities, and can be read at this link free of charge until October 2, 2025.

We thank all of you who took the time to respond to these surveys and contribute to these findings.

This work, conducted by the ClinGen Pharmacogenomics Interpretation Committee (PGxIC, formerly the PGx Working Group), presents findings from two community surveys that gathered perspectives from over 500 participants across the PGx and genomic medicine communities. The goal of the surveys was to better understand pharmacogenomics implementation barriers, and requirements for improved integration with genomic medicine.

The results demonstrated broad consensus for the importance of standardizing terminology and developing frameworks to evaluate gene-drug clinical validity, actionability, and variant classification, modeled after ClinGen’s well-established gene-disease frameworks. Respondents also expressed support for a centralized, authoritative PGx resource to improve consistency and accessibility of PGx knowledge for clinical implementation.

We are incredibly grateful to all the survey participants for sharing their insights, and to all PGxIC members for their contributions in survey design, analysis, and manuscript preparation.

Read the article here: https://www.sciencedirect.com/science/article/abs/pii/S1098360025001765

We are excited to announce that over the coming weeks, PharmGKB will officially become ClinPGx. Once the new ClinPGx website debuts, there will be a brief period where both websites will co-exist.  At the end of this period, PharmGKB URLs will automatically redirect users to the equivalent page on the new website. While you will notice a fresh homepage design and additional features, the core content will reflect the valuable resources currently offered by PharmGKB. You can expect to find the same information available in the familiar formats you rely on.

We appreciate your understanding during this process. To keep you informed, we will share updates through website banners, blog posts, and emails (for those who have opted in). If you have any questions, please do not hesitate to contact us at feedback@clinpgx.org.