Feasibility of CYP2C19-guided clopidogrel therapy in community pharmacy: a systematic review

Background/Objectives Pharmacogenetic (PGx) testing holds promise for improving drug efficacy and safety by tailoring therapy to patients’ genetic profiles. One of the most clinically relevant applications is CYP2C19 testing to guide clopidogrel therapy, particularly in cardiovascular patients. As accessible healthcare settings, community pharmacies may provide a practical model for delivering PGx services. This systematic review evaluates the feasibility of implementing CYP2C19 genetic testing for clopidogrel management in community pharmacy settings. Methods A systematic search of PubMed, ProQuest, Cochrane Central, Scopus, and EBSCO was conducted from inception to 23 December 2025, following PRISMA guidelines. Eligible studies assessed CYP2C19 testing in community pharmacies. Outcomes of interest included clinical, operational, economic, patient-reported, and provider-reported measures. Results Of 42 studies initially screened, three prospective studies met the inclusion criteria. All evaluated pharmacist-led CYP2C19 testing models in community pharmacies. Testing success rates were high (98%–100%). However, only the point-of-care testing enabled rapid turnaround times. Patient-reported perceptions were generally favorable, with most considering pharmacies appropriate for PGx testing. Pharmacists reported added clinical value but cited barriers such as reimbursement challenges, workflow integration, and knowledge gaps. Economic findings were mixed: point-of-care testing showed potential cost savings at higher rates of genotype-guided therapy modification, while reimbursement limitations hindered implementation in other settings. Conclusion Community pharmacy-based PGx testing for clopidogrel provides preliminary evidence supporting operational feasibility. To support sustainable implementation, efforts should focus on establishing funding mechanisms, enhancing provider education, and integrating PGx testing into routine workflows.