• Dr. Limdi is a clinical pharmacist and epidemiologist with significant expertise in pharmacogenomics and pharmacoepidemiology, from research and discovery to its application and implementation in clinical practice. Her research portfolio encompasses studies with both observational and a clinical trial designs and is focused on understanding the multiple factors that influence drug efficacy and safety, specifically anticoagulant and antiplatelet response. An established investigator in the field of pharmacogenomics, she has made significant contributions towards understanding of genetic basis of warfarin response. Her work has included discovering novel polymorphisms in CYP2C9, statistical analytic approaches that has ranged from candidate gene, haplotype based approach to genome-wide association and exome approaches, and a research portfolio that includes both prospective cohort and randomized clinical trials.

    Through her work, Dr. Limdi has collaborated extensively with pharmacogenomics researchers including with the International Warfarin Pharmacogenomics Consortium (IWPC), the Clinical Pharmacogenetics Implementation Committee (CPIC), and the Implementation of Genomics In pracTicE (IGNITE). As the Associate Director of Pharmacogenomics n the Hugh Kaul Personalized Medicine Institute, Dr. Limdi oversees discovery and clinical implementation of pharmacogenomics across the health UAB system. Through this initiative, her team has identified and overcome barriers, incorporated genotype-guided therapy and assessed clinically relevant outcomes to conduct economic analysis and inform health policy and reimbursement strategies for pharmacogenomics.
  • Selected Publications

    Academic Article

    Year Title Altmetric
    2021 Translational Pharmacogenomics: Discovery, Evidence Synthesis and Delivery of Race-Conscious MedicineClinical Pharmacology and Therapeutics.  110:909-925. 2021
    2021 Opportunity for Genotype-Guided Prescribing Among Adult Patients in 11 US Health SystemsClinical Pharmacology and Therapeutics.  110:179-188. 2021
    2021 Risk Factors for Major Hemorrhage Among Patients Receiving Dabigatran Across the Spectrum of CKD Not Requiring Dialysis TherapyAmerican Journal of Kidney Diseases.  78:151-153. 2021
    2021 Outcomes of Individuals With and Without Heart Failure Presenting With Acute Coronary SyndromeAmerican Journal of Cardiology.  148:1-7. 2021
    2021 Thromboembolic and Hemorrhagic Outcomes in the Direct Oral Anticoagulant Trials Across the Spectrum of Kidney FunctionClinical Pharmacology and Therapeutics.  109:1593-1605. 2021
    2021 Impact of the CYP2C19*17 Allele on Outcomes in Patients Receiving Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary InterventionClinical Pharmacology and Therapeutics.  109:705-715. 2021
    2021 Evaluation of population-level pharmacogenetic actionability in AlabamaClinical and Translational Science2021
    2021 Multisite evaluation of institutional processes and implementation determinants for pharmacogenetic testing to guide antidepressant therapyClinical and Translational Science2021
    2021 Pharmacogenetic Predictors of Cannabidiol Response and Tolerability in Treatment-Resistant EpilepsyClinical Pharmacology and Therapeutics2021
    2020 Prescribing Prevalence of Medications With Potential Genotype-Guided Dosing in Pediatric PatientsJAMA Network Open.  3:e2029411. 2020
    2020 Correction: Evaluating the extent of reusability of CYP2C19 genotype data among patients genotyped for antiplatelet therapy selection (Genetics in Medicine, (2020), 22, 11, (1898-1902), 10.1038/s41436-020-0894-2)Genetics in Medicine.  22:1919. 2020
    2020 Evaluating the extent of reusability of CYP2C19 genotype data among patients genotyped for antiplatelet therapy selectionGenetics in Medicine.  22:1898-1902. 2020
    2020 Cost-effectiveness of CYP2C19-guided antiplatelet therapy in patients with acute coronary syndrome and percutaneous coronary intervention informed by real-world data 2020
    2020 Race-based and sex-based differences in bioactive lipid mediators after myocardial infarctionESC Heart Failure.  7:1700-1710. 2020
    2020 Genetic Factors Influencing Warfarin Dose in Black-African Patients: A Systematic Review and Meta-AnalysisClinical Pharmacology and Therapeutics.  107:1420-1433. 2020
    2020 Residual risk for coronary heart disease events and mortality despite intensive medical management after myocardial infarctionJournal of Clinical Lipidology.  14:260-270. 2020
    2020 Validation of the Spartan RXCYP2C19 Genotyping Assay Utilizing Blood SamplesClinical and Translational Science.  13:260-264. 2020
    2020 Development of customizable implementation guides to support clinical adoption of pharmacogenomics: Experiences of the implementing genomics in practice (ignite) networkPharmacogenomics and Personalized Medicine.  13:217-226. 2020
    2020 Improvement in kidney function after ventricular assist device implantation and its influence on thromboembolism, hemorrhage, and mortalityASAIO Journal.  268-276. 2020
    2020 Severity of Hypertension Mediates the Association of Hyperuricemia With Stroke in the REGARDS Case Cohort StudyHypertension.  75:246-256. 2020
    2019 Circulating myocardial microRNAs from infarcted hearts are carried in exosomes and mobilise bone marrow progenitor cellsNature Communications.  10. 2019
    2019 Scalp EEG spikes predict impending epilepsy in TSC infants: A longitudinal observational studyEpilepsia.  60:2428-2436. 2019
    2019 Risk of Major Adverse Cardiovascular Events and Major Hemorrhage Among White and Black Patients Undergoing Percutaneous Coronary Intervention 2019
    2019 Genome-Wide Association Study of Apparent Treatment-Resistant Hypertension in the CHARGE Consortium: The CHARGE Pharmacogenetics Working GroupAmerican Journal of Hypertension.  32:1146-1153. 2019
    2019 Racial differences in adult-onset MRI-negative temporal lobe epilepsyEpilepsy and Behavior.  100. 2019
    2019 Genome-wide meta-analysis of SNP and antihypertensive medication interactions on left ventricular traits in African AmericansMolecular Genetics and Genomic Medicine.  7. 2019
    2019 Multi-site investigation of strategies for the clinical implementation of CYP2D6 genotyping to guide drug prescribingGenetics in Medicine.  21:2255-2263. 2019
    2019 Effect of CYP4F2, VKORC1, and CYP2C9 in Influencing Coumarin Dose: A Single-Patient Data Meta-Analysis in More Than 15,000 IndividualsClinical Pharmacology and Therapeutics.  105:1477-1491. 2019
    2019 Between a rock and a hard place: A high-risk patient with resistance to multiple P2Y12 antagonistsPharmacogenomics.  20:475-481. 2019
    2019 Genome-wide meta-analysis of SNP-by9-ACEI/ARB and SNP-by-thiazide diuretic and effect on serum potassium in cohorts of European and African ancestry 2019
    2019 A PheWAS study of a large observational epidemiological cohort of African Americans from the REGARDS studyBMC Medical Genomics.  12. 2019
    2019 CYP3A5 genotype affects time to therapeutic tacrolimus level in pediatric kidney transplant recipientsPediatric Transplantation.  23. 2019
    2018 Pharmacogenetics of warfarin dosing in patients of African and European ancestryPharmacogenomics.  19:1357-1371. 2018
    2018 Multisite Investigation of Strategies for the Implementation of CYP2C19 Genotype-Guided Antiplatelet TherapyClinical Pharmacology and Therapeutics.  104:664-674. 2018
    2018 Influence of Age on Warfarin Dose, Anticoagulation Control, and Risk of Hemorrhage 2018
    2018 Genetic deletion of 12/15 lipoxygenase promotes effective resolution of inflammation following myocardial infarctionJournal of Molecular and Cellular Cardiology.  118:70-80. 2018
    2018 Racial disparities in temporal lobe epilepsyEpilepsy Research.  140:56-60. 2018
    2018 Multisite Investigation of Outcomes With Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary InterventionJACC: Cardiovascular Interventions.  11:181-191. 2018
    2017 Genome-wide admixture and association study of subclinical atherosclerosis in the Women’s Interagency HIV Study (WIHS)PLoS ONE.  12. 2017
    2017 Clinical and genetic predictors of delayed remission after multiple levels of antidepressant treatment: Toward early identification of depressed individuals for advanced care optionsJournal of Clinical Psychiatry.  78:e1291-e1298. 2017
    2017 Comparison of two point-of-care cyp2c19 genotyping assays for genotype-guided antiplatelet therapyAnnals of Clinical and Laboratory Science.  47:738-743. 2017
    2017 Influence of Kidney Transplant Status on Warfarin Dose, Anticoagulation Control, and Risk of Hemorrhage 2017
    2017 Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Pharmacogenetics-Guided Warfarin Dosing: 2017 UpdateClinical Pharmacology and Therapeutics.  102:397-404. 2017
    2017 Precision Medicine at the University of Alabama at Birmingham: Laying the Foundational Processes Through Implementation of Genotype-Guided Antiplatelet TherapyClinical Pharmacology and Therapeutics.  102:493-501. 2017
    2017 Implementation and utilization of the molecular tumor board to guide precision medicine.Oncotarget.  8:57845-57854. 2017
    2017 Age and sex disparities in discharge statin prescribing in the stroke belt: Evidence from the reasons for geographic and racial differences in stroke study 2017
    2017 Differential Impact of Risk Factors in Blacks and Whites in the Development of Atrial Fibrillation: the Reasons for Geographic And Racial Differences in Stroke (REGARDS) StudyJournal of Racial and Ethnic Health Disparities.  4:718-724. 2017
    2017 Influence of common and rare genetic variation on warfarin dose among African-Americans and European-Americans using the exome arrayPharmacogenomics.  18:1059-1073. 2017
    2017 Racial differences in statin adherence following hospital discharge for ischemic strokeNeurology.  88:1839-1848. 2017
    2017 The IGNITE Pharmacogenetics Working Group: An Opportunity for Building Evidence with Pharmacogenetic Implementation in a Real-World SettingClinical and Translational Science.  10:143-146. 2017
    2017 Admixture Mapping of Subclinical Atherosclerosis and Subsequent Clinical Events among African Americans in 2 Large Cohort StudiesCirculation: Cardiovascular Genetics.  10. 2017
    2017 Influence of statin therapy at time of stroke onset on functional outcome among patients with atrial fibrillationInternational Journal of Cardiology.  227:808-812. 2017
    2017 Anticoagulation control in patients with ventricular assist devicesASAIO Journal.  63:759-765. 2017
    2017 Implementation and utilization of the molecular tumor board to guide precision medicineOncotarget.  8:57845-57854. 2017
    2017 Local ancestry and clinical cardiovascular events among African Americans from the atherosclerosis risk in communities study 2017
    2017 Quality of anticoagulation control and hemorrhage risk among African American and European American warfarin users 2017
    2017 Whole exome analyses to examine the impact of rare variants on left ventricular traits in African American participants from the HyperGEN and GENOA studies.J Hypertens Manag.  3. 2017
    2016 High-Sensitivity C-Reactive Protein and Risk of Stroke in Atrial Fibrillation (from the Reasons for Geographic and Racial Differences in Stroke Study)American Journal of Cardiology.  118:1826-1830. 2016
    2016 Addressing stroke risk factors in Black and White Americans: Findings from the national health and nutrition examination survey, 2009-2010Ethnicity and Disease.  26:9-16. 2016
    2016 US mortality: Influence of race, geography and cardiovascular risk among participants in the population-based REGARDS cohortJournal of Racial and Ethnic Health Disparities.  3:599-607. 2016
    2016 A systematic analysis and comparison of warfarin initiation strategies 2016
    2016 Comparison of approaches for stroke prophylaxis in patients with non-valvular atrial fibrillation: Network meta-analyses of randomized controlled trialsPLoS ONE.  11. 2016
    2016 Pharmacogenetics in Cardiovascular Medicine.Current Genetic Medicine Reports.  4:119-129. 2016
    2016 Effect of Left Ventricular Systolic Dysfunction on Response to WarfarinAmerican Journal of Cardiology.  118:232-236. 2016
    2016 Valvular Heart disease and acquired type 2A von willebrand syndrome: The "hemostatic" waring blender syndromeJAMA Cardiology.  1:205-206. 2016
    2016 APOL1 nephropathy risk variants are associated with altered high-density lipoprotein profiles in African AmericansNephrology Dialysis Transplantation.  31:602-608. 2016
    2016 Race-Specific Influence of CYP4F2 on Dose and Risk of Hemorrhage among Warfarin Users 2016
    2016 Paroxysmal atrial fibrillation and the hazards of under-treatmentInternational Journal of Cardiology.  202:214-220. 2016
    2015 Predictors of thromboembolic events in patients with ventricular assist deviceASAIO Journal.  61:640-647. 2015
    2015 Race influences warfarin dose changes associated with genetic factorsBlood.  126:539-545. 2015
    2015 Genome-wide association study of warfarin maintenance dose in a Brazilian samplePharmacogenomics.  16:1253-1263. 2015
    2015 Influence of Kidney Function on Risk of Supratherapeutic International Normalized Ratio-Related Hemorrhage in Warfarin Users: A Prospective Cohort StudyAmerican Journal of Kidney Diseases.  65:701-709. 2015
    2015 Validity of international classification of disease codes to identify ischemic stroke and intracranial hemorrhage among individuals with associated diagnosis of atrial fibrillationCirculation: Cardiovascular Quality and Outcomes.  8:8-14. 2015
    2014 Genetic variant in folate homeostasis is associated with lower warfarin dose in African AmericansBlood.  124:2298-2305. 2014
    2014 Influence of regular physical activity on warfarin dose and risk of hemorrhagic complications 2014
    2014 RYR3 gene variants in subclinical atherosclerosis among HIV-infected women in the Women's Interagency HIV Study (WIHS)Atherosclerosis.  233:666-672. 2014
    2014 The effects of angiotensinogen gene polymorphisms on cardiovascular disease outcomes during antihypertensive treatment in the GenHAT study.Frontiers in Pharmacology.  5:210. 2014
    2013 Vitamin K intake, body mass index and warfarin maintenance dose 2013
    2013 Influence of kidney function on risk of hemorrhage among patients taking warfarin: A cohort studyAmerican Journal of Kidney Diseases.  61:354-357. 2013
    2013 A pharmacogenetic versus a clinical algorithm for warfarin dosingNew England Journal of Medicine.  369:2283-2293. 2013
    2013 Genetic variants associated with warfarin dose in African-American individuals: A genome-wide association study 2013
    2013 Pathway analysis of genome-wide data improves warfarin dose prediction.BMC Genomics.  14 Suppl 3. 2013
    2013 Reversal of oral anticoagulation 2013
    2012 Warfarin pharmacogenetics: Challenges and opportunities for clinical translationFrontiers in Pharmacology.  3 OCT. 2012
    2012 Use of secondary prevention medications among adults with reduced kidney functionClinical Journal of the American Society of Nephrology.  7:604-611. 2012
    2012 Pharmacogenetic warfarin dose refinements remain significantly influenced by genetic factors after one week of therapyThrombosis and Haemostasis.  107:232-240. 2012
    2012 Prevalence and Correlates of Low Medication Adherence in Apparent Treatment-Resistant HypertensionJournal of Clinical Hypertension.  14:694-700. 2012
    2011 High-dimensional pharmacogenetic prediction of a continuous trait using machine learning techniques with application to warfarin dose prediction in African AmericansBioinformatics.  27:1384-1389. 2011
    2011 Preference-based quality-of-life measures for neocortical epilepsy surgeryEpilepsia.  52:1018-1020. 2011
    2011 Controlling population structure in human genetic association studies with samples of unrelated individualsStatistics and Its Interface.  4:317-326. 2011
    2011 Practical consideration of genotype imputation: Sample size, window size, reference choice, and untyped rateStatistics and Its Interface.  4:339-352. 2011
    2010 Warfarin dosing in patients with impaired kidney functionAmerican Journal of Kidney Diseases.  56:823-831. 2010
    2010 Expectations, validity, and reality in pharmacogeneticsJournal of Clinical Epidemiology.  63:960-969. 2010
    2010 Warfarin pharmacogenetics: A single VKORC1 polymorphism is predictive of dose across 3 racial groupsBlood.  115:3827-3834. 2010
    2010 Integration of genetic, clinical, and INR data to refine warfarin dosingClinical Pharmacology and Therapeutics.  87:572-578. 2010
    2009 Hyperammonemia following intravenous valproate loadingEpilepsy Research.  85:65-71. 2009
    2009 Influence of CYP2C9 and VKORC1 on warfarin response during initiation of therapyBlood Cells, Molecules and Diseases.  43:119-128. 2009
    2009 Effect of epilepsy magnetic source imaging on intracranial electrode placementAnnals of Neurology.  65:716-723. 2009
    2009 Warfarin pharmacogenomicsCurrent Opinion in Molecular Therapeutics.  11:243-251. 2009
    2009 Kidney function influences warfarin responsiveness and hemorrhagic ComplicationsJournal of the American Society of Nephrology.  20:912-921. 2009
    2009 A potentially deleterious new CYP2C9 polymorphism identified in an African American patient with major hemorrhage on warfarin therapyBlood Cells, Molecules and Diseases.  42:155-158. 2009
    2009 Estimation of the Warfarin Dose with Clinical and Pharmacogenetic DataNew England Journal of Medicine.  360:753-764. 2009
    2008 Ethnic differences in warfarin maintenance dose requirement and its relationship with geneticsPharmacogenomics.  9:1331-1346. 2008
    2008 VKORC1 polymorphims, haplotypes and haplotype groups on warfarin dose among African-Americans and European-AmericansPharmacogenomics.  9:1445-1458. 2008
    2008 Warfarin pharmacogenetics 2008
    2008 Functional imaging: I. Relative predictive value of intracranial electroencephalographyAnnals of Neurology.  64:25-34. 2008
    2008 Functional imaging: II. Prediction of epilepsy surgery outcomeAnnals of Neurology.  64:35-41. 2008
    2008 Influence of CYP2C9 and VKORC1 on warfarin dose, anticoagulation attainment and maintenance among European-Americans and African-AmericansPharmacogenomics.  9:511-526. 2008
    2008 Influence of CYP2C9 and VKORC1 1173C/T genotype on the risk of hemorrhagic complications in African-American and European-American patients on warfarinClinical Pharmacology and Therapeutics.  83:312-321. 2008
    2007 Valproate protein binding following rapid intravenous administration of high doses of valproic acid in patients with epilepsyJournal of Clinical Pharmacy and Therapeutics.  32:365-371. 2007
    2007 Influence of CYP2C9 genotype on warfarin dose among African-Americans and European-AmericansPersonalized Medicine.  4:157-169. 2007
    2007 Safety of rapid intravenous loading of valproateEpilepsia.  48:478-483. 2007
    2006 Racial differences in the prevalence of Factor V Leiden mutation among patients on chronic warfarin therapyBlood Cells, Molecules and Diseases.  37:100-106. 2006
    2006 Citrus aurantium and synephrine alkaloids in the treatment of overweight and obesity: An updateObesity Reviews.  7:79-88. 2006
    2005 Efficacy of rapid IV administration of valproic acid for status epilepticus [3] (multiple letters)Neurology.  65:500-501. 2005
    2005 Efficacy of rapid IV administration of valproic acid for status epilepticusNeurology.  64:353-355. 2005
    2004 Superiority of fixed-dose warfarin for chronic anticoagulationJournal of Stroke and Cerebrovascular Diseases.  13:118-121. 2004
    2003 Neurotoxicity following addition of intravenous valproate to lamotrigine therapyNeurology.  60:1991-1992. 2003
    2001 Rasmussen's Encephalitis.Current Treatment Options in Neurology.  3:555-563. 2001
    2000 The safety of rapid valproic acid infusionEpilepsia.  41:1342-1345. 2000


    Year Title Altmetric
    2009 Oxcarbazepine.  575-584. 2009
    2008 Warfarin Pharmacogenetics 2008
    2008 Warfarin Pharmocogenetics 2008
    2003 Managing Interactions: Antibiotics and antiepileptic drugs. 2003
    2000 Adverse and beneficial side effects of antiepileptic drugs 2000

    Research Overview

  • Harnessing the racial diversity of the population served at UAB, Dr. Limdi research and practice interests center around the evaluation of racial differences in the genetic underpinnings for drug response.
    1. Discovery of genetic variants and environmental factors influencing drug response
    2. Integrating clinical, genetic, socio-demographic and behavioral data to predict drug response
    3. Translating pharmacogenomic discoveries to health disparity populations
    4. Development of statistical genetic analysis approaches and methodologies
    5. Advancing Pharmacogenomics through collaborations with national and international consortia.
  • Principal Investigator On

  • Clinical Site Participation in Clarification of Optimal Anticoagulation Through Genetics (COAG) Clinical Trial  awarded by University of Pennsylvania
  • Collaborative Meta-Analysis of Genetic Predictors on Warfarin Response  awarded by UNIVERSITY OF VERONA
  • Discovery, Implementation and Mentorship in Personalized Cardiovascular Pharmacotherapy  awarded by National Heart, Lung, and Blood Institute/NIH/DHHS
  • Effect of Statins and Modifiable Factors on Stroke Outcome in Atrial Fibrillation  awarded by BOSTON MEDICAL CENTER
  • Genetic and Clinical Predictors of Response to Warfarin and Novel Anticoagulants  awarded by National Heart, Lung, and Blood Institute/NIH/DHHS
  • Genetic and Environmental Determinants of Warfarin Response  awarded by National Heart, Lung, and Blood Institute/NIH/DHHS
  • Integrating Genomic Risk Assessment for Chronic Disease Management in a Diverse Population  awarded by National Human Genome Research Institute/NIH/DHHS
  • Patient Oriented Research in Personalized Antithrombotic Therapy  awarded by National Heart, Lung, and Blood Institute/NIH/DHHS
  • Pharmacogenomic Resource for Improving Medication Effectiveness (PRIME)  awarded by UNIVERSITY OF ALABAMA HEALTH SERVICES FOUNDATION
  • Prediction of Warfarin Dosing Using Clinical and Genetic Factors  awarded by University of Pennsylvania
  • Predictors of Hemorrhage Among Patients on Direct Acting Oral Anticoagulants  awarded by National Heart, Lung, and Blood Institute/NIH/DHHS
  • Predictors of Thromboembolism and Hemorrhage in Patients on Ventricular Assist Devices  awarded by American Heart Association
  • Private Grant  awarded by DIAGNOSTICA STAGO, INC
  • Racial Differences in Causes and Consequences of Medication Adherence  awarded by American Heart Association (Southeast Affiliate)
  • The Student Scholarship in Cardiovascular Diseases  awarded by American Heart Association
  • Teaching Overview

  • In addition to research and implementation, Dr. Limdi is committed to developing talent through mentorship: She brings a comprehensive and diverse set of skills, and expertise in pharmacy practice, pharmacology, pharmacogenomics, clinical research methods, epidemiology and biostatistics to didactic teaching and training residents, post-doctoral trainees and junior faculty.
  • Education And Training

  • Doctor of Philosophy in Epidemiology, University of Alabama at Birmingham 2007
  • Master of Public Health, University of Alabama at Birmingham 2005
  • Doctor of Pharmacy, Samford University 1994
  • Bachelor of Pharmacy in Pharmacy, Pharmaceutical Sciences, and Administration, Samford University 1993
  • Bachelor of Pharmacy in Pharmacy, Pharmaceutical Sciences, and Administration, 1988
  • Full Name

  • Nita Limdi