A Poor Metabolizer for Cytochromes P450 2D6 and 2C19: A Case Report on Antidepressant Treatment
- 1 October 2006
- journal article
- case report
- Published by Cambridge University Press (CUP) in CNS Spectrums
- Vol. 11 (10) , 757-760
- https://doi.org/10.1017/s1092852900014887
Abstract
Scientific literature has never described a poor metabolizer for both the cytochrome P450 (CYP) 2D6 and the CYP 2C19. They are expected to be rare (<1% in different ethnic groups) and prone to adverse drug reactions with many antidepressants. In an ongoing pharmacogenetic study, after genotyping 1,576 subjects in three Kentucky state hospitals we have found one poor metabolizer for both CYP 2D6 and CYP 2C19, which corresponds to a prevalence of 0.06% (95% Cl 0.01 to 0.36).The naturalistic antidepressant treatment of this poor metabolizer for both enzymes is described in this article. As genotyping reaches clinical practice, it will be interesting to prospectively establish whether mirtazapine is a reasonable choice as an antidepressant for these patients, as the data and this case suggest.Keywords
This publication has 14 references indexed in Scilit:
- Heterozygous Mutation in CYP2C19 Significantly Increases the Concentration/Dose Ratio of Racemic Citalopram and Escitalopram (S-citalopram)Therapeutic Drug Monitoring, 2006
- Clinical Guidelines for Psychiatrists for the Use of Pharmacogenetic Testing for CYP450 2D6 and CYP450 2C19Psychosomatics, 2006
- The Dosing of Atypical AntipsychoticsPsychosomatics, 2005
- Amitriptyline or Not, That Is the Question: Pharmacogenetic Testing of CYP2D6 and CYP2C19 Identifies Patients with Low or High Risk for Side Effects in Amitriptyline TherapyClinical Chemistry, 2005
- The CYP2D6 Poor Metabolizer Phenotype May Be Associated With Risperidone Adverse Drug Reactions and DiscontinuationThe Journal of Clinical Psychiatry, 2005
- Impact of the CYP2D6 Ultrarapid Metabolizer Genotype on Mirtazapine Pharmacokinetics and Adverse Events in Healthy VolunteersJournal of Clinical Psychopharmacology, 2004
- Pharmacogenetics of antidepressants and antipsychotics: the contribution of allelic variations to the phenotype of drug responseMolecular Psychiatry, 2004
- Pharmacogenetics affects dosing, efficacy, and toxicity of cytochrome P450–metabolized drugsThe American Journal of Medicine, 2002
- Therapeutic Drug Monitoring of Racemic Venlafaxine and Its Main Metabolites in an Everyday Clinical SettingTherapeutic Drug Monitoring, 2002
- Clinical Pharmacokinetics of MirtazapineClinical Pharmacokinetics, 2000