Copyright Notice This presentation is copyrighted by the Psychopharmacology Institute. Subscribers can download it and use it for professional use. The contents of the presentation may be modified, but the Psychopharmacology Institute logo must remain visible in all slides.

Genotype Influences Medication Blood Levels: Fluoxetine, Paroxetine, and (Es)citalopram Simon Kung, M.D. Associate Professor of Psychiatry Mayo Clinic

The Clinical Pharmacogenetics Implementation Consortium: SSRIs and 2D6 Enzyme Major Findings Level of Evidence Fluoxetine 2D6 2D6 poor metabolizers had significantly higher fluoxetine plasma levels compared to extensive metabolizers.  High Hicks, J. K., Bishop, J. R., Sangkuhl, K., Müller, D. J., Ji, Y., Leckband, S. G., ... & Skaar, T. C. (2015). Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and CYP2C19 genotypes and dosing of selective serotonin reuptake inhibitors. Clinical Pharmacology & Therapeutics, 98(2), 127-134.

The Clinical Pharmacogenetics Implementation Consortium: SSRIs and 2D6 Enzyme Major Findings Level of Evidence Paroxetine 2D6 Ultrarapid metabolizers had significantly lower paroxetine plasma levels compared to extensive metabolizers. High Hicks, J. K., Bishop, J. R., Sangkuhl, K., Müller, D. J., Ji, Y., Leckband, S. G., ... & Skaar, T. C. (2015). Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and CYP2C19 genotypes and dosing of selective serotonin reuptake inhibitors. Clinical Pharmacology & Therapeutics, 98(2), 127-134.

The Clinical Pharmacogenetics Implementation Consortium Major Findings Level of Evidence 2C19 poor metabolizers had significantly higher citalopram/escitalopram plasma levels when compared to the concentrations of all study participants. High SSRI (Es) citalopram Enzyme 2D6 2C19 Hicks, J. K., Bishop, J. R., Sangkuhl, K., Müller, D. J., Ji, Y., Leckband, S. G., ... & Skaar, T. C. (2015). Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and CYP2C19 genotypes and dosing of selective serotonin reuptake inhibitors. Clinical Pharmacology & Therapeutics, 98(2), 127-134.

Key Points The Clinical Pharmacogenetics Implementation Consortium (CPIC) provides review articles and clinical recommendations about genotype-guided dose adjustments.  The CPIC also provides literature-review evidence to support their recommendations. Polymorphisms can result in slower or faster enzyme activity.

Next Presentation Antidepressant Pharmacodynamic Genes of Interest