CPIC Updates Guideline for CYP2D6/CYP2C19-Guided Tricyclic Antidepressant Dosing
This 2016 update to the CPIC tricyclic antidepressant guideline provides genotype-guided dosing recommendations based on CYP2D6 and CYP2C19 metaboliser status. Some TCAs are affected by CYP2D6 alone (nortriptyline, desipramine), while others require consideration of both enzymes (amitriptyline, clomipramine, imipramine). The guideline gives laboratories a clear framework for reporting actionable pharmacogenomic results for one of the most established gene-drug interaction classes.
The original study
Clinical pharmacogenetics implementation consortium guideline (CPIC) for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants: 2016 update.
- Authors
- Hicks JK, Sangkuhl K, Swen JJ, Ellingrod VL, Müller DJ, Shimoda K, et al.
- Journal
- Clinical pharmacology and therapeutics
- Type
- Journal Article, Practice Guideline, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.
- PMID
- 27997040
Original abstract
CYP2D6 and CYP2C19 polymorphisms affect the exposure, efficacy and safety of tricyclic antidepressants (TCAs), with some drugs being affected by CYP2D6 only (e.g., nortriptyline and desipramine) and others by both polymorphic enzymes (e.g., amitriptyline, clomipramine, doxepin, imipramine, and trimipramine). Evidence is presented for CYP2D6 and CYP2C19 genotype-directed dosing of TCAs. This document is an update to the 2012 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants.