Abstract
A pharmacokinetic interaction between the selective serotonin reuptake inhibitor citalopram and a tricyclic antidepressant, clomipramine, was noted in a patient treated for major depression and obsessive-compulsive disorder. After the addition of citalopram, a desmethylclomipramine plasma level increase and an 8-hydroacy-desmethylclomipramine plasma level decrease were observed. The CYP2D6 phenotype, determined when the patient received the antidepressant comedication, characterized a poor metabolizer status (dextromethorphan metabolic ratio >0.3), despite a heterozygous genotype containing a wild-type allele with extensive metabolic capacity and a mutant non-functional allele (CYP2D6*1A/CYP2D6*4A). This case seems to be one of the first descriptions of the clinical relevance of a CYP2D6 heterozygous genotype in a patient treated with antidepressant.
MeSH terms
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Adult
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Antidepressive Agents / adverse effects*
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Antidepressive Agents / pharmacokinetics
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Antidepressive Agents / therapeutic use
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Antidepressive Agents, Tricyclic / adverse effects*
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Antidepressive Agents, Tricyclic / pharmacokinetics
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Antidepressive Agents, Tricyclic / therapeutic use
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Citalopram / adverse effects*
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Citalopram / pharmacokinetics
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Citalopram / therapeutic use
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Clomipramine / adverse effects*
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Clomipramine / analogs & derivatives
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Clomipramine / blood
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Clomipramine / pharmacokinetics
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Clomipramine / therapeutic use
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Cytochrome P-450 CYP2D6 / genetics*
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Drug Interactions
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Drug Therapy, Combination
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Female
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Genotype
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Humans
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Obsessive-Compulsive Disorder / drug therapy
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Obsessive-Compulsive Disorder / psychology
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Phenotype
Substances
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Antidepressive Agents
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Antidepressive Agents, Tricyclic
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desmethylclomipramine
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Citalopram
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Cytochrome P-450 CYP2D6
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Clomipramine