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Practice Guideline
. 2013 May;93(5):402-8.
doi: 10.1038/clpt.2013.2. Epub 2013 Jan 16.

Clinical Pharmacogenetics Implementation Consortium guideline for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants

J K Hicks  1 , J J Swen, C F Thorn, K Sangkuhl, E D Kharasch, V L Ellingrod, T C Skaar, D J Müller, A Gaedigk, J C Stingl; Clinical Pharmacogenetics Implementation Consortium
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Practice Guideline

Clinical Pharmacogenetics Implementation Consortium guideline for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants

J K Hicks et al. Clin Pharmacol Ther. 2013 May.

Abstract

Polymorphisms in CYP2D6 and CYP2C19 affect the efficacy and safety of tricyclics, with some drugs being affected by CYP2D6 only, and others by both polymorphic enzymes. Amitriptyline, clomipramine, doxepin, imipramine, and trimipramine are demethylated by CYP2C19 to pharmacologically active metabolites. These drugs and their metabolites, along with desipramine and nortriptyline, undergo hydroxylation by CYP2D6 to less active metabolites. Evidence from published literature is presented for CYP2D6 and CYP2C19 genotype-directed dosing of tricyclic antidepressants.

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Figure 1
Major metabolic pathway of amitriptyline and nortriptyline.
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