Currently available guidelines for the implementation of pharmacogenetics recommend specific therapeutic guidelines for the following genotypes and allele combinations:

For CYP2D6 and CYP2C19 Poor Metabolizers (PM) and Ultrarapid Metabolizers (UM), the use of other antidepressants not primarily metabolized by these cytochromes is recommended. However, in case their use is necessary, the following dosage adjustments are indicated:

Poor CYP2D6 or CYP2C19 metabolizers: reduce the dose by 50% and monitor either therapeutic response and adverse effects or plasma concentrations to adjust the dose.
Ultrarapid CYP2D6 or CYP2C19 metabolizers: increase the dose by 40-50% assessing and monitoring the possible risk of increased cardiotoxicity. However, the following exceptions should be considered:

-In the case of CYP2C19 ultrarapid metabolism together with intermediate or poor metabolism for CYP2D6, start using standard doses and adjust subsequent ones based on the patient's follow-up.

-In the case of presenting ultrarapid metabolism for CYP2D6 together with poor metabolism for CYP2C19, the use of these drugs is definitely not recommended.

For Intermediate CYP2D6 Metabolizers (IM) , is recommended a 25% dose reduction and monitor either therapeutic response and adverse effects or plasma concentrations for dose adjustment.

Clinical Pharmacogenetics Implementation Consortium (CPIC)

Dutch Pharmacogenetics Working Group (DPWG)

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