Serum clomipramine and desmethylclomipramine levels in a CYP2C19 and CYP2D6 intermediate metabolizer

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Pharmacogenetics within psychiatry has the potential to aid in the dose and selection of medications. A substantial number of psychiatric medications are metabolized through either of the highly polymorphic drug-metabolizing enzymes CYP2D6 and CYP2C19. Of these, clomipramine is subject to metabolism by both CYP2C19 and CYP2D6, leaving individuals with deficiencies of these drug-metabolizing enzymes at risk of higher concentrations of the parent molecule. Herein, we present the case of a 29-year-old male with diagnoses of depression and obsessive compulsive disorder who had trialed and failed a dozen psychiatric medications, many of which are subject to metabolism by CYP2D6 and/or CYP2C19, and had most recently been taking clomipramine for approximately 2.5 years. Pharmacogenetic testing revealed this patient to be an intermediate metabolizer for both CYP2C19 (∗1/∗2) and CYP2D6 (∗4/∗41), which resulted in considerably elevated serum trough concentrations of clomipramine and its active metabolite desmethylclomipramine. This case provides a retrospective view of how the knowledge of an individual's pharmacogenetic test results can aid in their clinical care.

Original languageEnglish (US)
Pages (from-to)601-605
Number of pages5
Issue number7
StatePublished - May 2017

Bibliographical note

Publisher Copyright:
© 2017 Future Medicine Ltd.

Copyright 2017 Elsevier B.V., All rights reserved.


  • CYP2C19
  • CYP2D6
  • clomipramine
  • desmethylclomipramine
  • pharmacogenetics
  • pharmacogenomics


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