Nonresponse to high-dose bupropion for depression in a patient carrying CYP2B6 6 and CYP2C19 17 variants: a case report

We report the case of a patient with major depression treated with high-dose bupropion due to prior detected subtherapeutic blood concentrations at standard dosing. Pharmacogenetic panel testing identified the patient as a carrier of the *6 allele, which has been associated with reduced bupropion me...

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Bibliographic Details
Published in:Pharmacogenomics 2020-11, Vol.21 (16), p.1145-1150
Main Authors: Stäuble, Céline K, Lampert, Markus L, Mikoteit, Thorsten, Hatzinger, Martin, Hersberger, Kurt E, Meyer Zu Schwabedissen, Henriette E
Format: Article
Language:English
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Summary:We report the case of a patient with major depression treated with high-dose bupropion due to prior detected subtherapeutic blood concentrations at standard dosing. Pharmacogenetic panel testing identified the patient as a carrier of the *6 allele, which has been associated with reduced bupropion metabolism and decreased concentrations of the pharmacologically active metabolite hydroxybupropion. Interestingly, we also found the patient to be homozygous for the *17 allele, predicting an ultra rapid metabolizer phenotype. We propose a combined effect of the detected and genetic variants on bupropion metabolism. This case underlines the potential benefit of pre-emptive pharmacogenotyping but also the yet still fragmentary evidence making precise pharmacogenotype guided antidepressant selection and dosing challenging.
ISSN:1462-2416
1744-8042
DOI:10.2217/pgs-2020-0087