Table 2.

DPWG Therapeutic Recommendations for CYP2D6 and Venlafaxine (2019)

PhenotypeRecommendation
CYP2D6 poor metabolizer
1.

Avoid venlafaxine*

2.

If it is not possible to avoid venlafaxine and side effects occur:

a.

reduce the dose

b.

monitor the effect and side effects or check the plasma concentrations of venlafaxine and O-desmethylvenlafaxine

CYP2D6 intermediate metabolizer
1.

Avoid venlafaxine*

2.

If it is not possible to avoid venlafaxine and side effects occur:

a.

reduce the dose

b.

monitor the effect and side effects or check the plasma concentrations of venlafaxine and O-desmethylvenlafaxine

CYP2D6 ultrarapid metabolizer
1.

Be alert to a possible decrease in the sum of the plasma concentrations of venlafaxine and the active metabolite O-desmethylvenlafaxine

2.

if necessary, increase the dose to 150% of the standard dose

3.

if dose adjustment does not result in efficacy without unacceptable side effects or if dose adjustment based on therapeutic drug monitoring is not possible, then venlafaxine should be avoided*

*

Antidepressants that are not metabolized by CYP2D6 –– or to a lesser extent –– include, for example, duloxetine, mirtazapine, citalopram, and sertraline

This DPWG table is adapted from (2)

From: Venlafaxine Therapy and CYP2D6 Genotype

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Pratt VM, Scott SA, Pirmohamed M, et al., editors.
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