Table 4.

Tricyclic antidepressants dosing advice based on CYP2C19 and CYP2D6 phenotype according to DPWG and/or CPIC; see (78).

TCAs	CYP2C19				CYP2D6
	Poor metabolizer	Intermediate metabolizer	Normal metabolizer	Ultrarapid metabolizer	Poor metabolizer	Intermediate metabolizer	Normal metabolizer	Ultrarapid metabolizer
Amitriptyline	Nortriptyline/ desimpramine or 50% dose reduction	Recommended starting dose	Recommended starting dose	Nortriptyline/ desimpramine or 50% dose increase	No TCA or 50%	Reduce dose by 25%	Recommended starting dose	No TCA or higher dose
Clomipramine	Nortriptyline/ desimpramine or 50%	Recommended starting dose	Recommended starting dose	Nortriptyline/ desimpramine or 50% dose increase	No TCA or 50% dose reduction	Reduce dose by 25%	Recommended starting dose	No TCA or higher dose
Doxepine	Nortriptyline/ desimpramine or 50%	Recommended starting dose	Recommended starting dose	Nortriptyline/ desimpramine or 50%	Reduce dose by 60%	Reduce dose by 20%	Recommended starting dose	No TCA or 100% higher dose
Imipramine	Nortriptyline/ desimpramine or 50%	Recommended starting dose	Recommended starting dose	Nortriptyline/ desimpramine or 50%	No TCA or 70% dose reduction	No TCA or 30% dose reduction	Recommended starting dose	No TCA or 70% dose increase
Nortriptyline		Recommended starting dose	Recommended starting dose	100%	No TCA or 60% dose reduction	No TCA or 40% dose reduction	Recommended starting dose	No TCA or 60% dose increase