Table 2.

Summary therapeutic recommendations based on CYP2C19 and CYP2D6 phenotype for escitalopram, citalopram, sertraline, paroxetine, fluoxetine, and fluvoxamine.

Drug	Gene	Phenotype	Therapeutic recommendation (if present)a
Escitalopram	CYP2C19	PM	Do not exceed the following doses (50% of the standard maximum dose): - Adults up to 65 years: 10 mg/day - Adults 65 years or older: 5 mg/day
		IM	Do not exceed the following doses (75% of the standard maximum dose): - Adults <65 years: 15 mg/day - Adults 65 years or older: 7.5 mg/day
		UM	Avoid escitalopram. Antidepressants that are not metabolized or that are metabolized to a lesser extent by CYP2C19 are, for example, paroxetine or fluvoxamine.
Citalopram	CYP2C19	PM	Do not exceed the following daily doses (50% of the standard maximum dose): - Adults up to 65 years: 20 mg as tablets or 16 mg as drops, - Adults 65 years or older: 10 mg as tablets or 8 mg as drops
		IM	Do not exceed the following daily doses: - Adults up to 65 years: 30 mg as tablets or 22 mg as drops, - Adults 65 years or older: 15 mg as tablets or 10 mg as drops
		UM	-
Sertraline	CYP2C19	PM	Do not give doses exceeding 75 mg/day. Guide the dose by response and side effects and/or sertraline plasma concentration.
		IM	-
		UM	-
Paroxetine	CYP2D6	PM	-
		IM	-
		UM	Avoid paroxetine. Antidepressants that are not metabolized by CYP2D6, or to a lesser extent, include for example citalopram or sertraline.
Fluoxetine	CYP2D6	PM	-
		IM	-
		UM	-
Fluvoxamine	CYP2D6	PM	-
		IM	-
		UM	-
Fluvoxamine	CYP2C19	PM	-
		IM	-
		UM	-
Escitalopram/Citalopram	CYP2D6	PM	-
		IM	-
		UM	-
Sertraline	CYP2D6	PM	-
		IM	-
		UM	-

PM: poor metabolizer, IM: intermediate metabolizer, UM: ultrarapid metabolizer.

^aNo pharmacotherapeutic recommendation: therapy adjustment is not required or beneficial for this phenotype-drug combinations.