CYP2D6 genotypes in revolving door patients with bipolar disorders: A case series

Davide Seripa, Madia Lozupone, Giuseppe Miscio, Eleonora Stella, Maddalena La Montagna, Carolina Gravina, Maria Urbano, Lazzaro di Mauro, Antonio Daniele, Antonio Greco, Giancarlo Logroscino, Francesco Panza, Antonello Bellomo

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Abstract

RATIONALE: In psychiatric disorders, interindividual differences in cytochrome P450 (CYP)2D6 (CYP2D6) enzymatic activity could be responsible of adverse drug reactions (ADRs) and therapeutic failures (TFs) for CYP2D6-metabolized drugs, contributing to the periodical hospital readmissions of the revolving door (RD) condition.

PATIENT CONCERNS: We investigated CYP2D6 genotypes in a controlled series of 5 consecutive RD patients with Bipolar Disorder (BD).

DIAGNOSES: Psychiatric patients affected by Bipolar Disorder.

INTERVENTIONS: We defined TFs as a difference at the Brief Psychiatric Rating Scale score ΔBPRS < 25% at each 1-week of stable treatment, and ADRs as the onset of extrapyramidal symptoms and/or metabolic impairment with weight gain.

OUTCOMES: At 3 months, a mean number of 2.75 ± 1.26 ADR and a mean ΔBPRS score of 16.07 ± 0.05% were observed. At 6 months of follow-up, compared to the only patient without BD (ΔBPRS < 32.10%), BD patients (n = 4) showed TFs (ΔBPRS < 25%). CYP2D6 genotyping revealed intermediate metabolizer phenotypes for BD patients and an extensive metabolizer phenotype for the patient without BD. In BD patients, the ratio of drugs maintained/discontinued for TFs or ADRs was 1.75 for non-CYP2D6 versus 0.33 for CYP2D6 interacting drugs, while the proportion of ADR:TF was 0:4 versus 6:3.

LESSONS: Our findings may suggest that CYP2D6 clinically relevant genotypes may be involved in the unwanted outcomes observed in RD patients with BD.

Original languageEnglish
Pages (from-to)e11998
JournalMedicine
Volume97
Issue number37
DOIs
Publication statusPublished - Sep 1 2018

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ASJC Scopus subject areas

  • Medicine(all)

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Seripa, D., Lozupone, M., Miscio, G., Stella, E., La Montagna, M., Gravina, C., Urbano, M., di Mauro, L., Daniele, A., Greco, A., Logroscino, G., Panza, F., & Bellomo, A. (2018). CYP2D6 genotypes in revolving door patients with bipolar disorders: A case series. Medicine, 97(37), e11998. https://doi.org/10.1097/MD.0000000000011998