CPIC® Guideline for Serotonin Reuptake Inhibitor Antidepressants and CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A

Most recent guideline publication:

Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A Genotypes and Serotonin Reuptake Inhibitor Antidepressants (April 2023)

Updates since publication:

None

Tables provided in the main manuscript of the guideline:

Table 1. Assignment of predicted phenotypes based on diplotypes
Table 2. Dosing recommendations for antidepressants based on CYP2D6 phenotype
Table 3. Dosing recommendations for antidepressants based on CYP2C19 phenotype

Supplement to: Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A Genotypes and Serotonin Reuptake Inhibitor Antidepressants (April 2023)

Tables and figures included in the supplementa or referenced in the guideline:

Table S1. Evidence linking CYP2D6, CYP2C19 and CYP2B6 genotype to SSRI phenotype
Table S2. Evidence linking CYP2D6 genotype to SNRI and serotonin modulator phenotype
Table S3. Evidence linking SLC6A4 genotype to antidepressant phenotype
Table S4. Evidence linking HTR2A genotype to antidepressant phenotype
Table S5. Metabolism of antidepressants included in this guideline.
Table S6. Dosing Recommendation for fluoxetine based on CYP2D6 phenotype
Table S7. Dosing recommendations for citalopram and escitalopram based on HTR2A genotype
Table S8. Dosing recommendations for fluoxetine, fluvoxamine, paroxetine, sertraline, duloxetine, venlafaxine, desvenlafaxine, vilazodone, vortioxetine, levomilnacipran and milnacipran based on HTR2A genotype
Table S9. Dosing recommendations citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, duloxetine, venlafaxine, desvenlafaxine, vilazodone, vortioxetine, levomilnacipran and milnacipran based on SLC6A4 genotype
Table S10. Meta-analyses of evidence linking genetic variation to antidepressant phenotypes
CYP2D6 allele definition table 
CYP2C19 allele definition table 
CYP2B6 allele definition table 
CYP2D6 allele functionality table
CYP2C19 allele functionality table 
CYP2B6 allele functionality table 
CYP2D6 frequency table 
CYP2C19 frequency table 
CYP2B6 frequency table 
CYP2D6 diplotype-phenotype table 
CYP2C19 diplotype-phenotype table 
CYP2B6 diplotype-phenotype table 
Gene resource mappings
CYP2D6
CYP2C19
CYP2B6
Drug Resource mappings
Citalopram
Escitalopram
Fluvoxamine
Paroxetine
Sertraline
Venlafaxine
Vortioxetine
Clinical decision support:b
Implementation workflow
CYP2D6 consult 
CYP2C19 consult
CYP2B6 consult
Citalopram pre- and post-test alerts and workflow
Escitalopram pre- and post-test alerts and workflow
Fluvoxamine pre- and post-test alerts and workflow
Paroxetine pre- and post-test alerts and workflow
Sertraline pre- and post-test alerts and workflow
Venlafaxine pre- and post-test alerts and workflow
Vortioxetine pre- and post-test alerts and workflow
aSome of the tables included in the guideline may have been updated on-line, particularly to reflect newly described or newly characterized alleles. These include the gene-specific information tables (https://www.pharmgkb.org/page/pgxGeneRef) that support CPIC guidelines by providing information regarding star (*) allele definitions, allele function, allele frequency by major ethnic groups, translations of diplotype to phenotype, and gene resource mappings.
bThese resources support the adoption of CPIC guidelines into the electronic health record with clinical decision support and provide information that clinical implementers find helpful.