AUTHOR=Aldrich Stacey L. , Poweleit Ethan A. , Prows Cynthia A. , Martin Lisa J. , Strawn Jeffrey R. , Ramsey Laura B. 

TITLE=Influence of CYP2C19 Metabolizer Status on Escitalopram/Citalopram Tolerability and Response in Youth With Anxiety and Depressive Disorders

JOURNAL=Frontiers in Pharmacology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2019.00099

DOI=10.3389/fphar.2019.00099

ISSN=1663-9812

ABSTRACT=<p>In pediatric patients, the selective serotonin reuptake inhibitors (SSRIs) escitalopram and citalopram (es/citalopram) are commonly prescribed for anxiety and depressive disorders. However, pharmacogenetic studies examining CYP2C19 metabolizer status and es/citalopram treatment outcomes have largely focused on adults. We report a retrospective study of electronic medical record data from 263 youth &lt; 19 years of age with anxiety and/or depressive disorders prescribed escitalopram or citalopram who underwent routine clinical <italic>CYP2C19</italic> genotyping. Slower CYP2C19 metabolizers experienced more untoward effects than faster metabolizers (<italic>p =</italic> 0.015), including activation symptoms (<italic>p</italic> = 0.029) and had more rapid weight gain (<italic>p</italic> = 0.018). A larger proportion of slower metabolizers discontinued treatment with es/citalopram than normal metabolizers (<italic>p</italic> = 0.007). Meanwhile, faster metabolizers responded more quickly to es/citalopram (<italic>p</italic> = 0.005) and trended toward less time spent in subsequent hospitalizations (<italic>p</italic> = 0.06). These results highlight a disparity in treatment outcomes with es/citalopram treatment in youth with anxiety and/or depressive disorders when standardized dosing strategies were used without consideration of CYP2C19 metabolizer status. Larger, prospective trials are warranted to assess whether tailored dosing of es/citalopram based on CYP2C19 metabolizer status improves treatment outcomes in this patient population.</p>