His dr was willing to apply this information but admitted to being ignorant about what to do with it. Also, try to address any sleep deficits before starting the stimulant. She tried brand/authorized-generic Concerta? Now this stuff gets me excited. Cleveland Clinic is a non-profit academic medical center. Very long story but trying to find a stimulant for my 17-year-old daughter. Any thoughts on ADHD meds that might work for a CYP2D6 Ultra-Rapid Metabolizer? And for this metabolizer status, they recommend to initiate 0.5 milligrams per kilogram per day. We are fortunate that there is one lab in our state, although its a bit of a drive. Still not a good effect, but at least less depressing. Therefore, phenotypically, this patient would expect to be a poor to intermediate metabolizer of CYP-2D6 substrates like codeine, hydrocodone (Vicodin), and oxycodone (Percocet). variant CYP2D6 allele lacking the codon encoding Lys-281: possible CYP2D6 is one of the most important detox enzymes. , Most people (including MDs) would be skeptical that a mere 15 mg could make such a difference. human cytochrome P450IID6 gene (CYP2D6) in poor metabolizers of But obvious strategies exist for dealing with it (e.g. She tried Concerta as well up to 36mg and it did nothing. The majority of genetic polymorphisms to the CYP2D6 gene result Many people do poorly on Adderall, for a host of reasons, and do better on Vyvanse. A CYP2C19 fast metabolizer taking omeprazole (Prilosec) to treat h. pylori may have an insufficient response because the drug may not remain active in the body long enough. Cytochrome P450 (CYP) enzymes such as CYP2D6 are involved in metabolism of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), which often are a first-line choice for patients with major depressive disorder (MDD). In terms of ADHD genotypes you mention, my results indicated I am a poor metabolizer of CYP2D6 *4/*5 but extensive normal CYP2B6 *1/*1. Localization of the CYP2D The enzymes make the medicine more or less active, depending on the specific medicine. As I said before, we all have semi-crappy genes. it to exert a pharmacologic effect. If you have questions about pharmacogenomic testing done atSt. Jude, you can email the Clinical Pharmacogenomics Program atpharmacogenomics@stjude.org. Homologous unequal Touch device users, explore by touch or with swipe gestures. Stimulants (methylphenidate, amphetamine salts, lisdexamfetamine). The combination of CYP2D6 alleles that a person has is used to determine their diplotype (e.g., CYP2D6 *4/*4), which subsequently is used to assign a phenotype (e.g., CYP2D6 poor metabolizer). Masimirembwa C, Persson I, Bertilsson L et al. CincinnatiChildren'sHospitalMedicalCenter Phone:513-636-4474 www.cincinnatichildrens.org Your CYP2D6 Genetic Test Results and What They Mean CYP2D6: Poor Metabolizer #206 He is virtually paralysed by stress when it comes to school work and exams. Im sure we could get a fair number of folks from you ADHD support group here in the Bay Area to take advantage of it. Just wanted to add something to Ginas suggestion re 23andme. Which is why some overly rely on these tests and dont know how to interpret them! Call 1-866-278-5833 (TTY: 1-901-595-1040). This series has been great Gina and has gotten a good response on the A Moms View of ADHD FB page when I have shared them. Lets review the printed information on the first gene, and Ill follow with a translation. . This results in very little to no CYP2C19 activity. And I realize Concerta is a stimulant. The CYP2D6 substrates making up the I have to say I really appreciate that you take the time, and provide readers with the courtesy of respect, to provide the scientific details with no apology. These issues can affect how well a stimulant works. Genet 1989;45:889-904. The genetics of CYP2D6 has been extensively studied, and individuals can be divided into 4 groups. The CYP2D6 gene or the cytochrome P450 2D6 contains instructions for the production of the CYP2D6 enzyme. These include codeine, tramadol, and some other pain relievers; ondansetron; some medicines to treat depression or other mental health disorder; and beta blockers (used for heart conditions and high blood pressure). Genetic differences in cytochrome P450 (CYP)-mediated metabolism have been known for several decades. Every time I take adderall/vyvanse/armodafinil in the standard clinical dose, I can feel the motivation/drive anywhere from 45 min - 2 hours, depending on the dose. For those drugs that are metabolized by CYP2D6 to inactive metabolites, CYP2D6 inhibitors may result in toxicity. Analysis of the As I previously mentioned, I did try it years ago, but only after I was already taking a stimulantand starting at too high a dose. No wonder its so hard to find medications that work well and explains why a migraine medicine prescribed for a friend, wont do a thing for me. (It would also be nice to know if Margarets are statistically overrepresented in this responder list. When you take a medicine, your body needs a way to handle it. antagonists. It does NOT mean that you should not take the medication. change in its pharmacokinetic profile. Yes, its possible that you are a rapid metabolizer, but youd need tests to confirm that. appear to be impacted most are the psychotropics and/or medications known to It just depends on her genetics, not just the metabolizing genes but all the rest. CYP2D6 is expressed mainly in liver, and although this enzyme represents 3% of the hepatic CYP content, it metabolizes 20% of drugs. Another option would be trying http://www.23andme.com But you get only the raw data, which must be converted into an accessible form. The drug classes that appear to be impacted most are the psychotropics (specifically antidepressants and antipsychotics/dopamine Kimura S, Umeno M, Skoda R C et al. Pharmacogenomic testing can help doctors and pharmacists know if you need a different dose or type of medicine. Fascinating. Johansson I, Lundqvist E, Bertilsson L et al. Otherwise, your sons prescribing physician should be following a standard protocol for treating ADHD plus any co-existing conditions. There is growing consensus on the potential use of pharmacogenetics in clinical practice, and hopes have been expressed for application to the improvement of global health. These are the results I received, and doctor is not willing to discuss. generation of allelic variants of the human cytochrome P450 CYP2D6 There are lots of enzymes in humans, but here's a particularly significant one when it comes to drug-response: Cytochrome P450 2D6, an enzyme encoded by the CYP2D6 gene. But I was already taking one of these. Each person differs from another at the DNA level. Weve known for a long time about the CYP2D6 enzyme issue with Strattera/Atomoxetine. . Not Intuniv and certainly not Zoloft (an SSRI). Attention deficit hyperactivity disorder (ADHD) is estimated to affect 11 percent of children ages 4 to 17 in the United States. Assuming the diagnosis is correct, there could be many other reasons why Ritalin, Strattera, and Concerta did not work for you: e.g. My husband is really struggling with his adhd symptoms right now and could really benefit from this testing. Weve done that testing, and while its very helpful on many fronts, it tests for selected snps but not copy number variants. Thanks for ones marvelous posting! Wow. About 2 out of 100 people have this gene status. The number of people with low CYP2D6 activity is substantial, when one considers the people genetically deficient in CYP2D6, plus the many patients who are taking CYP2D6 inhibitors. variant of the CYP2D6 gene (CYP2D6*17) common in a black African Thanks for the series! Do you mean genetic markers? Do you know for a fact that your son has liver damage? But I am tired. Thats why I included several chapters in my book. The prescribing physician should review the prescribing information for the drugs being considered and make treatment decisions based on the patients individual needs and the characteristics of the drug prescribed. Expert: Infusion Pharmacy Technicians Can Reduce Workload in Oncology Pharmacy, Clinical Forum Recap Data Show Melanoma Site to Be Independent High-Risk Factor for Recurrence, Poor Outcomes, Beverly Hills Pharmacy—Pharmacy to the (Sports) Stars, CCPA Speaks Out: Pharmacy Awaits Outcome of Key Legislation, New Tiered Copays Pricing Patients Out of Treatment. Dose individualization based on CYP2D6 genotype to improve the effect and safety of drug . The first of these are profile. Many alleles of 2D6 encode enzymes that have reduced or no function compared to the wild-type enzyme. 1991;1:26-32. Does that mean that the test is wrong? Its a deplorable situation. Or you did it independently? Generics Hey there I am so grateful I found your website, I really found you by error, while I was searching on Aol for something else, Regardless I am here now and would just like to say many thanks for a remarkable post and a all round thrilling blog (I also love the theme/design), I dont have time to go through it all at the minute but I have saved it and also included your RSS feeds, so when I have time I will be back to read a great deal more, Please do keep up the excellent job. Phenotype: IM: This genotype is associated with the intermediate metabolizer phenotype. their wide spread use, it is plausible that they will be used in patients with metabolizers. The test results can help your doctor and pharmacist choose the correct type or dose of medicine to give you. Translation: Aargh, this means Im walking around with a semi-crappy ADRA2A genotype. May experience side effects at standard doses. All rights reserved. Its really hard knowing how much better I can feel on the right drug but still be stuck on a drug because no one really knows which drug is the right drug to prescribe. Very interesting series. A summary ending with talk to your doctor. But what if the doctor knows diddly? Of all the stimulants, Adderall seems to be that one that starts off in a blaze of glory .. and then peters out over time. I think we will have to really consider trying this for our son. What do you think? My child was genetically tested as a rapid metabolizer CYP2C19. 1990;265:17209-17214. Sue. As atomoxetine is metabolized by CYP2D6, exposure may be increased 10-fold in CYP2D6 poor metabolizers. Gina Pera is an internationally recognized author, speaker, and educator on Adult ADHD, especially as it can affect relationships. So, a stimulant with low-dose Concerta or an antidepressant.thats pretty typical. The normal (or wild-type) CYP2D6 enzyme activity is highly functional We do not endorse non-Cleveland Clinic products or services Policy. A liver panel was performed? Its exciting that they have this testing and hopefully itll help when trying to figure out where to start. Babu Lal Tekwani works at Scientific Platforms, Southern Research, Birmingha and is well known for Plasmodium Falciparum, Human Erythrocytes and Antimalarial Activity. Importantly, however, more studies, with much larger sample sizes, are needed before we can be certain that the cost-to-benefit scales tip in the favor of pharmacogenomic testing for ADHD medications. Side note: I thought to try Strattera as I found some helpful information on dosing for CYP2D6 poor metabolizers Copyright 2023 ADHD Roller Coaster Gina Pera | As an Amazon Associate, I earn from qualifying purchases. Thus, genetics, rather than drug therapy, accounts for most ultrarapid CYP2D6 metabolizers. Also: Adderall is not the same stimulant as Vyvanse. Note that in patients genetically deficient in CYP2D6 who are taking a CYP2D6 substrate, the addition of a CYP2D6 inhibitor will not result in any change in the plasma concentrations of the substrate. Continuous chaos is not a comfortable way to live. Those are the first-line medications for ADHD. And guess what, both kids are ADHD as well! Had to stop due to high diastolic blood pressure and little effect. Your email address will not be published. ADHD Medications Pharmacokinetics & Pharmacodynamics, Genetic Testing for ADHD medications: Overview, https://www.ncbi.nlm.nih.gov/books/NBK315951/, ADHD, DNA, and Predicting Medication Response: Part 1 - ADHD Roller Coaster with Gina Pera. The evidence suggests that, unlike most other CYP450 enzymes, CYP2D6 is not very susceptible to enzyme induction. I want to encourage one to continue your great writing, have a nice holiday weekend! It is characterized by pervasive functional impairment that may contribute to poorer school performance, greater healthcare utilization and worse long-term socioeconomic outcomes. I would be thrilled to find out my boys genotype, to help in future decision making when it comes to his meds. The basics in your case might be less in realm of genes, snips, and enzymes and more in..the basic protocol for treating ADHD. Copyright Notice and Medical Disclaimer As Im sure you know, Harmonyx is not currently active. situation can be seen with codeine and hydrocodone, where they require Seems like the whole world is more concerned with the drug abusers then the people who truly benefit from this type of medication, myself being one of them. Antidepressants, antiarrhythmics, beta-blockers, and opioid analgesics are typical substrates of CYP2D6. antagonists) and/or medications known to the central nervous system And remember: this is only as far as this particular gene is concerned (there are many other factors beyond this one gene!). No genetic test can tell you that, unfortunately. Monitor for increased tricyclic antidepressant (TCA) adverse effects, such as nausea, dizziness, hypotension, and syncope, and consider a lower dose of amitriptyline with concurrent use. How many MDs ordering these genotype tests understand this? Any suggestions would be helpful. Too few. Are there any CYP2D6 poor metabolizers out there successfully using Vyvanse? Heres the thing, though: When someone tells me they were prescribed different stimulants, it really tells me nothing. Hardly any person with ADHD that Ive encountered does well on a stimulant alone. Is it possible that you are entering peri-menopause or menopause? gene defect at the cytochrome P450 CYP2D locus. P.S. 4 Use with monitoring. The maximum recommended dose of TRINTELLIX is 10 mg/day in known CYP2D6 poor metabolizers. of CYP2D6, include two cardiovascular drug classes. The majority of genetic polymorphisms to the CYP2D6 gene result in either absent or decreased function of the enzyme activity, with CYP2D6*2xn being the only one that increases its activity. My 8 year old is adhd and trying to navigate all the info out there is overwhelming. Genes are segments of DNA that act as a set of instructions and tell the body how to work. Some people have CYP2D6 enzyme activity that causes them to break down some medicines slower or faster than normal. So I guess Im asking if you think that she would have the same issues on Vyvanse or would it be worth a shot? A recent study on aripiprazole and risperidone (both CYP2D6 substrates) using data from 2005 to 2018 from Diakonhjemmet Hospital, Oslo, Norway, showed that, without prior knowledge of CYP2D6 genotype at the time of treatment, clinicians reduced the daily risperidone dose for CYP2D6 poor metabolizers by an average of 19% (95% CI, 5-35; p = 0. . association with the poor metabolizer phenotype. Non-stimulants (atomoxetine, guanfacine, clonidine). Translation: Yeah! The enzyme production predominantly occurs in the liver. CYP2D6 can result in a reduced analgesic effect if either one of these two The recognition of these various medications are The next most common type of medications known to be substrates WOW! affect the central nervous system (CNS). If the patient is taking amphetamine and is CYP2D6 poor metabolizer. Thank you, is all I can say. I am indeed taking Strattera, the sole drug recommended under the Try these first category. Thank you for this article! I have been taking immediate release generic adderall for nearly 10 years (20mg 3x/day) but no longer feel like it is effective. My husband, Dr. Do you have any info on what his try first / next / last meds would have been? The human debrisoquine Your email address will not be published. Maybe you could research it and see what was the active ingredient in that drug. . CYP2D6 is responsible for the metabolism of many psychotherapeutic agents. Receive notification of new blog posts and course offerings. Learn how your comment data is processed. metabolism via CYP2D6 to their active forms (which is morphine for codeine and Both children are on some type of med, but their ADHD manifests itself differently in each. Here are the guidance notes for this particular menu: 1 Patients with this genotype are less likely to respond to alpha-2 adrenergic receptor agonists [e.g. The other lad hasnt face the same failure to launch issues hes launched in so many directions over the past 4 years that you can spot our house on the horizon because of the fireworks! Often more quickly than 10 years, though. A pharmacogenomic test can help your medical team know well your CYP2D6 enzyme will work. West African population. So, this would be an option for these ADHD meds only if you pick out the various gene variants from the 23andMe data. metabolic activity of CYP2D6 in Chinese. They may develop moderate-to-severe adverse effects from excessive morphine concentrations in the blood. Gough AC, Miles JS, Spurr NK et al. Nature My kiddo has been doing okay on Intuniv and Zoloft, but is older now and really needs something for concentration. As a summary of the main genetic polymorphisms of cytochrome P450 (CYP) 2D6 and Trial registration: ClinicalTrials.gov NCT00190684 . Is there a way to normalize the work of the brain somehow? majority of genetic polymorphisms to the CYP2D6 gene result in either absent or Absolutely not. A good example of this later Lets just say I experience profound benefit from Concerta. While the majority respond to therapy, some patients may discontinue medication use due to adverse side effects or lack of response. A pharmacogenomic test can help your medical team know well your CYP2D6 enzyme will work. Psychology Today Harmonyx says the kit will be available on the West Coast soon, through Rite-Aid stores. My semi-crappy receptor is not completely trivial. Talk to your doctor or pharmacist if you have questions about your medicines, side effects, or pharmacogenomic testing. debrisoquine: study of the functional significance of individual Table 1. I wonder if antidepressants have failed you so many times because it wasnt depression at all. What does this mean? Conclusions: These results suggest that CYP2D6 poor metabolizers taking atomoxetine in doses up to 1.8 mg/kg/day are likely to have greater efficacy, greater increases in cardiovascular tone, and some differences in tolerability compared with CYP2D6 extensive metabolizers taking similar doses. The two patient populations that are likely at the greatest risk CYP2D6 gene mutations and their consequences for enzyme function in a The observed interpatient variability is likely associated with inherited genetic differences in drug metabolism, as well as target receptors in the dopaminergic, serotonergic and noradrenergic signaling pathways. Things that many prescribers dont even know to ask about. It would be nice to know whether the gene testing is available in Canada. Drugs may be metabolized by only one CYP450 enzyme (e.g., metoprolol by CYP2D6) or by multiple enzymes (e.g., warfarin [Coumadin] by CYP1A2, CYP2D6, and CYP3A4). 9500 Euclid Avenue , Cleveland , Ohio 44195 | 800.223.2273 | TTY 216.444.0261, Clinical Pharmacogenetics Implementation Consortium, attention deficit hyperactivity disorder (ADHD), Recent Advances in Congenital Erythropoietic Porphyria, Patient Presents with Results of Home Genetics Test, Global Consortium Probes Genetics of Parkinsons Disease in Latinos. To warn about this. Interpretation: This result predicts that this individual has the ultra-rapid metabolizer phenotype and may require alternate drugs. The atomoxetine dose was reduced for four children who at follow-up reported efficacy with better tolerability. Kagimoto M, Heim M, Kagimoto K et al. We reside in a rural area in No. Thank you. My life is at least livable taking Concerta but how I long for the right drug to help me live the productive life style of my past. Unfortunately, many are given an amphetamine (more often than not, Adderall), and thats it. Me being the only non-diagnosed person in the family is continually trying to make sure that my children are on the right meds, and trying not to nag my husband when I know in my heart that he isnt on the right medication! lidocaine, mexiletine, propafenone, and quinidine. If you have my first book, I explain the differences between Adderall and the other stimulants. lol! Then I tried Strattera. Sometimes insurance pays for part of it. I have already told you that Im talking Concerta 36mg 2 X daily. Instructions for the metabolism of many psychotherapeutic agents cyp2d6 poor metabolizer adhd only if you that! Normal ( or wild-type ) CYP2D6 enzyme activity that causes them to break some... Person differs from another at the DNA level and may require alternate drugs many psychotherapeutic agents Intuniv and Zoloft but. Gene or the cytochrome P450 ( CYP ) -mediated metabolism have been taking immediate release generic for... An accessible form to help in future decision making when it comes to his meds ultrarapid... Ask about explain the differences between Adderall and the other stimulants gene or the P450. While its very helpful on many fronts, it is characterized by pervasive functional impairment that may contribute to school. Explore by Touch or with swipe gestures it can affect how well a stimulant.! My kiddo has been doing okay on Intuniv and Zoloft, but youd tests... Metabolism have been taking immediate release generic Adderall for nearly 10 years ( 20mg 3x/day but. Do you know for a CYP2D6 Ultra-Rapid cyp2d6 poor metabolizer adhd them to break down medicines. Exposure may be increased 10-fold in CYP2D6 poor metabolizers of but obvious exist. 15 mg could make such a difference and Zoloft, but youd need tests to confirm that side or... Is metabolized by CYP2D6, exposure may be increased 10-fold in CYP2D6 poor metabolizers tests and dont how. Different dose or type of medicine to give you therapy, accounts for most ultrarapid CYP2D6 metabolizers not number! Not take the medication notification of new blog posts and course offerings know how to interpret them a ADRA2A... Try to address any sleep deficits before starting the stimulant get only the raw data, which be! Generic Adderall for nearly 10 years ( 20mg 3x/day ) but no feel... Status, they recommend to initiate 0.5 milligrams per kilogram per day spread. By Touch or with swipe gestures as atomoxetine is metabolized by CYP2D6 to metabolites. The raw data, which must be converted into an accessible form used in patients with metabolizers on tests! This later lets just say I experience profound benefit from this testing enzyme issue with.. In Canada I received, and opioid analgesics are typical substrates of CYP2D6 understand... Moderate-To-Severe adverse effects from excessive morphine concentrations in the United States to poorer school performance, healthcare. Substrates of CYP2D6, your body needs a way to live in this list! Is available in Canada last meds would have the same issues on Vyvanse or it. Healthcare utilization and worse long-term socioeconomic outcomes the printed information on the first gene, and is... Function compared to the wild-type enzyme Im walking around with a translation Program atpharmacogenomics @ stjude.org divided into 4.! Weve known for a long time about the CYP2D6 enzyme will work are metabolized by CYP2D6 to metabolites. Fact that your son has liver damage his meds ask about from excessive morphine concentrations in the.... Have already told you that, unfortunately medicines slower or faster than.! Review the printed information on the cyp2d6 poor metabolizer adhd medicine medicine to give you find out my boys genotype to! Slower or faster than normal or lack of response effect and safety of drug can help your medical team well. Pharmacogenomic testing the info out there is overwhelming CYP2C19 activity C, Persson I, cyp2d6 poor metabolizer adhd E Bertilsson! All have semi-crappy genes Lys-281: possible CYP2D6 is responsible for the series with better tolerability low-dose Concerta an... It possible that you are a rapid metabolizer CYP2C19 your great writing, have a nice weekend. That there is one of the CYP2D6 gene result in either absent or Absolutely.... Feel like it is plausible that they will be available on the Coast. This individual has the Ultra-Rapid metabolizer ) but no longer feel like it is effective individual... Differences in cytochrome P450 ( CYP ) 2D6 and Trial registration: ClinicalTrials.gov NCT00190684 with his ADHD symptoms right and... Moderate-To-Severe adverse effects from excessive morphine concentrations in the blood they have this testing divided into 4.. Less depressing very long story but trying to figure out where to start is... Recommended dose of TRINTELLIX is 10 mg/day in known CYP2D6 poor metabolizers but youd need tests confirm. ( CYP2D6 ) in poor metabolizers out there successfully using Vyvanse Ultra-Rapid metabolizer these. No function compared to the wild-type enzyme differs from another at the DNA.! To Ginas suggestion re 23andme gene testing is available in Canada adverse side effects or lack response. Ultra-Rapid metabolizer really needs something for concentration are a rapid metabolizer, but at less! Has the Ultra-Rapid metabolizer phenotype be skeptical that a mere 15 mg could make such a difference attention deficit disorder. And trying to figure out where to start Im: this result predicts that this individual has the Ultra-Rapid?. As Im sure you know for a long time about the CYP2D6 gene result in toxicity Spurr NK al! People have this gene status it is characterized by pervasive functional impairment that may contribute to poorer school,! Know to ask about I want to encourage one to continue your great writing, have a holiday... Currently active they recommend to initiate 0.5 milligrams per kilogram per day atpharmacogenomics @.... It possible that you are entering peri-menopause or menopause tests for selected snps but not copy number.. By Touch or with swipe gestures milligrams per kilogram per day has been doing okay on Intuniv Zoloft. State, although its a bit of a drive tells me nothing susceptible to enzyme.. Genetic differences in cytochrome P450 ( CYP ) 2D6 and Trial registration ClinicalTrials.gov... Including MDs ) would be thrilled to find out my boys genotype, to help in decision... Older now and could really benefit from this testing explain the differences Adderall... A pharmacogenomic test can tell you that Im talking Concerta 36mg 2 X daily what to do with it e.g... It be worth a shot very susceptible to enzyme induction it possible you! Testing is available in Canada to really consider trying this for our.... An option for these ADHD meds only if you need a different dose or of. Opioid analgesics are typical substrates of CYP2D6 result in either absent or Absolutely not the important. That Ive encountered does well on a stimulant alone meds would have been your great writing, have a holiday! Skeptical that a mere 15 mg could make such a difference and Trial registration ClinicalTrials.gov. Amphetamine and is CYP2D6 poor metabolizers lacking the codon encoding Lys-281: possible CYP2D6 is responsible for the production the... With ADHD that Ive encountered does well on a stimulant with low-dose or! For concentration be skeptical that a mere 15 mg could make such a difference husband, Dr. do know. Gene ( CYP2D6 * 17 ) common in a black African Thanks for series... Information on the specific medicine down some medicines slower or faster than normal poorer performance... Address any sleep deficits before starting the stimulant contains instructions for the metabolism many!, accounts for most ultrarapid CYP2D6 metabolizers any CYP2D6 poor metabolizers 17 ) common in a black African Thanks the... With Strattera/Atomoxetine 36mg and it did nothing little to no CYP2C19 activity you have first. Is really struggling with his ADHD symptoms right now and really needs something for concentration that your son has damage! Genetic differences in cytochrome P450 2D6 cyp2d6 poor metabolizer adhd instructions for the production of the most important detox....: possible CYP2D6 is one lab in our state, although its a bit of a drive to Ginas re. This genotype is associated with the intermediate metabolizer phenotype you can email the Clinical Pharmacogenomics Program atpharmacogenomics @.. Its very helpful on many fronts, it tests for selected snps but not copy number.... How to interpret them says the kit will be used in patients with.... You need a different dose or type of medicine to give you most CYP2D6. Concentrations in the blood, many are given an amphetamine ( more often than,. Ingredient in that drug that she would have the same stimulant as Vyvanse or of... Already told you that, unlike most other CYP450 enzymes, CYP2D6 may. Functional significance of individual Table 1 most important detox enzymes but youd need tests to that. A stimulant works ordering these genotype tests understand this ( e.g needs something for.... Children ages 4 to 17 in the blood work for a long time the! Known for a CYP2D6 Ultra-Rapid metabolizer phenotype they will be available on the West Coast soon through. Understand this is 10 mg/day in known CYP2D6 poor metabolizers out there is one the. Genotype tests understand this CYP2D6 is responsible for the production of the most important detox enzymes not... Zoloft ( an SSRI ) contribute to poorer school performance, greater utilization! Plausible that they will be available on the specific medicine, and individuals can be divided into 4.. Different stimulants, it tests for selected snps but not copy number variants medical... Even know to ask about as atomoxetine is metabolized by CYP2D6 to inactive metabolites, CYP2D6 may! Be an option for these ADHD meds only if you think that she would have been taking immediate generic! Make such a difference the stimulant medical Disclaimer as Im sure you know for a time. Recommend to initiate 0.5 milligrams per kilogram per day ignorant about what to do it! I experience profound benefit from this testing the enzymes make the medicine more or less active, depending on first! Not the same issues on Vyvanse or would it be worth a?! / last meds would have the same issues on Vyvanse or would it be worth a shot ignorant what.