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Methods for selecting medications

  • US 8,401,801 B2
  • Filed: 02/20/2004
  • Issued: 03/19/2013
  • Est. Priority Date: 02/20/2003
  • Status: Active Grant
First Claim
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1. A method of administering an antidepressant medication to a patient in need thereof comprising:

  • (1) determining the patients genotype for a panel of genes comprising the following;

    (a) a cytochrome P450 CYP2D6 gene consisting of two alleles independently selected from the group consisting of fully functional alleles 2D6*1A, *2, *2N, and *35, partially functional alleles 2D6*10 and *17, and non-functional alleles 2D6*3, *4, *5, *6, *7, *8, and *12,(b) a cytochrome P450 CYP2C19 gene consisting of two alleles independently selected from the group consisting of fully functional alleles 2C19*1A and *1B, and non-functional alleles 2C19*2A, *2B, *3, *4, *5A, *5B, *6, *7 and *8, and(c) a serotonin transporter gene 5HTTR consisting of two alleles independently selected from the short (s) and long (1) forms of the 5HTTR gene;

    (2) assigning a metabolic phenotype to the patient based on the genotype of the cytochrome P450 genes in (1), wherein the metabolic phenotype is selected from poor (P), intermediate (I), and extensive (E), and said phenotype is assigned based upon the number of functional alleles for each cytochrome P450 gene as follows;

    P=no fully functional alleles and either one or no partially functional alleles, I=either one fully functional allele and a non-functional allele or two partially functional alleles, and E=either one fully functional allele and one partially functional allele or two fully functional alleles; and

    (3) administering to the patient an antidepressant medication selected from the group consisting of;

    (i) bupropion, mirtazapine, fluvoxamine and sertraline if the patient'"'"'s metabolic phenotype is P/P (poor for both 2D6 and 2C19) and the 5HTTR genotype is heterozygous (l/s) or homozygous (l/l);

    (ii) bupropion, mirtazapine and fluvoxamine if the patient'"'"'s metabolic phenotype is P/P and the 5HTTR genotype is homozygous (s/s);

    (iii) bupropion, mirtazapine, fluvoxamine, sertraline, amitriptyline, nortriptyline, venlafaxine and paroxetine if the patient'"'"'s metabolic phenotype is I/P (intermediate for 2D6 and poor for 2C19) and the 5HTTR genotype is heterozygous (l/s) or homozygous (l/l);

    (iv) bupropion, mirtazapine, fluvoxamine, sertraline, amitriptyline, nortriptyline and venlafaxine, if the patient'"'"'s metabolic phenotype is I/P and the 5HTTR genotype is homozygous (s/s);

    (v) bupropion, mirtazapine, citalopram, escitalopram, fluvoxamine and sertraline if the patient'"'"'s metabolic phenotype is P/E (poor for 2D6 and extensive for 2C19) and the 5HTTR genotype is heterozygous (l/s) or homozygous (l/l);

    (vi) bupropion, mirtazapine, citalopram, escitalopram, and fluvoxamine if the patient'"'"'s metabolic phenotype is P/E and the 5HTTR genotype is homozygous (s/s);

    (vii) bupropion, venlafaxine, amitriptyline, imipramine, mirtazapine, nortriptyline, fluoxetine, paroxetine, sertraline, citalopram, escitalopram and fluvoxamine if the patient'"'"'s metabolic phenotype is E/P (extensive for 2D6 and poor for 2C19), and the 5HTTR genotype is heterozygous (l/s) or homozygous (l/l);

    (viii) bupropion, venlafaxine, amitriptyline, imipramine, mirtazapine, nortriptyline, fluoxetine, paroxetine and sertraline if the patient'"'"'s metabolic phenotype is E/P and the 5HTTR genotype is homozygous (s/s);

    (ix) bupropion, mirtazapine, escitalopram, sertraline, amitriptyline, imipramine, nortriptyline, venlafaxine, citalopram, fluvoxamine, fluoxetine and paroxetine, if the patient'"'"'s metabolic phenotype is I/E (intermediate for 2D6 and extensive for 2C19) and the 5HTTR genotype is heterozygous (l/s) or homozygous (l/l);

    (x) bupropion, mirtazapine, escitalopram, sertraline, amitriptyline, imipramine, nortriptyline, venlafaxine, citalopram and fluvoxamine, if the patient'"'"'s metabolic phenotype is I/E and the 5HTTR genotype is homozygous (s/s); and

    (xi) amitriptyline, bupropion, citalopram, fluvoxamine, imipramine, mirtazapine, nortriptyline, venlafaxine, escitalopram, fluoxetine, paroxetine and sertraline if the patient'"'"'s metabolic phenotype is E/E (extensive for both 2D6 and 2C19) and the 5HTTR genotype is heterozygous (l/s) or homozygous (s/s or l/l).

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