Pharmacogenetics of olanzapine metabolism.
The pharmacokinetics of the atypical antipsychotic, olanzapine, display large interindividual variation leading to multiple-fold differences in drug exposure between patients at a given dose. This variation in turn gives rise to the need for individualized dosing in order to avoid concentration-dependent adverse effects or therapeutic failure. Genetically determined differences in olanzapine metabolism represent a less studied source of variability in comparison to environmental and physiological factors. In this review, we summarize available in vitro and in vivo data addressing the influence of polymorphisms in drug-metabolizing enzymes on olanzapine serum exposure. The polymorphic CYP2D6 enzyme appears to have no significant influence on olanzapine steady-state serum concentrations. The formation of the various olanzapine metabolites is influenced by polymorphisms in the genes coding for CYP1A2, CYP1A expression regulator AHR, UGT1A4 and UGT2B10, as well as FMO3. An impact on steady-state olanzapine serum concentrations has been suggested for variants of CYP1A2 and UGT1A4, with somewhat conflicting findings. The potential involvement of FMO1 and CYP3A43 in olanzapine disposition has also been suggested but needs future validation.
Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-14186 Stockholm, Sweden.
Mao Mao
MM
Söderberg
Marja-Liisa
ML
Dahl
D001569:Benzodiazepines / Q000378:metabolism*; D019363:Cytochrome P-450 CYP1A1 / Q000097:blood / Q000235:genetics / Q000493:pharmacokinetics; D019388:Cytochrome P-450 CYP1A2 / Q000097:blood / Q000235:genetics / Q000493:pharmacokinetics; D019389:Cytochrome P-450 CYP2D6 / Q000097:blood / Q000235:genetics / Q000493:pharmacokinetics; D005260:Female; D014453:Glucuronosyltransferase / Q000097:blood / Q000235:genetics / Q000493:pharmacokinetics; D006801:Humans; D008658:Inactivation, Metabolic / Q000235:genetics*; D000077152:Olanzapine; D010105:Oxygenases / Q000097:blood / Q000235:genetics / Q000493:pharmacokinetics; D010597:Pharmacogenetics
C019787:bilirubin glucuronoside glucuronosyltransferase; D001569:Benzodiazepines; D010105:Oxygenases; C020066:dimethylaniline monooxygenase (N-oxide forming); C569463:CYP1A1 protein, human; D019363:Cytochrome P-450 CYP1A1; D019388:Cytochrome P-450 CYP1A2; D019389:Cytochrome P-450 CYP2D6; C552162:UGT2B10 protein, human; D014453:Glucuronosyltransferase; D000077152:Olanzapine