title: The combination of pharmacogenetic and pharmacokinetic analyses to optimize clomipramine dosing in major depression: a case report.
abstract: OBJECTIVE
  Polymorphisms in cytochrome P450 2D6 and 2C19 can lead to interindividual differences in drug plasma concentrations, affecting clomipramine efficacy. Pharmacokinetic and pharmacogenetic analyses may improve drug therapy.
  
  
  METHODS
  We report the case of a depressed woman requiring higher doses than standard of clomipramine. Identification of low plasma drug levels led to extensive pharmacogenetic analyses of all genes and major functional polymorphisms reported to affect clomipramine metabolism.
  
  
  CONCLUSIONS
  Therapeutic drug monitoring and pharmacogenetic analyses may be useful in the investigation and optimization of clomipramine in standard-dose non-responders.
authors: Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy.|Scientific Direction, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.
authors: Stefania
authors: S
authors: Antoniazzi
authors: Department of Psychiatry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors: Alessandro
authors: A
authors: Tatulli
authors: Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy.
authors: Felicia S
authors: FS
authors: Falvella
authors: Department of Psychiatry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors: Michela
authors: M
authors: Cigliobianco
authors: Department of Psychiatry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors: Riccardo A
authors: RA
authors: Paoli
authors: Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy.
authors: Dario
authors: D
authors: Cattaneo
authors: Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy.
authors: Stefania
authors: S
authors: Cheli
authors: Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Faculty of Medicine and Surgery, Second University of Naples, Naples, Italy.
authors: Francesca F
authors: FF
authors: Bernardi
authors: Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy.|E. Medea Scientific Institute, Lecco, Italy.
authors: Emilio
authors: E
authors: Clementi
authors: Department of Psychiatry, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors: Carlo A
authors: CA
authors: Altamura
mesh_terms: D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage*; D002997:Clomipramine / Q000008:administration & dosage*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000235:genetics; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D010597:Pharmacogenetics / Q000379:methods; D011110:Polymorphism, Genetic / Q000235:genetics
chemical_list: D000929:Antidepressive Agents, Tricyclic; D002997:Clomipramine
keywords: clomipramine; pharmacogenetics; therapeutic drug monitoring