DAMBORSKÁ, Alena, Lenka HANAKOVA, Eva PINDUROVA and Kateřina HORSKÁ. Case report: Therapeutic drug monitoring and CYP2D6 phenoconversion in a protracted paroxetine intoxication. Frontiers in Pharmacology. Lausanne: Frontiers Media SA, 2024, vol. 15, September 2024, p. 1-7. ISSN 1663-9812. Available from: https://dx.doi.org/10.3389/fphar.2024.1444857.
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Basic information
Original name Case report: Therapeutic drug monitoring and CYP2D6 phenoconversion in a protracted paroxetine intoxication
Authors DAMBORSKÁ, Alena (203 Czech Republic, belonging to the institution), Lenka HANAKOVA (203 Czech Republic), Eva PINDUROVA (203 Czech Republic) and Kateřina HORSKÁ (203 Czech Republic, belonging to the institution).
Edition Frontiers in Pharmacology, Lausanne, Frontiers Media SA, 2024, 1663-9812.
Other information
Original language English
Type of outcome Article in a journal
Field of Study 30104 Pharmacology and pharmacy
Country of publisher Switzerland
Confidentiality degree is not subject to a state or trade secret
WWW URL
Impact factor Impact factor: 5.600 in 2022
Organization unit Faculty of Medicine
Doi http://dx.doi.org/10.3389/fphar.2024.1444857
UT WoS 001314626100001
Keywords in English paroxetine; poor and intermediate metabolizer; phenoconversion; overdose; case report
Tags 14110222
Tags International impact, Reviewed
Changed by Changed by: Mgr. Tereza Miškechová, učo 341652. Changed: 23/9/2024 12:17.
Abstract
Objective The cytochrome P450 2D6 (CYP2D6) is an enzyme involved in the oxidative biotransformation of various widely used drugs, including paroxetine, a substrate and strong inhibitor of the enzyme. The aim is to report on a case of protracted intoxication with paroxetine after a single overdose in a genotype-predicted intermediate CYP2D6 metabolizer.Observation A 49-year-old man was receiving chronic treatment for more than 6 years with paroxetine 60 mg/day for an indication of agoraphobia. The patient ingested fifty 20 mg tablets of paroxetine in a suicide attempt. The toxic plasma level, accompanied by delirium, persisted for approximately 1 month after the overdose. According to the genotype profile, the patient was evaluated as an intermediate metabolizer with reduced CYP2D6 enzyme activity.Conclusion As a consequence of the suicide attempt with overdose and the chronic paroxetine treatment that preceded it, phenoconversion to a poor metabolizer with very low CYP2D6 enzyme activity is suggested as contributing to an extremely long intoxication accompanied by delirium. Prolonged monitoring over a standard 24 h of both physical symptoms and drug plasma levels, together with a genetic profile assessment and phenoconversion consideration, is recommended after a single overdose in patients chronically treated with paroxetine.
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