Antipsychotics

Antipsychotics and pharmacogenetics

Also known as: Neuroleptics

11 medications 10 brand products CYP2D6CYP1A2CYP3A5

Which antipsychotic fits my genetics best?

Depending on your genotype, these 10 medications split into up to 4 groups, from take-as-directed through to worth avoiding. Gene2Rx Pro reads CYP2D6 and CYP3A4 from your own report and tells you which is which.

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Why pharmacogenetics matter for antipsychotics

Antipsychotics treat schizophrenia, bipolar disorder, severe depression (as augmentation), and several other conditions. Modern antipsychotics mostly clear through CYP2D6 and CYP3A4, with smaller contributions from CYP1A2. Aripiprazole, brexpiprazole, iloperidone, and pimozide all have FDA label guidance for CYP2D6 poor metabolizers.^[1] Clozapine is unusual in being CYP1A2-dominant, which is why smoking status interacts so strongly with clozapine dosing.^[2]

Akathisia, extrapyramidal symptoms, and metabolic side effects are usually dose-related, which is where pharmacogenetic testing can help most with tolerability.^[3]

Key genes in this class

CYP2D6

Cytochrome P450 2D6

CYP2D6 is the most clinically important pharmacogene. It metabolizes around a quarter of all prescription drugs, including many antidepressants, opioids, and stimulants. The gene is unusually variable: roughly 7 percent …

CYP1A2

Cytochrome P450 1A2

CYP1A2 is the liver enzyme that clears caffeine, clozapine, and a handful of other drugs. Its activity is shaped by both genetics and lifestyle (smoking speeds it up, certain foods …

CYP3A5

Cytochrome P450 3A5

CYP3A5 is unusual: most people of European descent carry a non-functional variant and don't produce active enzyme at all. Most people of African descent do. For drugs like tacrolimus (used …

Medications in this class with pharmacogenetic guidelines

Each link goes to the drug's full pharmacogenetics page with CPIC and FDA phenotype recommendations.

Aripiprazole CYP2D6 Aripiprazole Lauroxil CYP2D6 Brexpiprazole CYP2D6 Clozapine CYP2D6 Haloperidol CYP2D6 Iloperidone CYP2D6 Perphenazine CYP2D6 Pimozide CYP2D6 Quetiapine CYP3A4 Thioridazine CYP2D6 Zuclopenthixol CYP2D6

Brand products in the Antipsychotics class

Combined products and brand names for the medications above. Each links to a pharmacogenetic breakdown.

Abilify

aripiprazole

Aristada

aripiprazole-lauroxil

References

U.S. Food and Drug Administration. Table of Pharmacogenomic Biomarkers in Drug Labeling (2024). fda.gov
DPWG / KNMP, via PharmGKB. Dutch Pharmacogenetics Working Group (DPWG) Guidelines. pharmgkb.org
PharmGKB / Stanford University. PharmGKB: The Pharmacogenomics Knowledge Base. pharmgkb.org

Which antipsychotics is right for your genetics?

This page covers the pharmacogenetics of antipsychotics in general. A Gene2Rx report tells you how your personal genotype interacts with every drug on this page.

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Informational only, not medical advice. Pharmacogenetic guidelines describe population-level patterns that inform prescribing decisions. Never start, stop, or change a medication without talking to your prescribing clinician.