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CYP2D6

Drugs affected by CYP2D6

Cytochrome P450 2D6

45 medications 48 brand products

About CYP2D6

CYP2D6 is the most clinically important pharmacogene.[1] It metabolizes around a quarter of all prescription drugs, including many antidepressants, opioids, and stimulants.[2] The gene is unusually variable: roughly 7 percent of people are poor metabolizers (they barely activate CYP2D6), and another 1 to 3 percent are ultrarapid metabolizers (their enzyme is overactive).[3]

For most CYP2D6 drugs, poor metabolizers feel stronger effects and more side effects at standard doses, while ultrarapid metabolizers may feel almost nothing. For prodrugs like codeine, the relationship flips: poor metabolizers feel less effect because they can't activate the drug.

What we test for CYP2D6

Gene2Rx reports your CYP2D6 genotype across 147 named star alleles, built from 123 variants curated by PharmVar.

147
Star alleles
123
Variants tested
PharmVar
Source
GRCh38
Genome build
Normal Function 13 Decreased Function 17 No Function 56 Uncertain Function 25 Unknown Function 36

Notable CYP2D6 alleles

*1 Normal Function
The reference allele — wild-type CYP2D6 activity; carriers are typical metabolizers.
*4 No Function
The most common no-function allele in European populations; carriers poorly metabolize codeine and many antidepressants.
~20% in Europeans
*10 Decreased Function
The dominant decreased-function allele in East Asian populations; lowers CYP2D6 activity.
~40% in East Asians
*17 Decreased Function
A decreased-function allele common in African populations.
~20% in Africans
*41 Decreased Function
A decreased-function allele caused by a splice-site variant; common in Europeans and South Asians.
What are star alleles?

Star alleles (like *1, *2, *4) are standardized names for distinct versions of a pharmacogene. *1 is the reference; higher numbers identify variants discovered later that change the enzyme's activity.

You inherit one allele from each parent, so your genotype is a pair (e.g. *1/*4). The pair determines your predicted phenotype — for example, whether you metabolize a drug at a normal, decreased, or no-function rate.

PharmVar is the international registry that defines and curates these allele names. Gene2Rx tests the variants required to call every CYP2D6 allele in the PharmVar catalog.

Medications with CYP2D6 guidelines

Gene2Rx covers 45 medications with published pharmacogenetic guidance for CYP2D6, drawn from CPIC and FDA sources. Each drug links to its full pharmacogenetics page.

antiarrhythmics

antidepressants - SNRI

antihistimines

antipsychotic

drugs used in addictive disorders

estrogen modulators

gaucher's disease treatments

saliva production stimulators

urologicals

Brand products containing a CYP2D6-affected ingredient

These branded medications include at least one active ingredient whose metabolism or action involves CYP2D6. Each links to its full pharmacogenetic breakdown.

References

  1. Clinical Pharmacogenetics Implementation Consortium (CPIC). CPIC Guidelines. cpicpgx.org
  2. U.S. Food and Drug Administration. Table of Pharmacogenomic Biomarkers in Drug Labeling (2024). fda.gov
  3. PharmGKB / Stanford University. PharmGKB: The Pharmacogenomics Knowledge Base. pharmgkb.org

Find out your personal CYP2D6 phenotype

This page lists drugs affected by CYP2D6. A Gene2Rx report tells you which metabolizer group you fall into, and what that means for every medication on this list.

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Informational only, not medical advice. The presence of a CYP2D6 pharmacogenetic guideline does not mean every patient needs to change their dose. Never start, stop, or change a medication without talking to your prescribing clinician.

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