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Antidepressants · TricyclicsExample report

Imipramine

Tofranil

Consider alternative

Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.

The genes behind this label

The guidelines read 2 genes for imipramine. Each card shows the two copies this person inherited and what they mean.

CYP2D6*4/*4

Poor metabolizer

Neither copy works.

0.0 activity scoreTypical: 1.25 to 2.25

Turns on or clears about 1 in 4 prescription drugs. These include many drugs for depression, pain and ADHD.

This result changes the label.

CYP2C19*1/*2

Intermediate metabolizer

One copy works and one doesn't.

Handles several SSRIs, acid reducers such as omeprazole, and the blood thinner clopidogrel.

This result changes the label.

What the guidelines say

What each guideline says about your result.

CYP2D6Poor metabolizer (activity score 0.0)CYP2C19Intermediate metabolizer

CPIC guideline, both genes together

Evidence: optionalRead the guideline (Clinical Pharmacogenetics Implementation Consortium, opens in a new tab)

In plain words: Your two genes together change how your body handles this drug. It may cause more side effects or not work as well, so a different antidepressant is often suggested.
What it means: CYP2D6: Greatly reduced metabolism of TCAs to less active compounds compared to normal metabolizers; Higher plasma concentrations of active drug will increase the probability of side effects CYP2C19: Reduced metabolism of tertiary amines compared to normal metabolizers
What the guideline suggests: Avoid imipramine use. If imipramine is warranted, consider a 50% reduction of recommended starting dose. Utilizing therapeutic drug monitoring to guide dose adjustments is strongly recommended.

From the combined CYP2D6 and CYP2C19 table in CPIC's guideline for tricyclic antidepressants. CYP2D6 is matched on its activity score.

CPIC reads your CYP2D6 and CYP2C19 results together for imipramine, so this label reflects both genes.

About imipramine

Imipramine (Tofranil) is a tricyclic antidepressant approved for depression and, as a short-term add-on, for bedwetting in children 6 and older.

Used for: Depression; childhood enuresis (bedwetting) in children 6 and older, as temporary add-on treatment (the FDA-labeled uses)

Others in antidepressants

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And 5 more

Don't change a dose on your own. Bring this report to your prescriber or pharmacist. They can weigh it with everything else they know about you.

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