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. 2023 Nov 1;29(6):469-475.
doi: 10.1097/PRA.0000000000000750.

Personalized Medicine in the Treatment of a Patient With Obsessive-Compulsive Disorder With Clomipramine

Sheldon H Preskorn  1 , Ryan Rode
Affiliations

Personalized Medicine in the Treatment of a Patient With Obsessive-Compulsive Disorder With Clomipramine

Sheldon H Preskorn et al. J Psychiatr Pract. .

Abstract

Clomipramine (CIMI) is an effective treatment for obsessive-compulsive disorder in patients who have failed to respond to trials of selective serotonin transport inhibitors (eg, sertraline). The case presented here illustrates how knowledge of the pharmacodynamics and pharmacokinetics of CIMI in a specific patient can be used to personalize treatment to optimize the likelihood of efficacy (ie, maximum benefit to risk ratio). The approach described in this column considered: (1) the patient's diminished ability to clear CIMI and its major metabolite, desmethlyclomipramine due to a genetic deficiency in cytochrome P450 2D6 enzyme activity, and (2) the patient's ability to extensively convert CIMI to desmethlyclomipramine. That conversion impairs the ability to inhibit the serotonin transporter, the mechanism that is most likely responsible for the efficacy of CIMI in obsessive-compulsive disorder.

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Conflict of interest statement

Over his 45-year career, S.H.P. has worked with over 145 pharmaceutical and biotech companies in the United States and throughout the world. Over the past year, he has received grants/research support from or has served as a consultant, on the advisory board, or on the speaker’s bureau for Alkermes, BioXcel, Janssen. All clinical trial and study contracts were with and payments made to the Kansas University Medical Center Research Institute, a research institute affiliated with Kansas University School of Medicine-Wichita. R.R. declares no conflicts of interest.

References

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