Psychiatric Disorder or Adverse Drug Reaction? – How CYP2D6 Metabolizing Activity Can Result in Dextromethorphan IntoxicationPsychiatrisches Krankheitsbild oder unerwünschte Arzneimittelwirkung? – Wie die CYP2D6-Aktivität eine Dextromethorphan-Vergiftung hervorrufen kann
06 June 2018 (online)
Dextromethorphan is frequently used as an antitussive drug in children and adults. We here present a 9-year-old girl who developed psychiatric symptoms after treatment with therapeutic doses of dextromethorphan.
Dextromethorphan is mainly metabolized to dextrorphan by cytochrome P450 2D6 (CYP2D6), and to minor metabolites by cytochrome P450 3A4 (CYP3A4). CYP2D6 is a polymorphically expressed enzyme. Its genetically determined drug metabolizing activity can result in 4 different phenotypes: poor metabolizers (PM), intermediate metabolizers (IM), extensive metabolizers (EM), and ultrarapid metabolizers (UM) (Gaedigk et al., Clin Pharmacol Ther 2008; 83: 234–242).