Q: In ICU, out of the following, which ethnic group may be seen with higher than usual doses of antidepressants?

A) African Americans 
B) Asian Americans 
C) Ethiopians (blacks) 
D) Saudi Arabians 
E) Whites Americans


Answer: C

Pharmacogenetics plays an important role in obtaining therapeutic level in patients. Ethnic/genetic origin plays a crucial role as some groups may require higher than normal doses to reach therapeutic level . When it comes to antidepressants, Ethiopians (blacks) can have up to 29 percent of increased CYP2D6 metabolism. In contrast, African Americans have only 5 percent and White Americans have about 4 percent of increased CYP2D6 metabolism. People originating from Saudi Arabia can also have very high increased CYP2D6 metabolism, up to 20 percent. Interestingly, Asian Americans are rarely seen to have increased CYP2D6 metabolism.


References: 

D'Empaire I, Guico-Pabia CJ, Preskorn SH. Antidepressant treatment and altered CYP2D6 activity: are pharmacokinetic variations clinically relevant? J Psychiatr Pract 2011; 17:330.