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To explore the pharmacogenetic effects of the cytochrome P450 (CYP)2D6 genotype in patients with systolic heart failure treated using controlled/extended-release (CR/XL) metoprolol, this study assessed the CYP2D6 locus for the nonfunctional *4 allele (1846G>A; rs3892097) in the Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF; n = 605). Participants were characterized as extensive, intermediate, or poor metabolizers (EMs, IMs, or PMs, respectively), based on the presence of the CYP2D6*4 allele (EM: *1*1, 60.4%; IM: *1*4, 35.8%; and PM: *4*4, 3.8%). Plasma metoprolol concentrations were 2.1-/4.6-fold greater in the IM/PM groups as compared with the EM group (P < 0.0001). Metoprolol induced significantly lower heart rates and diastolic blood pressures during early titration, indicating a CYP2D6*4 allele dose-response effect (P < 0.05). These effects were not observed at maximal dose, suggesting a saturable effect. Genotype did not adversely affect surrogate treatment efficacy. CYP2D6 genotype modulates metoprolol pharmacokinetics/pharmacodynamics during early titration; however, the MERIT-HF-defined titration schedule remains recommended for all patients, regardless of genotype.
Author(s): Batty JA, Hall AS, White HL, Wikstrand J, de Boer RA, van Veldhuisen DJ, van der Harst P, Waagstein F, Hjalmarson Å, Kjekshus J, Balmforth AJ
Publication type: Article
Publication status: Published
Journal: Clinical Pharmacology & Therapeutics
Print publication date: 01/03/2014
Online publication date: 06/11/2013
Acceptance date: 16/09/2013
ISSN (print): 0009-9236
ISSN (electronic): 1532-6535
Publisher: Nature Publishing Group
PubMed id: 24193112
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