CYP2C19

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CYP2C19 is an abbreviation for Cytochrome P450 2C19, which is a liver enzyme that plays a significant role in the metabolism of various drugs and substances in the body. It is a member of the cytochrome P450 superfamily, a large and diverse group of enzymes.
Function:

• Drug Metabolism: CYP2C19 is responsible for processing or metabolizing at least 10% of commonly prescribed drugs.
• Examples of affected drugs:
• Clopidogrel (Plavix): An antiplatelet medication used to prevent blood clots. CYP2C19 converts clopidogrel into its active form.
• Proton pump inhibitors (PPIs) like Omeprazole: Used to treat ulcers and acid reflux.
• Antidepressants: Such as citalopram, clomipramine, amitriptyline and imipramine.
• Antiseizure drugs: For example, mephenytoin.
• Benzodiazepines: including diazepam, lorazepam, oxazepam and temazepam.
• Voriconazole
• Proguanil (antimalarial).
• Propranolol
• Fenbendazole
• Other functions: It's involved in the synthesis of cholesterol, steroids, and other lipids. It also metabolizes polyunsaturated fatty acids (PUFA) and plant monoterpenes.

• The CYP2C19 gene is highly polymorphic, meaning there are many variations in the gene sequence among individuals. Over 35 variant star (*) alleles have been catalogued.
• These genetic variations can significantly affect how efficiently CYP2C19 metabolizes drugs.
• Individuals are categorized based on their CYP2C19 activity levels:
• Poor Metabolizers (PM): Have significantly reduced or absent enzyme activity.
• Intermediate Metabolizers (IM): Have reduced enzyme activity.
• Extensive Metabolizers (EM): Have normal enzyme activity. Now more commonly known as Normal Metabolizers.
• Rapid Metabolizers (RM): Have increased enzyme activity.
• Ultra-Rapid Metabolizers (UM): Have greatly increased enzyme activity.
• The frequency of these metabolizer types varies among different ethnic groups.

• Pharmacogenomics: CYP2C19 genotyping is used to guide drug selection and dosing. This testing can help predict a person's response to certain medications, to avoid adverse effects and adjust the dosage.
• Clopidogrel Response: Genetic variants of CYP2C19 can significantly influence a patient's response to clopidogrel, impacting the risk of cardiovascular events.
• Benzodiazepines: People with certain CYP2C19 variants might experience different effects and that certain benzodiazepines should be avoided.