A patient is taking Paroxetine and presents to A&E with tremor, tachycardia, hypertension and high temperature. After a genetic screening, the variant CYP2D6*4 is identified. Discuss:
• What is Paroxetine and how does it work (mechanism and clinical use)?
• What is the role of the CYP2D6 in the drugs’ metabolism in general?
• What is the metabolic pathway of Paroxetine and how is it affected by the genetic variant described in this case study?
• What is the resulting alteration in the blood levels of Paroxetine?
• What is the link between the altered blood levels of Paroxetine and the signs and symptoms reported (can you identify the syndrome)?
