Table 1. CYP2C19 phenotypes and the therapeutic recommendations for esomeprazole therapy

PhenotypePhenotype detailsExamples of diplotypesTherapeutic recommendations for esomeprazole
Ultrarapid metabolizer
Normal or increased CYP2C19 activity*17/*17
Be extra alert to insufficient response. For the eradication of H. pylori, increase dose by 50–100%. 
For other conditions, consider dose increase by 50–100%.
Extensive metabolizer
Normal CYP2C19 activity*1/*1
Dose recommended by drug label
Intermediate metabolizer
Decreased CYP2C19 activity
Dose recommended by drug label
Poor metabolizer
Markedly reduced or absent CYP2C19 activity
Dose recommended by drug label

Good quality evidence supports the dose recommendations for poor and intermediate metabolizers; data are lacking for ultrarapid metabolizers.

Table is adapted from Swen J.J., Nijenhuis M., de Boer A., Grandia L. et al. Pharmacogenetics: from bench to byte - an update of guidelines. Clinical pharmacology and therapeutics. 2011;89(5):662–73 (3).

From: Esomeprazole Therapy and CYP2C19 Genotype

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