Substrate dependent. Cytochrome P450 (P450) 2D6 can be a major drug-metabolizing enzyme expressed in the liver1. CYP2D6 catalyzes the hepatic metabolism of a sizable number of clinically important medicines, like codeine, amitriptyline, fluvoxamine, risperidone, fluoxetine, aripiprazole, paroxetine, and dextromethorphan2,three. The CYP2D6 gene is extremely polymorphic. To date, more than 130 allelic variants have already been designated by the Pharmacogene Variation Consortium (PharmVar)4,five.Division of Pharmacogenomics and Personalized Medicine, Division of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. 2Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand. 3Advanced Analysis and Development Laboratory, Bumrungrad International Hospital, Bangkok, Thailand. 4Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children’s Mercy Kansas City, Kansas City, MO, USA. 5School of Medicine, TrkC Source University of Missouri-Kansas City, Kansas City, MO, USA. 6Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Study Institute of Pharmacy, University of Groningen, Groningen, The Netherlands. 7Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 8Yuwaprasart Waithayopathum Kid and Adolescent Psychiatric Hospital, Department of Mental Wellness Services, Ministry of Public Wellness, Samut Prakan, Thailand. e mail: [email protected] Reports | (2021) 11:4158 | https://doi.org/10.1038/s41598-021-83570-w 1 Vol.:(0123456789)www.nature.com/scientificreports/CYP2D6 allele frequencies differ substantially amongst various ethnic and ancestral populations6. The decreased function CYP2D610 allele (100C T, P34S) may be the most typical allele in East Asian populations, which includes Thai, Chinese, Taiwanese, Korean, Vietnamese, and Filipino106. This allele can also be observed in other populations, such as Europeans, Africans, and their descendants, its frequency, nevertheless, significantly lower8. Conversely, the nonfunctional CYP2D64 allele is additional frequent in European populations but is seldom observed in Asian SIK1 manufacturer populations8. CYP2D6 genetic variation results in a wide array of metabolic capacity ranging from no to increased activity. Determined by their genotype, people are grouped into four phenotype groups, i.e., poor metabolizers (PMs), intermediate metabolizers (IMs), regular metabolizers (NMs), and ultrarapid metabolizers (UMs)17. The activity score method (AS) has been broadly accepted to translate the CYP2D6 genotype into phenotype as well as the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Dutch Pharmacogenetics Working Group (DPWG) for their respective guidelines18,19. Briefly, every allele is assigned a worth of 0, 0.5 or 1 reflecting no function, decreased or normal function, as well as the sum in the values gives the AS of a genotype. The previous CPIC translation system classified AS = 0 as PM, AS = 0.5 as IM, AS = 1 to two as NM, and two as UM. In an effort to harmonize genotype to phenotype translation, a CPIC-led working group has lately published a revised approach and recommends utilizing this new strategy to translate genotype to phenotype19. One particular main modify was downgrading the value utilized for activity score calculation with the decreased function CYP2D610 allele from 0.five to 0.25 to more accurately reflect the substantially decreased f.