Drug Interactions with Cytochrome P450 Enzymes


CYP450 enzymes are involved in many drug-drug interactions. Some drugs can inhibit or induce the activity of these enzymes, leading to altered metabolism of co-administered drugs.


CYP1A2

  • Inhibitor: Ciprofloxacin, Levofloxacin, Cimetidine, Citalopram, Ketoconazole, Paroxetine
  • Inducer: Phenytoin, Carbamazepine, Charbroiled foods, Tobacco, Ritonavir, St. John’s wort
  • Substrate: Naproxen, Amitriptyline, Verapamil, Clopidogrel, Duloxetine, Ramelteon


CYP2C9

  • Inhibitor: Cimetidine, Fluoxetine, Voriconazole, Fluconazole, Amiodarone, Efavirenz, Metronidazole
  • Inducer: Rifampin, Carbamazepine, Phenytoin
  • Substrate: Tamoxifen, Losartan, S-Warfarin, Celecoxib, Phenytoin, Carvedilol, Voriconazole, Glyburide, Sildenafil


CYP2C8

  • Inhibitor: Gemfibrozil, Nicardipine, Atazanavir, Trimethoprim
  • Inducer: Phenobarbital, Rifampin, Carbamazepine
  • Substrate: Paclitaxel, Carbamazepine, Amiodarone, Pioglitazone


CYP2C19

  • Inhibitor: Ketoconazole, Omeprazole, Topiramate, Fluoxetine, Fluvoxamine
  • Inducer: Rifampin, Carbamazepine, Phenytoin
  • Substrate: Diazepam, Phenytoin, Citalopram, Omeprazole, Diphenhydramine, Duloxetine, R-Warfarin


CYP2D6

  • Inhibitor: Methadone, Cimetidine, Fluoxetine, Ritonavir, Haloperidol, Amiodarone, Paroxetine, Quinidine, Sertraline
  • Inducer: Carbamazepine, Phenytoin, Ethanol, St. John’s wort, Ritonavir
  • Substrate: Amitriptyline, Metoprolol, Paroxetine, Duloxetine, Haloperidol, Venlafaxine, Tramadol, Trazodone, Narcotic analgesics


CYP2E1

  • Inhibitor: Cimetidine, Disulfiram
  • Inducer: Ritonavir, Isoniazid, Ethanol
  • Substrate: Acetaminophen, Caffeine, Venlafaxine


CYP3A family

  • Inhibitor: Erythromycin, Ketoconazole, Saquinavir, Verapamil, Metronidazole, Amiodarone, Cimetidine, Diltiazem, Posaconazole, Metronidazole, Nifedipine, Voriconazole, Atazanavir
  • Inducer: Carbamazepine, Phenobarbital, St. John’s wort, Nevirapine, Carbamazepine, Rifampin, Garlic supplements, Grapefruit, Seville orange, Bitter orange
  • Substrate: Atorvastatin, Warfarin, Lidocaine, Ethyl estradiol, Cyclosporine, Alprazolam, Ziprasidone, Doxorubicin, Amitriptyline, Methadone, Cyclosporine, Amlodipine, Indinavir, Cyclosporine, Paclitaxel, Ritonavir, Lidocaine, Lovastatin, Midazolam, Tamoxifen, Zaleplon, Atazanavir


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