Cytochrome P-450 (CYP) Metabolism Reference Table

Compiled By Jessica Oesterheld, M.D.

This is an illustrative guide to the cytochrome P450 contribution to drug interactions likely for medication pairs that are substrates, inhibitors or inducers of the same enzyme. More than one-half of patients also carry genetic variations in CYP 1A2, 2C9, 2C19, and 2D6 genes that can dramatically alter patient drug exposures, and for which DNA testing can be ordered. The GeneMedRx drug interaction software provides a more complete and automated tool for comprehensive medication management, with optional input of genetic variations, OTCs, foods, herbals, and other relevant patient factors to produce drug interaction reports based on the cumulative effect of all known drug metabolism variables. To appreciate the full benefits of this information, click here to get a free 30-day trial version of GeneMedRx. This metabolism-based drug interaction software predicts response to medication combinations with optional input of genetic variations. Last

Update: May 16, 2008
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CYTOCHROME P450 DRUG-INTERACTIONS SUBSTRATES TABLE

Substrates (primary enzyme for metabolism)   
italics = brand name
    {brackets} = minor or less potent   bold = potent   (p) = pro-drug   > = entire class or group

1A2

2B6

2C8                 

2C19

2C9

2D6

3A4,5,7

Psychotropics:
amitriptyline
chlorpromazine
clomipramine
clozapine
duloxetine
fluphenazine
fluvoxamine
imipramine
melatonin
{mirtazapine}
{olanzapine}
perphenazine
propafenone
{propranolol}
ramelteon
    Rozerem
thioridazine
thiothixene
trifluoperazine

Other:
anagrelide
caffeine
cinacalcet
cyclobenzaprine
    Flexeril
dacarbazine
erlotinib
flutamide
frovatriptin
lidocaine
mexiletine
naproxen
ondansetron
{phenacetin}
R-warfarin
propranolol
R-warfarin
riluzole
Rilutek
ropinirole
ropivaciane
     Naropin
tacrine
Cognex
theophylline
tizanidine
Zanaflex
zileutin
     Zyflo
zolmitriptan
Zomig

bupropion
cyclophos-
phamide (p)
efavrinez
    Sustiva     
ifosphamide (p)
ketamine
meperidine
methadone
{nicotine}
propofol
sertraline
selegiline
{tamoxifen}
testosterone

{amiodarone}
{carbamazepine}
replaglidine
rosiglitazone
taxols
torsemide
{verapamil}
{zopiclone}

Psychotropics:
amitriptyline
citalopram
clomipramine
diazepam
escitalopram
flunitrazapam
{fluoxetine}
imipramine
moclobemide
sertraline
trimipramine

Anticonvulsants:
mephenytoin
phenytoin

Proton Pump
Inhibitors:

{esomeprazole}
lansoprazole
omeprazole
{pantoprazole}

Others:
carisoprodol
    Soma
cilostazol
clopidogrel
cyclophos-
phophamide (p)
ifosphos-
phamide (p)
nelfinavir
proguanil (p)
Malarone
propranolol
R-warfarin
tolbutamide
voriconazole

Psychotropics:
fluoxetine
{sertraline}
valproic acid

NSAIDS:
aceclofenac
celecoxib
diclofenac
flurbiprofen
ibuprofen
indomethacin
lornoxicam
meloxicam
{naproxen}
piroxicam
suprofen
tenoxicam

Hypoglycemics:
chlorpropamide
glipizide
Glucotrol
Glimepiride
    Amaryl
glyburide
    DiaBeta
nateglinide
Starlix
{rosiglitazone}
{Avandia}
tolbutamide
Orinase

Others:
bosentan
candesartan
    Atacand
fluvastatin
    Lescol
irbesartan
losartan
Cozaar (p)
phenobarbital
phenytoin
sulfa drugs
{tamoxifen}
S-warfarin
tetrahydro-cannabinol (marijauna)
torsemide
Tomide

Psychotropics:
amphetamines
amitriptyline
aripiprazole
atomoxetine
benztropine
chlorpromazine
{citalopram}
clomipramine
desipramine
doxepin
duloxetine
fluoxetine
fluvoxamine
haloperidol
imipramine
mirtazapine
nortripyline
paroxetine
perphenazine
risperidone
{sertraline}
thioridazine
venlafaxine

Antihistamines:
chlorpheniramine
diphenhydramine
hydroxyzine
Atarax

Beta Blockers:
carveodilol
metoprolol
propranolol
timolol

>Cough Medicines

Opiates:
codeine(p)
hydrocodone (p)
{oxycodone}
tramadol

Others:

dolesetron(p)
doxorubicin
encainide
MDMA  (ecstasy)
metoclopramide
     Reglan
mexiletine
phenacetin
proprafenone
Rythmol
{ranitidine}
{Zantac}
tamoxifen(p)
tolterodine
    Detrol
tropisetron

Psychotropics:
alprazolam
amitriptyline
aripiprazole
buspirone
carbamazepine
citalopram
{clomipramine}
{clozapine}
{diazepam}
estazolam
eszopiclone
Lunesta
fluoxetine
haloperidol
midazolam
nefazodone
pimozide
quetiapine
risperidone
sertraline
trazodone
triazolam
zaleplon
    Sonata
{ziprasidone}
zolpidem
    Ambien

Drugs of abuse/
treatment:

buprenorphine
cocaine
fentanyl
ketamine
methadone
oxycodone
phencyclidine
     PCP

Antibiotics/ Antifungals:
macrolides (not azithromycin)
itraconazole
ketoconazole
telithromycin
Ketek

Anticonvulsants:
carbamazepine
ethosuximide
felbamate
tiagabine
    Gabitril
Zonisamide
    Zonegran

Antihistamines:
Desloratadine
Clarinex
fexofenadine
Allegra
loratadine
    Claritin

Asthma
Medication:

fluticasone
     Flovent
salmeterol
    Serevent
zileuton
Zyflo

>Calcium Channel
Blockers

Hormones/chemo-therapeutics:
cortisols
desogestrel (p)
ethinyl estradiol
OCs
progestins
/progesterone
vincristine and
others

Others:
aprepitant
Emend
cinacalcet
esomeprazole
granisetron
nateglinide
Starlix
omeprazole
pioglitazone
Actos
quinidine
sildenafil
Statins
(atorvastatin,
lovastatin,
simvastatin)
tolterodine
Detrol

CYTOCHROME P450 DRUG-INTERACTIONS INHIBITORS TABLE

Inhibitors (reduces or blocks the ability of the enzyme to metabolize the substrates)

1A2

2B6

2C8

2C19

2C9

2D6

3A4,5,7

acyclovir
amiodarone
caffeine
cimetidine
ciprofloxacin
enoxacin
echinacea
enoxacin
famotidine
flutamide
fluvoxamine
grapefruit juice
lidocaine
lomefloxacin
mexiletine
    Mexitil
moclobemide
norfloxacin
ofloxacin
oral contraceptives
perphenazine
phenacetin
propafenone
ropinirole
tacrine
ticlopidine
tocainide
verapamil
zileuton
     Zyflo

clopidogrel           
    Plavix
efavirenz
fluoxetine
fluvoxamine
ketoconazole
memantine
nelfinavir
oral contraceptives
paroxetine
ritonavir
thiotepa
ticlopidine
    Ticlid

gemfibrozil
glitazones
trimethoprim

artemisinin
chloramphenicol
delavirdine
efavirenz
esomeprazole
felbamate
{fluconazole}
{fluoxetine}
fluvoxamine
indomethacin
inh
modafinil
    Provigil
omeprazole
Prilosec
oral contraceptives
oxcarbazepine
ticlopidine
topiramate
voriconazole

amiodarone
anastrazole
cimetidine
delavirdine
efavirenz
fenofibrate
Tricor
fluconazole
{fluoxetine}
fluvoxamine
fluvastatin
isoniazid
ketoconazole
leflunomide
modafiinil
phenylbutazone
{sertraline}
sulfamethoxazole
sulfaphenazole
tamoxifen
teniposide
valproic acid
voriconazole
 Vfend
{zafirlukast},
{Accolate}
5-fluorouracil

amiodarone
{amitriptyline}
bupropion
celecoxib
chlorpheniramine
chlorpromazine
cimetidine
cinacalcet
{citalopram}
chlorpheniramine
clomipramine
{desipramine}
diphenhydramine
doxepin
duloxetine
{fluvoxamine}
fluoxetine
goldenseal
halofantrine
haloperidol
{hydroxyzine}
imipramine
methadone
metoclopramide
moclobemide
paroxetine
pimozide
propafenone
quinidine/quinine
ritonavir
{sertraline}
terbinafine
thioridazine
ticlopidine

amiodarone
amprenavir
aprepitant -initially
atazanavir
    Reyataz
{cimetidine}
ciprofloxacin
clarithromycin
delavirdine
diltiazem
doxycycline
echinacea
enoxacin
erythromycin
fluconazole
fluvoxamine
grapefruit juice
indinavir
itraconazole
ketoconazole
miconazole
nefazodone
nelfinavir
ritonavir and boosted PIs
saquinavir
telithromycin
verapamil
voriconazole

CYTOCHROME P450 DRUG-INTERACTIONS INDUCERS TABLE

Inducers (increases the ability of the enzyme to metabolize the substrates)

1A2

2B6

2C8

2C19

2C9

2D6

3A4,5,7

carbamazepine
charbroiled meat
cigarette smoke
cruciferous veggies
esomeprazole
griseofulvin
insulin
lansprazole
marijuana smoke
moricizine
omeprazole
rifampin
ritonavir

lopinavir/ritonavir
phenobarbital
phenytoin
rifampin

rifampin

gingko biloba
rifampin
St John’s Wort

aprepitant-long term
barbituates
bosentan
carbamazepine
rifampin-chronic
ritonavir and boosted Pis
St John’s Wort-long term

?rifampin

aprepitant -long term
barbituates
bosanten
carbamazepine
efavirenz
felbamate
glucocorticoids
modafinil
nafcillin
nevirapine
{oxcarbazepine}
phenytoin
primidone
rifampins
St John’s Wort
pioglitazone
Actos
topiramate at >200 mg/d

GeneMedRx has not been reviewed or approved by the United States Food and Drug Administration and cannot be used to diagnose or treat any disease or other health condition.