USER:QUNHO CYP3A4

**Selected inducers, inhibitors and substrates of CYP3A4**
Inhibitors	Inducers
Strong protease inhibitors ritonavir indinavir nelfinavir saquinavir some macrolide antibiotics clarithromycin telithromycin chloramphenicol ( antibiotic) some azole antifungals ketoconazole itraconazole posaconazole voriconazole nefazodone ( antidepressant) cobicistat Moderate amiodarone aprepitant ( antiemetic) some calcium channel blockers verapamil diltiazem some macrolide antibiotics erythromycin some azole antifungals fluconazole miconazole bergamottin (constituent of grapefruit juice) cimetidine ciprofloxacin cyclosporine donedarone fluvoxamine imatinib Valerian verapamil Weak buprenorphine ( analgesic) cafestol (in unfiltered coffee) cilostazol fosaprepitant gabapentin lomitapide orphenadrine ranitidine ranolazine tacrolimus ticagrelor valproic acid Unspecified potency cannabidiol dithiocarbamate (functional group) mifepristone ( abortifacient) norfloxacin (antibiotic) some non-nucleoside reverse transcriptase inhibitors delavirdine gestodene ( hormonal contraceptive) mibefradil (in angina pectoris) star fruit milk thistle niacinamide ginkgo biloba piperine isoniazid quercetin	Strong potency antiandrogens enzalutamide apalutamide phenytoin Unspecified potency anticonvulsants, mood stabilizers carbamazepine phenytoin ( anticonvulsant) oxcarbazepine topiramate barbiturates phenobarbital Butalbital St. John's wort some bactericidals rifampicin rifabutin some non-nucleoside reverse transcriptase inhibitors efavirenz nevirapine some hypoglycemics pioglitazone troglitazone glucocorticoids ( blood glucose increase, immunosuppressive) modafinil ( stimulant) quercetin capsaicin

**Selected inducers, inhibitors and substrates of CYP3A4**
Substrates	Inhibitors	Inducers
some immunosuppressants ciclosporin (cyclosporin) tacrolimus sirolimus many chemotherapeutics docetaxel tamoxifen paclitaxel cyclophosphamide doxorubicin erlotinib etoposide ifosfamide teniposide vinblastine vincristine vindesine imatinib irinotecan sorafenib sunitinib vemurafenib temsirolimus anastrozole gefitinib azole antifungals ketoconazole itraconazole macrolides clarithromycin erythromycin telithromycin (not azithromycin) dapsone (in leprosy) tricyclic antidepressants amitriptyline clomipramine imipramine cyclobenzaprine SSRIs citalopram norfluoxetine sertraline some other antidepressants mirtazapine ( NaSSA) nefazodone reboxetine venlafaxine ( SNRI) trazodone ( SARI) vilazodone buspirone ( anxiolytic) antipsychotics haloperidol aripiprazole risperidone ziprasidone pimozide quetiapine opioids (mainly analgesics) alfentanil buprenorphine ( analgesic, addiction maintenance treatment) codeine ( analgesic, antitussive, antidiarrheal) fentanyl hydrocodone (partial involvement, not the bioactivation factor) methadone ( analgesic, addiction maintenance treatment) levacetylmethadol tramadol (to inactive metabolites, do not confuse with metabolism via CYP2D6) benzodiazepines alprazolam midazolam triazolam diazepam (bioactivation to desmethyldiazepam) some hypnotics zopiclone zaleplon zolpidem donepezil ( acetylcholinesterase inhibitor) statins atorvastatin lovastatin simvastatin cerivastatin (not pravastatin) (not rosuvastatin) calcium channel blockers diltiazem felodipine nifedipine verapamil amlodipine lercanidipine nitrendipine nisoldipine amiodarone ( class III antiarrhythmic) dronedarone ( class III antiarrhythmic) quinidine ( class I antiarrhythmic) PDE5 inhibitors sildenafil tadalafil kinins ( vasodilators, smooth muscle contractors) sex hormones agonists and antagonists finasteride ( antiandrogen) estradiol ( estrogen) progesterone ethinylestradiol ( hormonal contraceptive) testosterone ( androgen) toremifene ( SERM) bicalutamide H1-receptor antagonists terfenadine astemizole chlorphenamine protease inhibitors indinavir ritonavir saquinavir nelfinavir non-nucleoside reverse transcriptase inhibitors nevirapine some glucocorticoids budesonide hydrocortisone dexamethasone albendazole ( antihelminthic) cisapride ( 5-HT4 receptor agonist) aprepitant ( antiemetic) caffeine ( stimulant) cocaine ( stimulant) cilostazol ( phosphodiesterase inhibitor) dextromethorphan ( antitussive) domperidone ( antidopaminergic) eplerenone ( aldosterone antagonist) lidocaine ( local anesthetic, antiarrhythmic) ondansetron ( 5-HT3 antagonist) propranolol ( beta blocker) salmeterol ( beta agonist) warfarin ( anticoagulant) clopidogrel, becoming bioactivated ( antiplatelet) omeprazole ( proton pump inhibitor) nateglinide ( antidiabetic) methoxetamine montelukast ( leukotriene receptor antagonist) vilaprisan ( selective progesterone receptor modulator)	Strong protease inhibitors ritonavir indinavir nelfinavir saquinavir some macrolide antibiotics clarithromycin telithromycin chloramphenicol ( antibiotic) some azole antifungals ketoconazole itraconazole posaconazole voriconazole nefazodone ( antidepressant) cobicistat Moderate amiodarone aprepitant ( antiemetic) some calcium channel blockers verapamil diltiazem some macrolide antibiotics erythromycin some azole antifungals fluconazole miconazole bergamottin (constituent of grapefruit juice) cimetidine ciprofloxacin cyclosporine donedarone fluvoxamine imatinib Valerian verapamil Weak buprenorphine ( analgesic) cafestol (in unfiltered coffee) cilostazol fosaprepitant gabapentin lomitapide orphenadrine ranitidine ranolazine tacrolimus ticagrelor valproic acid Unspecified potency cannabidiol dithiocarbamate (functional group) mifepristone ( abortifacient) norfloxacin (antibiotic) some non-nucleoside reverse transcriptase inhibitors delavirdine gestodene ( hormonal contraceptive) mibefradil (in angina pectoris) star fruit milk thistle niacinamide ginkgo biloba piperine isoniazid quercetin	Strong potency antiandrogens enzalutamide apalutamide phenytoin Unspecified potency anticonvulsants, mood stabilizers carbamazepine phenytoin ( anticonvulsant) oxcarbazepine topiramate barbiturates phenobarbital Butalbital St. John's wort some bactericidals rifampicin rifabutin some non-nucleoside reverse transcriptase inhibitors efavirenz nevirapine some hypoglycemics pioglitazone troglitazone glucocorticoids ( blood glucose increase, immunosuppressive) modafinil ( stimulant) quercetin capsaicin

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