Drug-herb-gene CYP3A4 interactions
The liver enzyme CYP3A4 is the key body mechanism for metabolizing pain medications. Patients who take pain medications must be aware that drugs, herbs, & genes can complexly alter CYP3A4 activity. Ask your doctor before making changes.
Drugs metabolized by CYP3A4
- Fentanyl
- Buprenorphine
- Oxycodone
- Methadone
- Diazepam
- Midazolam
- Alprazolam
- Metoprolol
- Losartan
- Amlodipine
- Rivaroxaban
- Dabigatran
- Apixaban
- Tacrolimus
CYP3A4 inhibitors
Drugs:
- Amiodarone
- Cimetidine
- Conazoles
- Diltiazem
- Verapamil
- Erythromycin
- Clarithromycin
- Fluoxetine
- Isoniazide
- Protease inhibitors
Herbs:
- Grapefruit
- Black pepper
- Goldenseal
Inflammation
CYP3A4 inducers
Drugs:
- Butalbital
- Dexamethasone
Herbs:
- St. John’s Wort
Gentle pain treatments Chronic Pain Health Medicine Pain Pharmacology
Dr. Ming Kao View All →
Pain physician & PhD computational biologist @StanfordPain • Advanced pain interventions with CIPS & FIPP • Opinions mine & not medical advice
