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

Dr. Ming Kao View All →

Pain physician & PhD computational biologist @StanfordPain • Advanced pain interventions with CIPS & FIPP • Opinions mine & not medical advice

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