Drug-herb-gene CYP3A4 interactions

Posted by Dr. Ming Kao

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