The Effect of Cytochrome P450 Metabolism on Drug Response,

Interactions, and Adverse Effects

Table 2
Examples of Common Drug-Drug Interactions Involving the Cytochrome P450 Enzyme
System

ENZYME
INHIBITOR METABOLIZING POSSIBLE CLINICAL
DRUG(S)/PRODUCT DRUG(S)
OR ENZYME EFFECT
INDUCER

Amiodarone CYP2C9 Warfarin CYP2C9 Increased risk of

(Cordarone) and (Coumadin) bleeding caused by
CYP3A4 increased warfarin
inhibitor level19

Carbamazepine CYP3A4 Ethinyl CYP3A4 Unplanned pregnancy

(Tegretol), inducer estradiol- caused by reduced
phenobarbital, containing estradiol level20
phenytoin (Dilantin) contraceptives

Clarithromycin CYP3A4 Simvastatin CYP3A4 Myopathy or

(Biaxin), inhibitor (Zocor), rhabdomyolysis caused
erythromycin, verapamil by increased
telithromycin (Ketek) (Calan) simvastatin level21

Hypotension and QT
interval prolongation
caused by increased
verapamil level22

Diltiazem CYP3A4 Prednisone CYP3A4 Immunosuppression

(Cardizem), inhibitor caused by increased
verapamil prednisolone serum
levels23

Fluoxetine (Prozac), CYP2D6 Risperidone CYP2D6 Increased risk of

paroxetine (Paxil), inhibitor (Risperdal), extrapyramidal adverse
tramadol effects caused by
(Ultram) increased risperidone
 level24; decrease in
analgesic effect caused
by low level of active
metabolite25

Grapefruit juice CYP3A4 Buspirone CYP3A4 Dizziness and

inhibitor (Buspar) serotonin syndrome
caused by increased
buspirone level26

Metronidazole CYP2C9 Warfarin CYP2C9 Increased risk of

(Flagyl) inhibitor bleeding caused by
increased warfarin
level27

Terbinafine (Lamisil) CYP2D6 Amitriptyline CYP2D6 Dry mouth, dizziness,

inhibitor and cardiac toxicity
caused by prolonged
increase in amitriptyline
and nortriptyline
(Pamelor) levels28

CYP=cytochrome P.

Information from references 19 through 28.

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