Cytochrome P-450 interactions
Inducers (+)
Modafinil, Chronic alcohol use, St. John’s wart, Phenytoin, Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine
“Most chronic alcoholics Steal Phen-Phen and Never Refuse Greasy Carbs”
Substrates
Anti-epileptics, Theophylline, Warfarin, OCPs
“TWO epilepsies”
Inhibitors (-)
Sodium valproate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Acute alcohol abuse, Chloramphenicol, Erythromycin/clarithromycin, Sulfonamides, Ciprofloxacin, Omeprazole, Metronidazole, Amiodarone, Grapefruit juice
“SICKFACES.COM (when I Am drinking Grapefruit juice)”
Acute alcohol abues, Antibiotics, Azoles, Amiodarone, Cimetidine/Omeprazole, Grapefruit juice.
Medications
Warfarin
Dietary changes
- Foods containing high levels of vitamin K
- Leafy green vegetables (eg, spinach, Brussels sprouts)
- ? therapeutic effect of warfarin
- Medications that prolongs INR in those on warfarin
- Acetaminophen – d/t interruption of vitamin K recycling in the liver
- Medications that inhibit cytochrome P450 activity
- Amiodarone
- Antibiotics/antifungal
- Most of the quinolones and macrolides.
- Trimethoprim/sulfamethoxazole, metronidazole, fluconazole
- Medications that enhance cytochrome P450 activity
- Rifampin
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