Cytochrome P450

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Cytochrome P450 3A4 enzyme complex

Cytochrome P450 is a family of enzymes mainly responsible for the degradation of substances. It accounts for about 75% of the total metabolism in the human body.[1]

Some substances can modulate the activity of CYP enzymes by either inducing or directly inhibiting the activity of CYP. This is a major source of adverse substance reactions, as changes in CYP enzyme activity can affect metabolism and release of various substances.

For example, if one substance inhibits the CYP-mediated metabolism of another substance, the second substance may accumulate in the body in toxic amounts. Therefore, these substance interactions may require dosage adjustment or the selection of substances that do not interact with the CYP system.

Substrates

Inhibitors

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Some CYP450 inhibitors are also MAOIs.

Make sure to check our list of MAOI interactions that can be dangerous.

Cytochrome P450 inhibitors inhibit the ability of the human body to break down certain substances, potentially increasing the amount of time a substance is active in the body.

In some cases, this inhibition of how substances are broken down in the body can lead to dangerous adverse effects. Under some conditions, this can be fatal.

  • Black Cohosh (Cimicifuga racemosa): CYP3A4[5]
  • Cannabis
  • Fluoxetine[11]
  • Grapefruit: Bergamottin, a natural furanocoumarin in both grapefruit flesh and peel that inhibits the CYP3A4
  • Goldenseal: CYP2D6, CYP3A4 and CYP3A5[12]
  • Watercress: CYP2E1[13]
  • St. John’s Wort: CYP3A4 and CYP1A2[14]
  • Star fruit, aka carambola (from Averrhoa carambola): CYP2A6[15]
  • MAOIs

See also

External links

References

  1. Guengerich FP (January 2008). "Cytochrome p450 and chemical toxicology". Chemical Research in Toxicology. 21 (1): 70–83. doi:10.1021/tx700079z. PMID 18052394. 
  2. https://www.ncbi.nlm.nih.gov/pubmed/10215755
  3. https://www.ncbi.nlm.nih.gov/pubmed/10215755
  4. 4.0 4.1 4.2 4.3 https://drug-interactions.medicine.iu.edu/clinical-table.aspx
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1142198/
  6. Jiang, R; Yamaori, S; Okamoto, Y; Yamamoto, I; Watanabe, K (2013). "Cannabidiol is a potent inhibitor of the catalytic activity of cytochrome P450 2C19". Drug metabolism and pharmacokinetics. 28 (4): 332–8. doi:10.2133/dmpk.dmpk-12-rg-129. PMID 23318708. 
  7. 7.0 7.1 Qian, Y; Gurley, BJ; Markowitz, JS. "The Potential for Pharmacokinetic Interactions Between Cannabis Products and Conventional Medications". Journal of clinical psychopharmacology. 39 (5): 462–471. doi:10.1097/JCP.0000000000001089. PMID 31433338. 
  8. Yamaori, S; Okamoto, Y; Yamamoto, I; Watanabe, K (November 2011). "Cannabidiol, a major phytocannabinoid, as a potent atypical inhibitor for CYP2D6". Drug metabolism and disposition: the biological fate of chemicals. 39 (11): 2049–56. doi:10.1124/dmd.111.041384. PMID 21821735. 
  9. "Epidiolex (Cannabidiol) FDA Label" (PDF). US Food and Drug Administration (FDA). Retrieved June 28, 2018.  For label updates see FDA index page for NDA 210365
  10. Watanabe K, Yamaori S, Funahashi T, Kimura T, Yamamoto I (March 2007). "Cytochrome P450 enzymes involved in the metabolism of tetrahydrocannabinols and cannabinol by human hepatic microsomes". Life Science. 80 (15): 1415–9. doi:10.1016/j.lfs.2006.12.032. PMID 17303175. 
  11. https://drug-interactions.medicine.iu.edu/clinical-table.aspx
  12. Gurley BJ, Gardner SF, Hubbard MA, Williams DK, Gentry WB, Khan IA, Shah A (2005). "In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes". Clin. Pharmacol. Ther. 77: 415–26. doi:10.1016/j.clpt.2005.01.009. PMC 1894911Freely accessible. PMID 15900287. 
  13. Leclercq, Isabelle; Desager, Jean-Pierre; Horsmans, Yves (1998). "Inhibition of chlorzoxazone metabolism, a clinical probe for CYP2E1, by a single ingestion of watercress". Clinical Pharmacology & Therapeutics. 64 (2): 144–9. doi:10.1016/S0009-9236(98)90147-3. PMID 9728894. 
  14. Wenk M, Todesco L, Krähenbühl S (2004). "Effect of St John's wort on the activities of CYP1A2, CYP3A4, CYP2D6, N-acetyltransferase 2, and xanthine oxidase in healthy males and females" (PDF). Br J Clin Pharmacol. 57 (4): 495–499. doi:10.1111/j.1365-2125.2003.02049.x. PMC 1884478Freely accessible. PMID 15025748. 
  15. https://www.ncbi.nlm.nih.gov/pubmed/18261370
  16. 16.0 16.1 16.2 https://www.ncbi.nlm.nih.gov/pubmed/21433154
  17. https://www.ncbi.nlm.nih.gov/pubmed/7781267
  18. https://www.ncbi.nlm.nih.gov/pubmed/12130727
  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5822518/