CYP 450

• cyclosporine, macrolides, azoles are all inhibitors

CYP450 Inducers

Inducers	Inhibitors	Substrates
St. John's Wort	Grapefruit Juice	Warfarin
Carbamazepine	Cimetidine	Phenytoin
Phenytoin	Erythromycin	Theophylline
Phenobarbital	Ciprofloxacin	Statin (except pravastatin)
Rifampin	Azoles	Cyclophosphamide
Griseofulvin	Ritonavir	zaleplon
Chronic EtOH	Isoniazid	zolpidem
Modafinil	Bactrim/Metronidazolex	Benzodiazepine
	Amiodarone
	Simprevir
	Diltiazem
	Fluoroquinolones

• Activated chrome bumper: barbiturates (e.g. phenobarbital) are potent inducers of the cytochrome P450 system

• Speeding chrome bumper: rifampin activated cytochrome P450

• Greased up chrome bumper: griseofulvin activates cytochrome P-450

CYP450 Inhibitors

• Broken chrome bumper: cytochrome P-450 inhibition

• Broken chrome bumper: azole antifungals inhibit fungal cytochrome P-450 responsible for the conversion. Also SE because CYP 450

• Right on!: ritonovir has greatest cytochrome P-450 inhibitory effect and boosts concentration of other protease inhibitors

• Broken chrome bumper: INH inhibits cytochrome P450

• Vandalized chrome bumper: inhibition of cytochrome P450

• Broken chrome bumper: amiodarone inhibits the cytochrome P450 system

• Broken chrome bumper: simeprevir inhibits cytochrome P450

Substrates

• chrome tank: all statins except for pravastatin are metabolized by cytochrome p450 (CYP-450) in the liver

• Activating chrome bumper: cyclophosphamide is ACTIVATED by hepatic cytochrome P450 enzymes

• Liver spot: zaleplon and zolpidem are rapidly metabolized by the liver, P450 system

• CYP-450 chrome tank crushing warhead: warfarin is a substrate of cytochrome P-450 (drugs increase CYP activation increase warfarin metabolism)

• Chrome bumper hitting energy drinks: methylxanthines (e.g. theophylline) are metabolized by the cytochrome P-450 system