CYP3A4 interactions

Because domperidone is metabolized mainly by CYP3A4, interactions of azole antifungals with domperidone can occur. In human liver microsomes domperidone underwent hydroxylation to 5-hydroxydomperidone and N-dealkylation to 2,3-dihydro-2-oxo-lH-benzimidazole-... 

Drugs that participate in major CYP3A4 interactions with macrohdes are listed in Table 4. Other drugs that may be affected include alprazolam (138), the water-soluble artemisinin analogue artehnic acid (139), gallopamil (140), lovastatin (141), nefazodone (142), and risperidone... 

Lewis DFV, Eddershaw PJ, Goldfarb PS, Tarbit MH. Molecular modelling of CYP3A4 from an alignment with CYP102 identification of key interactions between putative active site residues and CYP3A- specific chemicals. Xenobiotica 1996 10 1067-86. 

Only a small number of drug interactions have been reported with donepezil. In vitro studies show a low rate of binding of donepezil to cytochrome P-450 (CYP)3A4 or 2D6. Whether or not donepezil has the potential for enzyme induction is not known. No interactions with theophylline, cimeti-dine, warfarin, digoxin, or ketoconazole have been documented. In vitro studies show that inhibitors of CYP3A4 and 2D6 have the potential to inhibit the metabolism of donepezil. The clinical relevance of this is unknown. However, monitoring for possible increased peripheral side effects is advised... 

There are currently no reported drug interactions with buprenorphine however, buprenorphine is metabolized primarily by CYP3A4... 

St. John s wort This herbal remedy may induce CYP3A4 the certainty of an interaction probably rests on the specific preparation being used, but caution would dictate that this herbal product should be avoided in those receiving methadone treatment withdrawal symptoms have been noted in patients taking methadone maintenance who have added St. John s wort to their drug regimen. 

TABLE 52-6. Potential Drug-Drug Interactions with the Calcineurin Inhibitors and Sirolimus Mediated Through the CYP3A4 Isozyme11... 

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