Cytochrome P450 enzymes induction/inhibition

Lin, J.H. and Lu, A.Y. (2001) Interindividual variability in inhibition and induction of cytochrome P450 enzymes. Annual Review of Pharmacology and Toxicology, 41, 535—567. 

Robertson P, DeCory HH, Madan A, Parkinson A (2000) in vitro inhibition and induction of human hepatic cytochrome P450 enzymes by modafinil. Drug Metab Dispos 28 664— 671... 

In Vivo Probes for Studying Induction and Inhibition of Cytochrome P450 Enzymes in Humans... 

Pelkonen O, Turpeinen M, Hakkola J et al (2008) Inhibition and induction of human cytochrome P450 enzymes—current status. Arch Toxicol 82 667-715... 

In a few cases, marked extrapyramidal side-effects (akathisia, dystonia, and parkinsonism) have been reported with flupbenazine, perphenazine, sulpiride, and thiothixene when fluoxetine is added to the regimen. The mechanism is speculated to be the result of fluoxetine-induced further suppression of dopaminergic activity in the nigrostriatal pathways (serotonergic stimulation leads to decreased dopamine release), in addition to increases in their plasma concentration. Fluoxetine has been shown to increase haloperidol serum levels by about 20%, presumably via inhibition of cytochrome P450 enzymes. Fluoxetine can increase the risk of seizure induction when added to clozapine due to an increase in clozapine serum levels, or by additive effects. Concomitant treatment with fluoxetine and risperidone is associated with a mean 4-fold increase in the plasma concentration of risperidone. ... 

Rifampin is a prototype inducer of the cytochrome P450 enzyme CYP3A4. This induction of microsomal enzymes by rifampin is thought to increase the production of toxic metabolites, contributing to the potential of valproate to cause hepatotoxicity, although this clinical outcome is rare. Valproate inhibits glucuronidation of zidovudine and increased events from zidovudine are possible. 

By using in vitro preparations of human enzymes it is possible to predict those antibiotics that will adversely affect the metabolism of other drugs [110]. Such studies have shown that rifaximin, at concentrations ranging from 2 to 200 ng/ml, did not inhibit human hepatic cytochrome P450 isoenzymes 1A2, 2A6, 2B6, 2C9, 2C19, 2D6, 2E1 and 3A4 [34], In an in vitro hepatocyte induction model, rifaximin was shown to induce cytochrome P450 3A4 (CYP3A4) [34], an isoenzyme which rifampicin is known to induce [109],... 

Metabolism - Lopinavir is extensively metabolized by the hepatic cytochrome P450 system, almost exclusively by the CYP3A isozyme. Ritonavir is a potent CYP3A inhibitor that inhibits the metabolism of lopinavir and, therefore, increases plasma levels of lopinavir. Ritonavir has been shown to induce metabolic enzymes, resulting in the induction of its own metabolism. 

Carbamazepine induces hepatic cytochrome P450 (CYP) enzymes, which may reduce levels of other medications. Through the mechanism of hepatic enzyme induction, carbamazepine therapy can lead to oral contraceptive failure therefore, women should be advised to consider alternative forms of birth control while taking carbamazepine. Similarly, use of medications or substances that inhibit CYP 3A3/4 (discussed in Chapter 1) may result in significant increases in plasma carbamazepine levels. 

To better understand the health effects of plant phenolic compounds and to better utilize them, it is necessary to know the molecular mechanisms by which plant phenolic compounds induce cytoprotective enzymes. In vitro studies indicated that plant phenolic compounds such as curcumin often inhibited the enzymatic activities of GST, UGT, SULT as well as cytochrome P450s [Oetari et al., 1996], suggesting that the induction of cytoprotective enzyme activities could not be explained by direct interaction with plant phenolic compounds. On the other hand, much evidence indicates that the increased activity of cytoprotective enzymes are mainly attributable to enhanced transcriptional activation and enzyme synthesis [Holtzclaw et al., 2004]. 

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