Metabolism and CYP450 Drug Interactions for Psychiatric ... - PPAG
Metabolism and CYP450 Drug Interactions for Psychiatric ... - PPAG
Metabolism and CYP450 Drug Interactions for Psychiatric ... - PPAG
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<strong>Metabolism</strong> <strong>and</strong> <strong>CYP450</strong> <strong>Drug</strong> <strong>Interactions</strong> <strong>for</strong> <strong>Psychiatric</strong> Medications<br />
Bolded enzymes are major/strong, <strong>and</strong> others are minor unless otherwise noted: w = weak, m = moderate, s = strong<br />
Medications used in depression<br />
<strong>Drug</strong> How Metabolized Induces Inhibits<br />
Bupropion 2B6, 1A2, 2A6, 2C9, 2E1 None 2D6<br />
Citalopram 2C19, 2D6 (insignificant), 3A4 None 1A2, 2B6, 2C19, 2D6<br />
Duloxetine 1A2, 2D6 None 2D6<br />
Escitalopram 2C19, 2D6, 3A4 None 2D6<br />
Fluoxetine 2C9 (major), 2C19, 2D6, 3A4 (minor), 1A2, 2B6, 2E1 None 1A2 (m), 2B6 (w/s), 2C8/9, 2C19 (m), 2D6, 3A4<br />
Fluvoxamine 1A2, 2D6 None 1A2, 2B6 (w/s ), 2C8/9 (m), 2C19, 2D6 (m), 3A4 (w/m/s), 2C10<br />
Mirtazapine 1A2, 2D6, 3A4, 2C9 None 1A2, 3A4<br />
Nefazodone 2D6, 3A4 None 1A2, 2C9, 2D6, 3A4, 2B6<br />
Paroxetine 2D6 None 1A2, 2B6 (m/s), 2C8/9, 2C19, 2D6, 3A4 (insignificant)<br />
Sertraline<br />
2B6 (minor), 2C9 (minor), 2C19, 2D6 (major), 3A4<br />
(minor)<br />
None 2B6, 2C9, 2C19, 2D6, 3A4 (dosages >200mg) (ALL w/m/s)<br />
1A2, 2C8<br />
St Johns Wort 3A4 3A4 None<br />
Trazodone 2D6, 3A4 None 2D6 (m), 3A4<br />
TCA’s 2D6, others depending on specific drug None 2D6 (strength <strong>and</strong> other enzymes depending on drug)<br />
Venlafaxine 2C8/9, 2C19, 2D6, 3A4 (minor) None 2B6, 2D6, 3A4<br />
Desvenlafaxine 3A4 None 3A4<br />
Medications used in ADHD<br />
<strong>Drug</strong> How Metabolized Induces Inhibits<br />
Amphetamine(s) 2D6 None 2D6<br />
Atomoxetine 2C19, 2D6 None None<br />
Methylphenidate(s) 2D6 (minor) None None<br />
Modafinil 3A4 1A2, 2B6, 3A4 2C19 (w/s), 2D6, 1A2, 2A6, 2C9, 2E1, 3A4<br />
Medications used <strong>for</strong> EPS<br />
<strong>Drug</strong> How Metabolized Induces Inhibits<br />
Benztropine 2D6 None None<br />
Bromocriptine 3A4 None 3A4 (w), 1A2<br />
Diphenhydramine 2D6, 1A2, 2C9, 2C19 None 2D6 (m)<br />
Hydroxyzine None None 2D6<br />
Propranolol 1A2, 2C19 (minor), 2D6, 3A4 None 1A2, 2D6<br />
Trihexyphenidyl None None None<br />
Medications used in psychosis<br />
<strong>Drug</strong> How Metabolized Induces Inhibits<br />
Aripiprazole 2D6, 3A4 None None<br />
Clozapine 1A2, 2C19, 2D6, 3A4, 2A6, 2C9 None 2C9, 2D6 (m), 3A4, 1A2, 2C19, 2E1<br />
Haloperidol 1A2, 2D6, 3A4 None 2D6 (m), 3A4<br />
Olanzapine 1A2, 2D6 None 1A2, 2C8/9, 2C19, 2D6, 3A4<br />
Quetiapine 2D6, 3A4 None None<br />
Risperidone 2D6, 3A4 None 2D6<br />
Ziprasidone 1A2, 3A4 (primarily via aldehyde oxidase) None 2D6, 3A4 (insignificant)<br />
Asenapine 1A2, 3A4, 2D6 None 2D6<br />
Iloperidone 2D6, 3A4 None None<br />
Medications used in anxiety <strong>and</strong> insomnia<br />
<strong>Drug</strong> How Metabolized Induces Inhibits<br />
Alprazolam 3A4 None None<br />
Buspirone 2D6, 3A4 None None<br />
Clonazepam 3A4 None None<br />
Diazepam 2B6, 2C9, 2C19, 3A4, 1A2 None 2C19, 3A4<br />
Lorazepam Almost none None None<br />
Temazepam 2B6, 2C9, 2C19, 3A4 None None<br />
Zaleplon 3A4, (primarily via aldehyde oxidase) None None<br />
Zolpidem 1A2, 2C9, 2C19, 2D6, 3A4 None None<br />
Medications used in bipolar disorder<br />
<strong>Drug</strong> How Metabolized Induces Inhibits<br />
Carbamazepine 2C8, 3A4 1A2, 2B6, 2C8/9, 2C19, None<br />
3A4 (autoinducer) 2D6<br />
Lamotrigine Minimal CYP None None<br />
Lithium CYP not involved None None<br />
Oxcarbazepine 3A4 3A4 (strong at high doses) 2C19 (w/s) (dose related)<br />
Topiramate Minimal CYP 3A4 Mild 2C19<br />
Valproic Acid / Derivatives 2A6, 2C9, 2C19, 2B6, 2E1 2A6 2C8/9, 2C19, 2D6, 3A4<br />
Updated by Michael Speck, 2011 PharmD C<strong>and</strong>idate <strong>and</strong> Misty Gonzalez, PharmD, BCPP. Not to be shared or photocopied without prior permission‐ misgonz@siue.edu
References:<br />
1. Fuller MA, Sajatovic M. <strong>Drug</strong> In<strong>for</strong>mation H<strong>and</strong>book <strong>for</strong> Psychiatry, 5 th ed. Hudson, OH.: Lexi Comp, 2004.<br />
2. Flockhart DA. <strong>Drug</strong> <strong>Interactions</strong>: Cytochrome P450 <strong>Drug</strong> Interaction Table. Indiana University School of Medicine. http://medicine.iupui.edu/clinpharm/ddis/table.asp.<br />
3. Lexi-Comp Online [database on the Internet]. Hudson (OH): Lexi-Comp, Inc. c2010 [updated periodically; cited 2010 Nov 1]. Avaliable from:<br />
http://proxy.library.siue.edu:2139/crlsql/servlet/crlonline<br />
4. Clinical Pharmacology [database on the Internet]. Tampa Bay (FL): Gold St<strong>and</strong>ard, an Elsevier Company. c2010 [updated periodically; cited 2010 Nov 1]. Avalable from:<br />
http://proxy.library.siue.edu:2163/default.aspx<br />
5. <strong>Drug</strong> Facts <strong>and</strong> Comparisons [database on the Internet]. Indianapolis (IN): Wolter Kluwer, Facts <strong>and</strong> Comparisons. c2010 [updated periodically: cited 2010 Nov 1].<br />
Available from: http://proxy.library.siue.edu:2081/References.aspxbook=DFC<br />
6. Micromedex Healthcare Series [database on the Internet]. Greenwood Village (CO): Thomson Reuters (Healthcare) Inc. c2010 [updated periodically; cited 2010 Nov 1].<br />
Available from: http://proxy.library.siue.edu:2079/hcs/librarian/<br />
7. Indiana University: Department of medicine, School of Medicine. Cytochrome P450 <strong>Drug</strong> In<strong>for</strong>mation Table. c2003 [cited 2010 Nov 1]. Available from: www.druginteractions.com<br />
Not to be shared or photocopied without prior permission‐ misgonz@siue.edu
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