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Cytochrome P450 3A4 (CYP3A4) inhibitors and inducers
Strong inhibitors
Atazanavir
Boceprevir
Clarithromycin
Cobicistat and cobicistat containing coformulations
Darunavir
Idelalisib
Indinavir
Itraconazole
Ketoconazole
Lopinavir
Mifepristone
Nefazodone
Nelfinavir
Ombitasvir-paritaprevir-ritonavir
Ombitasvir-paritaprevir-ritonavir plus dasabuvir
Posaconazole
Ritonavir and ritonavir containing coformulations
Saquinavir
Telaprevir
Telithromycin
Voriconazole
Moderate inhibitors
Amiodarone*
Aprepitant
Cimetidine*
Conivaptan
Crizotinib
Cyclosporine*
Diltiazem
Dronedarone
Erythromycin
Fluconazole
Fosamprenavir
Fosaprepitant*
Grapefruit juice
Imatinib
Isavuconazole (isavuconazonium sulfate)
Letermovir
Netupitant
Nilotinib
Ribociclib
Schisandra
Verapamil
Strong inducers
Apalutamide
Carbamazepine
Enzalutamide
Fosphenytoin
Lumacaftor
Mitotane
Phenobarbital
Phenytoin
Primidone
Rifampin (rifampicin)
Moderate inducers
Bexarotene
Bosentan
Dabrafenib
Dexamethasone
Efavirenz
Eslicarbazepine
Etravirine
Modafinil
Nafcillin
Rifabutin​¶
Rifapentine
St. John's wort
 
  • The inhibitors and inducers of CYP3A4 metabolism listed above can alter serum concentrations of other drugs that are dependent upon CYP3A family of liver enzymes for elimination or activation.
  • These classifications are based upon US Food & Drug Administration (US FDA) guidance.[1,2] Other sources may use a different classification system resulting in some agents being classified differently. 
  • Data are for systemic drug forms. Degree of inhibition or induction may be altered by dose, method, and timing of administration.
  • Weak inhibitors and inducers are not listed in this table with exception of a few examples. Clinically significant interactions can occasionally occur due to weak inhibitors and inducers (eg, target drug is highly dependent on CYP3A4 metabolism and has a narrow therapeutic index). Accordingly, specific interactions should be checked using a drug interaction program such as Lexicomp interactions included within UpToDate.
  • Refer to UpToDate topics on specific agents and indications for further details.
* Classified as a weak inhibitor of CYP3A4 according to US FDA system.[1]
¶ Classified as a weak inducer of CYP3A4 according to US FDA system.[1]
Data from: Lexicomp Online (Lexi-Interact). Copyright © 1978-2018 Lexicomp, Inc. All Rights Reserved.

References:

  1. ​US Food & Drug Administration. Clinical drug interaction studies - Study design, data analysis and clinical implications; Guidance for industry (October 24, 2017) available at: https://www.fda.gov/downloads/drugs/guidances/ucm292362.pdf 
  2. US Food & Drug Administration. Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: FDA.gov website.
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