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Drug interaction
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==== Examples of metabolism-based interactions ==== An example of this is shown in the following table for the [[CYP1A2]] enzyme, showing the substrates (drugs metabolized by this enzyme) and some inductors and inhibitors of its activity:<ref name="Nelson" /> {| class="wikitable" style="margin:1em auto;" width="100%" |- | colspan="3" style="text-align:center;" | '''Drugs related to CYP1A2''' |- ! Substrates !! Inhibitors !! Inductors |- style="vertical-align: top;" | * [[Caffeine]] * [[Theophylline]] * [[Phenacetin]] * [[Clomipramine]] * [[Clozapine]] * [[Thioridazine]] || * [[Omeprazole]] * [[Nicotine]] * [[Cimetidine]] * [[Ciprofloxacin]] || * [[Phenobarbital]] * [[Fluvoxamine]] * [[Venlafaxine]] * [[Ticlopidine]] |} Some foods also act as inductors or inhibitors of enzymatic activity. The following table shows the most common: {| class="wikitable" style="margin:1em auto;" width=100% |- |colspan="3" style="text-align:center;"| Foods and their influence on drug metabolism<ref>{{cite journal | vauthors = Bailey DG, Malcolm J, Arnold O, Spence JD | title = Grapefruit juice-drug interactions | journal = British Journal of Clinical Pharmacology | volume = 46 | issue = 2 | pages = 101–10 | date = August 1998 | pmid = 9723817 | pmc = 1873672 | doi = 10.1046/j.1365-2125.1998.00764.x }}<br/>Comment in: {{cite journal | vauthors = Mouly S, Paine MF | title = Effect of grapefruit juice on the disposition of omeprazole | journal = British Journal of Clinical Pharmacology | volume = 52 | issue = 2 | pages = 216–7 | date = August 2001 | pmid = 11488783 | pmc = 2014525 | doi = 10.1111/j.1365-2125.1978.00999.pp.x }}{{Dead link|date=January 2019 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref name="Marduga" /><ref>{{cite journal |author=Covarrubias-Gómez, A. |title=¿Qué se auto-administra su paciente?: Interacciones farmacológicas de la medicina herbal |journal=Revista Mexicana de Anestesiología |volume=28 |issue=1 |pages=32–42 |date=January–March 2005 |url=http://www.medigraphic.com/espanol/e-htms/e-rma/e-cma2005/e-cma05-1/em-cma051f.htm |archive-url=https://archive.today/20120629232743/http://www.medigraphic.com/espanol/e-htms/e-rma/e-cma2005/e-cma05-1/em-cma051f.htm |url-status=dead |archive-date=2012-06-29 |display-authors=etal }}</ref> |- ! Food !! Mechanism !! Drugs affected |- | * [[Avocado]] * [[Brassicaceae|Brassica]]s (Brussels sprouts, broccoli, cabbage) |Enzymatic inductor |[[Acenocoumarol]], [[warfarin]] |- |[[Grapefruit]] juice |Enzymatic inhibition | * [[Calcium channel blocker]]s: [[nifedipine]], [[felodipine]], [[nimodipine]], [[amlodipine]] * [[Cyclosporine]], [[tacrolimus]] * [[Terfenadine]], [[astemizole]] * [[Cisapride]], [[pimozide]] * [[Carbamazepine]], [[saquinavir]], [[midazolam]], [[alprazolam]], [[triazolam]] {{main|Grapefruit drug interactions}} |- |[[Soybean|Soya]] |Enzymatic inhibition |[[Clozapine]], [[haloperidol]], [[olanzapine]], [[caffeine]], [[Non-steroidal anti-inflammatory drug|NSAIDs]], [[phenytoin]], [[zafirlukast]], [[warfarin]] |- |[[Garlic]] |Increases antiplatelet activity | * [[Anticoagulant]]s * [[Non-steroidal anti-inflammatory drug|NSAIDs]], [[acetylsalicylic acid]] |- |[[Ginseng]] |To be determined |[[Warfarin]], [[heparin]], [[aspirin]] and [[Non-steroidal anti-inflammatory drug|NSAIDs]] |- |''[[Ginkgo biloba]]'' |Strong inhibitor of platelet aggregation factor |[[Warfarin]], [[aspirin]] and [[Non-steroidal anti-inflammatory drug|NSAIDs]] |- |''[[Hypericum perforatum]]'' (St John's wort) |Enzymatic inductor (CYP450) |Warfarin, [[digoxin]], [[theophylline]], cyclosporine, [[phenytoin]] and antiretrovirals |- |[[Ephedra (medicine)|Ephedra]] |Receptor level agonist |[[MAOI]], central nervous system stimulants, alkaloids [[ergotamine]]s and [[xanthine]]s |- |Kava (''Piper methysticum'') |Unknown |[[Levodopa]] |- |[[Ginger]] |Inhibits thromboxane synthetase (''in vitro'') |Anticoagulants |- |Chamomile |Unknown |[[Benzodiazepine]]s, [[barbiturate]]s and [[opioid]]s |- |[[Crataegus|Hawthorn]] |Unknown |Beta-adrenergic antagonists, [[cisapride]], digoxin, [[quinidine]] |}
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