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Cytochrome P450 3A4
CYP3A4
> 50% of prescription drugs are 3A4 substrates—plenty of fish!
0% of individuals are 3A4 ultrarapid metabolizers. Less than 1% are poor metabolizers.
Conclusion: 3A4 is the workhorse of CYP metabolism, accounting for 30% of hepatic CYP activity and 70% of CYP activity in the gut. Since > 50% of drugs are 3A4 substrates, think twice before prescribing strong 3A4 inhibitors or inducers.
![CYP3A4 inhibitor visual mnemonic fish by Dr Jason Cafer MD](https://static.wixstatic.com/media/966baf_a3b36c12e56c495c93fd32522d5d46bc~mv2.jpg/v1/fill/w_866,h_486,al_c,q_85,usm_0.66_1.00_0.01,enc_auto/Slide84_JPG.jpg)
![CYP3A4 inducers visual mnemonic by Dr Jason Cafer MD](https://static.wixstatic.com/media/966baf_6f73f6caeecc4c76a77934836fef8322~mv2.jpg/v1/fill/w_158,h_89,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/Slide85_JPG.jpg)
3A4 inhibitors
![CYP3A4 inhbitors biaxin clarithromycin erythromycin nizoral ketoconazole sporanox itraconazole diflucan fluconazole by Dr Jason Cafer MD](https://static.wixstatic.com/media/966baf_381981d801ac4d21a30320838bf2230b~mv2.jpg/v1/fill/w_146,h_82,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/Slide86_JPG.jpg)
![CYP3A4 inhibitors from psychopharmacology book by Jason Cafer MD grapefruit juice, serzone nefazodone, darunavir ritonavir atazanavir cardizem diltiazem calan verapamil](https://static.wixstatic.com/media/966baf_046319a8260a47d1888a447ee74c3022~mv2.jpg/v1/fill/w_147,h_83,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/Slide87_JPG.jpg)
3A4 inducers
![Teaching Slides - Cafers Antidepressants 3A4 inducers - dilantin phenytoin luminal phenobarbital primidone tegretol carbamazepine provigil modafinial nuvigil armodafinil rifampin efavirenz nevirapine st john's wort](https://static.wixstatic.com/media/966baf_57fd196166da43e086663b7d534df2e3~mv2.jpg/v1/fill/w_147,h_83,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/Teaching%20Slides%20-%20Cafers%20Antidepressants.jpg)
3A4 substrates
![Benzodiazepines as CYP3A4 substrates - valium diazepam xanax alprazolam tranxene clorazepate prosom estazolam halcion triazolam librium chlordiazepoxide klonopin clonazepam versed midazolam by Dr Jason Cafer MD psychiatrist](https://static.wixstatic.com/media/966baf_14b836d1334d4507a4f954f35a132a6b~mv2.jpg/v1/fill/w_145,h_82,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/Teaching%20Slides%20-%20Cafers%20Antidepressants.jpg)
![CYP3A4 substrates - fish by Dr Jason Cafer MD - antipsychotics - latuda lurasidone caplyta lumateperone orap pimozide nuplazid pimavanserin vraylar cariprazine seroquel quetiapine abilify aripiprazole rexulti brexpiprazole visual mnemonics by Dr Jason Cafer MD](https://static.wixstatic.com/media/966baf_3e5c4789c989436e861fc32dde295964~mv2.jpg/v1/fill/w_146,h_82,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/Teaching%20Slides%20-%20Cafers%20Antidepressants.jpg)
![3A4 substrates fish by Dr Jason Cafer MD - buspar buspirone viibryd vilazodone suboxone buprenorphine ingrezza valbenazine dayvigo lemborexant belsomra suvorexant](https://static.wixstatic.com/media/966baf_c0c6af6c878d4679b126c1a3732b9fed~mv2.jpg/v1/fill/w_147,h_83,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/Teaching%20Slides%20-%20Cafers%20Antidepressants.jpg)
![CYP3A4 substrates fish by Dr Jason Cafer MD viagra sildenafil estrogens progestins cialis tadalafil vardenafil levitra stendra avanafil Addyi flibanserin](https://static.wixstatic.com/media/966baf_b54ef3746a0142b387be0902f0c16cb6~mv2.jpg/v1/fill/w_147,h_83,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/Teaching%20Slides%20-%20Cafers%20Antidepressants.jpg)
![Cafer's Psychopharmacology CYP3A4 substrates statins lipitor atorvastatin zocor simvastatin interactions](https://static.wixstatic.com/media/966baf_9b988a830f1c40ae86aad8135463630d~mv2.jpg/v1/crop/x_0,y_0,w_960,h_529/fill/w_147,h_81,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/Teaching%20Slides%20-%20Cafers%20Antidepressants.jpg)
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