Strong enzymatic inductors

Abemaciclib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of strong CYP3A4 inducers should be avoided due to the risk of decreased efficacy of abemaciclib.

Abiraterone [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Strong inducers of CYP3A4 (decreased mean plasma AUCinf of abiraterone) during treatment are to be avoided, unless there is no therapeutic alternative.

Acalabrutinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use with strong CYP3A4 inducers should be avoided due to risk for lack of efficacy.

Acenocoumarol [1], strong CYP2C19 inductors ---> SmPC of [1] of eMC

Inducers of CYP2C19 may diminish the anticoagulant effect of acenocoumarol.

Acenocoumarol [1], strong CYP2C9 inductors ---> SmPC of [1] of eMC

Inducers of CYP2C9 may diminish the anticoagulant effect of acenocoumarol.

Acenocoumarol [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Inducers of CYP3A4 may diminish the anticoagulant effect of acenocoumarol.

Afatinib [1], strong P-gp inductors ---> SmPC of [1] of EMA

Strong P-gp inducers may decrease exposure to afatinib

Agomelatine, strong CYP1A2 inductors

The strong CYP1A2 induction may decrease plasma concentrations of agomelatine.

Alectinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Appropriate monitoring is recommended for patients taking concomitant strong CYP3A inducers (including, but not limited to, carbamazepine, phenobarbital, phenytoin, rifabutin, rifampicin and St. John's Wort (Hypericum perforatum)).

Aliskiren/amlodipine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.

Aliskiren/amlodipine, strong P-gp inductors ---> SmPC of [aliskiren] of EMA

Inducers of P-gp might decrease the bioavailability of aliskiren. Caution required with concomitant use

Aliskiren/amlodipine/hydrochlorothiazide [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of CYP3A4 inducers (e.g. rifampicin, Hypericum perforatum) may give a lower plasma concentration of amlodipine.

Aliskiren/amlodipine/hydrochlorothiazide, strong P-gp inductors ---> SmPC of [aliskiren] of EMA

Inducers of P-gp might decrease the bioavailability of aliskiren. Caution required with concomitant use

Aliskiren/hydrochlorothiazide [1], strong P-gp inductors ---> SmPC of [1] of EMA

Inducers of P-gp might decrease the bioavailability of aliskiren. Caution required with concomitant use

Alitretinoin, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of alitretinoin

Alprazolam [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Since alprazolam is metabolized by CYP3A4, inducers of this enzyme may enhance the metabolism of alprazolam.

Amiodarone, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of amiodarone

Amlodipine, strong CYP3A4 inductors ---> SmPC of [amlodipine/valsartan] of EMA

The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.

Amlodipine/valsartan [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.

Amlodipine/valsartan/hydrochlorothiazide [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.

Amprenavir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The strong CYP3A4 induction may decrease the plasma levels of amprenavir

Apalutamide [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

No dose adjustment is necessary when Erleada is co-administered with inducers of CYP3A4 or CYP2C8.

Apalutamide [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

No dose adjustment is necessary when Erleada is co-administered with inducers of CYP3A4 or CYP2C8.

Apixaban [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of apixaban with strong CYP3A4 and P-gp inducers may lead to reduced apixaban plasma concentrations. No dose adjustment for apixaban (almost always) is required during concomitant therapy with such agents

Apixaban [1], strong P-gp inductors ---> SmPC of [1] of EMA

The concomitant use of apixaban with strong P-gp inducers may lead to a reduction in apixaban exposure.

Apremilast [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of strong CYP3A4 enzyme inducer rifampicin resulted in a reduction of systemic exposure of apremilast. Therefore, the use of strong CYP3A4 enzyme inducers with apremilast is not recommended.

Aprepitant [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant administration of aprepitant with active substances that strongly induce CYP3A4 activity should be avoided as the combination results in reductions of the plasma concentrations of aprepitant that may result in decreased efficacy of aprepitant

Aripiprazole [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant administration of aripiprazole and inducers of CYP3A4 may be expected to reduce the geometric means of Cmax and AUC for aripiprazole. The concomitant use of CYP3A4 inducers with aripiprazole should be avoided

Artesunate [1], strong glucuronidation inductors ---> SmPC of [1] of EMA

Co-administration of Artesunate Amivas with UGT inducers (e.g. nevirapine, ritonavir, rifampicin, carbamazepine, phenytoin) may decrease DHA exposures, leading to a reduction in, or loss of, efficacy. Co-administration should be avoided.

Atazanavir/cobicistat [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Coadministration (contraindicated) of EVOTAZ with strong inducers of CYP3A may result in decreased plasma concentrations of atazanavir and/or cobicistat, leading to loss of therapeutic effect and possible development of resistance to atazanavir.

Atenolol/nifedipine, strong CYP3A4 inductors

The CYP3A4 induction decreases the bioavailability and efficacy of nifedipine

Atorvastatin [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Concomitant administration of atorvastatin with inducers of cytochrome P450 3A can lead to variable reductions in plasma concentrations of atorvastatin.

Avacopan [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The use of strong CYP3A4 enzyme inducers with avacopan is to be avoided. Patients anticipated to require long-term administration of these medicinal products are not to be treated with avacopan.

Avanafil [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The potential effect of CYP inducers, especially inducers of CYP3A4 on the pharmacokinetics and efficacy of avanafil has not been evaluated. The concomitant use of avanafil and a CYP inducer is not recommended as it may decrease the efficacy of avanafil.

Avapritinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration with strong or moderate CYP3A inducers should be avoided because it may decrease the plasma concentrations of avapritinib

Avatrombopag [1], strong CYP2C9 inductors ---> SmPC of [1] of EMA

Concomitant use of strong CYP3A4/5 or CYP2C9 inducers reduces avatrombopag exposure, and may result in a decreased effect on platelet counts; however, no dose adjustment is recommended

Avatrombopag [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of strong CYP3A4/5 or CYP2C9 inducers reduces avatrombopag exposure, and may result in a decreased effect on platelet counts; however, no dose adjustment is recommended

Axitinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of axitinib with strong CYP3A4/5 inducers may decrease axitinib plasma concentrations. Selection of concomitant medicinal products with no or minimal CYP3A4/5 induction potential is recommended.

Barnidipine, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease plasma levels of barnidipine.

Bazedoxifene [1], strong glucuronidation inductors ---> SmPC of [1] of EMA

The metabolism of bazedoxifene may be increased by concomitant use of substances known to induce UGTs potentially leading to decreased systemic concentrations of bazedoxifene.

Bedaquiline [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Bedaquiline exposure may be reduced during co-administration with inducers of CYP3A4. Co-administration of bedaquiline and moderate or strong CYP3A4 inducers used systemically should be avoided.

Bexarotene [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

On the basis of the oxidative metabolism of bexarotene by cytochrome P450 3A4 (CYP3A4). Co-administration with CYP3A4 inducers may theoretically cause a reduction in plasma bexarotene concentrations.

Bictegravir/emtricitabine/tenofovir alafenamide [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of bictegravir and medicinal products that potently induce both CYP3A and UGT1A1 is contraindicated

Bictegravir/emtricitabine/tenofovir alafenamide [1], strong P-gp inductors ---> SmPC of [1] of EMA

Medicinal products that induce P-gp are expected to decrease the absorption of tenofovir alafenamide, resulting in decreased plasma level of tenofovir alafenamide, which may lead to loss of therapeutic effect of Biktarvy and development of resistance.

Bictegravir/emtricitabine/tenofovir alafenamide [1], strong UGT1A1 inductors ---> SmPC of [1] of EMA

Co-administration of bictegravir and medicinal products that potently induce both CYP3A and UGT1A1 is contraindicated

Bisoprolol, strong CYP3A4 inductors

The CYP3A4-induction may decrease plasma levels of bisoprolol

Boceprevir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of boceprevir with potent CYP3A4 inducers is not recommended

Bortezomib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of bortezomib with strong CYP3A4 inducers is not recommended, as efficacy may be reduced.

Bosentan [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant administration of bosentan and CYP3A4 inductors is expected to lead to reduced systemic exposure to bosentan. A clinically significant reduction of efficacy cannot be excluded.

Bosutinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of bosutinib with strong CYP3A inductors should be avoided, as a decrease in bosutinib plasma levels will occur.

Brexpiprazole [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

If brexpiprazole is used concomitantly with strong CYP3A4 inducers (e.g. rifampicin), the total daily dose requirement of brexpiprazole is increased by approximately a factor of three times the recommended daily dose

Brigatinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of Alunbrig with strong and moderate CYP3A inducers should be avoided

Brotizolam, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of brotizolam

Budesonide [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Concomitant treatment of budesonide with CYP3A4 inducers may reduce budesonide exposure, which may require a dose increase.

Buprenorphine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

CYP3A4 inducers may induce the metabolism of buprenorphine resulting in decreased buprenorphine levels.

Buprenorphine/naloxone [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of CYP3A4 inducers with buprenorphine may decrease buprenorphine plasma concentrations, potentially resulting in sub-optimal treatment of opioid dependence with buprenorphine.

Buspirone [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

When used buspirone in combination with a potent inducer of CYP3A4, an adjustment of the dosage of buspirone may be necessary to maintain buspirone's anxiolytic effect.

Cabazitaxel [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur

Cabozantinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of cabozantinib with strong CYP3A4 inductors (decreased plasma cabozantinib exposure (AUC) should be approached with caution.

Caffeine [1], strong CYP1A2 inductors ---> SmPC of [1] of EMA

Cytochrome P450 1A2 (CYP1A2) is the major enzyme involved in the metabolism of caffeine in humans. Therefore, caffeine has the potential to interact with active substances that induce CYP1A2

Calcium antagonists, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of the calcium antagonist

Cannabidiol [1], strong CYP2C19 inductors ---> SmPC of [1] of EMA

Strong inducers of CYP2C19 administered concomitantly with cannabidiol may decrease the plasma concentrations of cannabidiol and decrease the effectiveness of cannabidiol. Dose adjustment may be necessary.

Cannabidiol [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Strong inducers of CYP3A4 administered concomitantly with cannabidiol may decrease the plasma concentrations of cannabidiol and decrease the effectiveness of cannabidiol. Dose adjustment may be necessary.

Carbamazepine [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Co-administration of carbamazepine with CYP 3A4 inducers might increase the rate of carbamazepine metabolism, thus leading to potential decreases in the carbamazepine serum level and therapeutic effect.

Cariprazine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of cariprazine with strong and moderate inducers of CYP3A4 may result in a significant decrease in total cariprazine exposure, therefore the co-administration of cariprazine and strong or moderate CYP3A4 inducers is contraindicated

Carvedilol, strong CYP2C9 inductors

Strong CYP2C9 inductors may decrease plasma concentrations of carvedilol

Carvedilol, strong CYP2D6 inductors

Strong CYP2D6 inductors may decrease plasma concentrations of carvedilol

Carvedilol, strong P-gp inductors

Induction of P-glycoprotein may lead to decreased bioavailability of oral carvedilol

Ceritinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of ceritinib with strong CYP3A inducers decreases ceritinib plasma concentrations. Concomitant use of strong CYP3A inducers should be avoided.

Ceritinib [1], strong P-gp inductors ---> SmPC of [1] of EMA

Co-administration of ceritinib with strong P-gp inducers decreases ceritinib plasma concentrations. Caution should be exercised with concomitant use of P-gp inducers.

Cilostazol [1], strong CYP2C19 inductors ---> SmPC of [1] of EMA

The effect of CYP3A4 and CYP2C19 inducers on cilostazol pharmacokinetics has not been evaluated. The antiplatelet effect may theoretically be altered

Cilostazol [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The effect of CYP3A4 and CYP2C19 inducers on cilostazol pharmacokinetics has not been evaluated. The antiplatelet effect may theoretically be altered

Cinacalcet [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Cinacalcet is metabolised in part by the enzyme CYP3A4. Co-administration of a strong inductor of CYP3A4 may decrease cinacalcet levels. Dose adjustment of cinacalcet may be required

Clarithromycin [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Drugs that are inducers of CYP3A may induce the metabolism of clarithromycin. This may result in sub-therapeutic levels of clarithromycin leading to reduced efficacy.

Clonazepam, strong CYP3A4 inductors

The strong CYP3A4 induction enhances the metabolism of clonazepam

Clopidogrel, strong CYP2C19 inductors

The strong CYP2C19 induction may increase plasma concentrations of the active metabolite and the effect of clopidogrel. The co-administration should be discouraged

Clopidogrel, strong CYP3A4 inductors

The strong CYP3A4 induction may increase plasma concentrations of the active metabolite and the effect of clopidogrel. The co-administration should be discouraged

Cloprednol, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of cloprednol

Clozapine [1], strong CYP1A2 inductors ---> SmPC of [1] of eMC

Concomitant administration of clozapine with substances known to induce cytochrome P450 enzymes (CYP1A2) may decrease the plasma levels of clozapine, leading to reduced efficacy.

Cobicistat [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of cobicistat with medicinal products that are strong inducers of CYP3A may result in decreased plasma concentrations of cobicistat. Coadministration is contraindicated

Cobimetinib [1], strong CYP1A2 inductors ---> SmPC of [1] of EMA

In vitro, cobimetinib is a potential inducer of CYP1A2 and may therefore reduce the exposure of substrates of this enzyme e.g., theophylline.

Cobimetinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of moderate and strong CYP3A inducers should be avoided. Given that cobimetinib concentrations are likely to be significantly reduced when co-administered with moderate to strong CYP3A inducers, patient's efficacy may be compromised.

Conjugated oestrogens/bazedoxifene [1], strong glucuronidation inductors ---> SmPC of [1] of EMA

The metabolism of bazedoxifene may be increased by concomitant use of substances known to induce UGTs, potentially leading to decreased systemic concentrations of bazedoxifene.

Contraceptives, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the concentrations of the steroid and even contraceptive failure

Crizotinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Coadministration of crizotinib with strong CYP3A inducers may decrease crizotinib plasma concentrations. The concurrent use of strong and moderate CYP3A inducers should be avoided

Cyclophosphamide, strong CYP3A4 inductors

The strong CYP3A4 induction may increase the toxicity of cyclophosphamide (prodrug)

Cyclosporine [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.

Cyclosporine [1], strong P-gp inductors ---> SmPC of [1] of eMC

All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.

Cyproterone [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Inducers of CYP3A4 may reduce the levels of cyproterone acetate.

Dabigatran etexilate [1], strong P-gp inductors ---> SmPC of [1] of EMA

Dabigatran etexilate is a substrate for the efflux transporter P-gp. Concomitant administration of a P-gp inducer is expected to result in decreased dabigatran concentrations and should be avoided

Dabigatran [1], strong P-gp inductors ---> SmPC of [1] of EMA

Dabigatran etexilate is a substrate for the efflux transporter P-gp. Concomitant administration of a P-gp inducer is expected to result in decreased dabigatran concentrations and should be avoided

Dabrafenib [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

Dabrafenib is a substrate for the metabolising enzymes CYP2C8. Medicines that are strong inductors of CYP2C8 are therefore likely to decrease dabrafenib concentrations. Avoid coadministration of dabrafenib with potent inducers of CYP2C8.

Dabrafenib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Dabrafenib is a substrate for the metabolising enzymes CYP3A4. Medicines that are strong inductors of CYP3A4 are therefore likely to decrease dabrafenib concentrations. Avoid coadministration of dabrafenib with potent inducers of CYP3A4.

Daclatasvir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Daclatasvir is contraindicated in combination with medicinal products that strongly induce CYP3A4, and thus may lead to lower exposure and loss of efficacy of daclatasvir.

Daclatasvir [1], strong P-gp inductors ---> SmPC of [1] of EMA

Daclatasvir is contraindicated in combination with medicinal products that strongly induce P-gp, and thus may lead to lower exposure and loss of efficacy of daclatasvir.

Daridorexant [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Based on these results, concomitant use with a moderate or strong CYP3A4 inducer substantially decreases exposure to daridorexant, which may reduce efficacy.

Darifenacin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Substances that are inducers of CYP3A4 are likely to decrease the plasma concentrations of darifenacin.

Darolutamide [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Use of strong and moderate CYP3A4 inducers and P-gp inducers (e.g. carbamazepine, phenobarbital, St. John's Wort, phenytoin, and rifampicin) during treatment with darolutamide is not recommended, unless there is no therapeutic alternative.

Darolutamide [1], strong P-gp inductors ---> SmPC of [1] of EMA

Darunavir/cobicistat, strong CYP3A4 inductors ---> SmPC of [darunavir] of EMA

Darunavir and cobicistat are metabolised by CYP3A, and co-administration with CYP3A inducers may result in subtherapeutic plasma exposure to darunavir. Co-administration of darunavir/cobicistat with strong inducers of CYP3A is contraindicated

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Medicinal products that induce CYP3A activity would be expected to increase the clearance of darunavir and cobicistat, resulting in lowered plasma concentrations of darunavir and cobicistat

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide [1], strong P-gp inductors ---> SmPC of [1] of EMA

Medicines that induce P-gp activity are expected to decrease tenofovir alafenamide absorption, resulting in decreased plasma level of tenofovir alafenamide, which may lead to loss of therapeutic effect and development of resistance.

Darunavir/ritonavir, strong CYP3A4 inductors ---> SmPC of [darunavir] of EMA

Darunavir and ritonavir are metabolised by CYP3A. Medicinal products that induce CYP3A activity would be expected to increase the clearance of darunavir and ritonavir, leading to loss of therapeutic effect and possible development of resistance

Dasabuvir with ombitasvir/paritaprevir/ritonavir, strong CYP3A4 inductors ---> SmPC of [ombitasvir/paritaprevir/ri

Co-administration of Viekirax and dasabuvir with medicinal products that are moderate or strong enzyme inducers is expected to decrease ombitasvir, paritaprevir, ritonavir and dasabuvir plasma concentrations and reduce their therapeutic effect.

Dasatinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The administration of dasatinib with a strong CYP3A4 inductor may increase metabolism and decrease dasatinib plasma concentrations. Therefore, concomitant use of potent CYP3A4 inducers with dasatinib is not recommended.

Deferasirox [1], strong glucuronidation inductors ---> SmPC of [1] of EMA

The concomitant use of deferasirox with potent UGT inducers may result in a decrease in deferasirox efficacy.

Deflazacort, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of glucocorticoid

Delamanid [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Taking medicinal products that are strong inducers of CYP3A4 (e.g. carbamazepine) with delamanid is contraindicated

Dexibuprofen, strong CYP2C8 inductors

The strong CYP2C8 induction may decrease the dexibuprofen effect

Dexibuprofen, strong CYP2C8 inductors

The CYP2C8 induction may decrease the dexibuprofen effect

Dextromethorphan/quinidine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Potent CYP3A4 inducers may accelerate the metabolism of quinidine, resulting in lower plasma concentrations and hence decreased inhibition of CYP2D6. This may lead to decreased efficacy of dextromethorphan/quinidine.

Diazepam, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma levels of diazepam. The co-administration is not recommended

Dienogest, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma levels of dienogest

Digitoxin, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of digitoxin

Diltiazem [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Co-administration of diltiazem with a CYP3A4 inducer may result in a decrease of diltiazem plasma concentrations.

Disopyramide [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Inducers of CYP3A may reduce disopyramide and increase MN-disopyramide serum levels. Since the magnitude of such potential effects is not foreseeable, such drug combinations are not recommended.

Docetaxel [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

In vitro studies have shown that the metabolism of docetaxel may be modified by the concomitant administration of compounds which induce cytochrome P450-3A. Caution should be exercised since there is a potential for a significant interaction.

Dolutegravir [1], strong UGT1A1 inductors ---> SmPC of [1] of EMA

Dolutegravir is eliminated mainly through metabolism by UGT1A1. Medicinal products that induce this enzyme may decrease dolutegravir plasma concentration and reduce the therapeutic effect of dolutegravir

Dolutegravir/abacavir/lamivudine [1], strong P-gp inductors ---> SmPC of [1] of EMA

Co-administration of dolutegravir/abacavir/lamivudine and other drugs that induce P-gp may decrease dolutegravir plasma concentration and reduce the therapeutic effect of dolutegravir

Dolutegravir/abacavir/lamivudine [1], strong UGT1A1 inductors ---> SmPC of [1] of EMA

Co-administration of dolutegravir/abacavir/lamivudine and other drugs that induce UGT1A1 may decrease dolutegravir plasma concentration and reduce the therapeutic effect of dolutegravir

Dolutegravir/rilpivirine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of Juluca with medicinal products that induce CYP3A may result in decreased plasma concentrations of rilpivirine, which could reduce the therapeutic effect of Juluca

Dolutegravir/rilpivirine [1], strong UGT1A1 inductors ---> SmPC of [1] of EMA

Doravirine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration with medicinal products that are strong cytochrome P450 (CYP)3A enzyme inducers is contraindicated as significant decreases in doravirine plasma concentrations are expected to occur, which may decrease the effectiveness of Pifeltro

Doravirine/lamivudine/tenofovir disoproxil [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Doravirine/lamivudine/tenofovir disoproxil should not be co-administered with medicines that are strong CYP3A enzyme inducers as significant decreases in doravirine plasma levels are expected to occur, which may decrease the effectiveness

Doxorubicine, strong P-gp inductors

The strong induction of P-glycoprotein may decrease the plasma levels of doxorubicin

Dronedarone [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Rifampicin decreased dronedarone exposure. Therefore, co-administration of rifampicin and other potent CYP3A4 inducers is not recommended as they decrease dronedarone exposure.

Duvelisib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of duvelisib with strong CYP3A4 inducers (e.g., apalutamide, carbamazepine, enzalutamide, mitotane, phenytoin, rifampin, St. John's wort) should be avoided.

Edoxaban [1], strong P-gp inductors ---> SmPC of [1] of EMA

The concomitant use of edoxaban with P-gp inducers may lead to reduced edoxaban plasma concentrations. Edoxaban should be used with caution when co-administered with P-gp inducers.

Efavirenz [1], strong CYP2B6 inductors ---> SmPC of [1] of EMA

Compounds which induce CYP3A4 or CYP2B6 activity may give rise to decreased plasma concentrations of efavirenz.

Efavirenz [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Compounds which induce CYP3A4 or CYP2B6 activity may give rise to decreased plasma concentrations of efavirenz.

Elbasvir/grazoprevir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Elbasvir and grazoprevir are substrates of CYP3A and P-gp. Co-administration of inducers of CYP3A or P-gp with ZEPATIER is contraindicated because it may decrease elbasvir and grazoprevir plasma concentrations

Elbasvir/grazoprevir [1], strong P-gp inductors ---> SmPC of [1] of EMA

Eliglustat [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant administration of a strong CYP3A4 inducer resulted in a decrease in eliglustat exposure. Use of a strong CYP3A inducer with eliglustat is not recommended in poor, intermediate and extensive metabolisers.

Eltrombopag [1], strong CYP1A2 inductors ---> SmPC of [1] of EMA

Medicinal products that induce a single enzyme are unlikely to significantly affect plasma eltrombopag concentrations

Eltrombopag [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

Medicinal products that induce a single enzyme are unlikely to significantly affect plasma eltrombopag concentrations

Eltrombopag [1], strong UGT1A1 inductors ---> SmPC of [1] of EMA

Medicinal products that induce a single enzyme are unlikely to significantly affect plasma eltrombopag concentrations

Eltrombopag [1], strong UGT1A3 inductors ---> SmPC of [1] of EMA

Medicinal products that induce a single enzyme are unlikely to significantly affect plasma eltrombopag concentrations

Elvitegravir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of elvitegravir with medicines that are strong inducers of CYP3A is contraindicated as the expected decrease in elvitegravir plasma levels can lead to loss of therapeutic effect and possible development of resistance to elvitegravir

Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of Genvoya and some medicinal products that induce CYP3A may result in significantly decreased cobicistat and elvitegravir plasma concentrations, which may result in loss of therapeutic effect and development of resistance.

Elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The strong CYP3A4 induction may decrease the cobicistat and elvitegravir plasma levels, which may result in loss of therapeutic effect and development of resistance

Empagliflozin/linagliptin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of rifampicin decreased linagliptin exposure by 40 %, suggesting that the efficacy of linagliptin may be reduced when administered in combination with a strong P-glycoprotein (P-gp) or cytochrome P450 (CYP) isozyme CYP3A4 inducer

Empagliflozin/linagliptin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration with other potent inducers of P-gp and CYP3A4, such as carbamazepine, phenobarbital and phenytoin, has not been studied.

Empagliflozin/linagliptin [1], strong P-gp inductors ---> SmPC of [1] of EMA

Emtricitabine/rilpivirine/tenofovir alafenamide [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of Odefsey and medicinal products that induce CYP3A has been observed to decrease the plasma concentrations of rilpivirine which could potentially lead to loss of virologic response to Odefsey. Concomitant use contraindicated.

Emtricitabine/rilpivirine/tenofovir alafenamide [1], strong P-gp inductors ---> SmPC of [1] of EMA

Medicinal products that induce P-gp activity (e.g., rifampicin, rifabutin, carbamazepine, phenobarbital) are expected to decrease the absorption of tenofovir alafenamide, resulting in decreased plasma concentration of tenofovir alafenamide

Emtricitabine/rilpivirine/tenofovir disoproxil [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of medicinal products that induce CYP3A has been observed to decrease the plasma concentrations of rilpivirine which could potentially lead to loss of therapeutic effect. Concomitant use contraindicated

Emtricitabine/tenofovir alafenamide [1], strong P-gp inductors ---> SmPC of [1] of EMA

Encorafenib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

A reduction in encorafenib exposure is likely and may result in compromised efficacy. Alternative agents with no or minimal CYP3A induction potential should be considered.

Enzalutamide [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

CYP2C8 plays an important role in the elimination of enzalutamide. Strong inductors of CYP2C8 are to be avoided or used with caution during enzalutamide treatment.

Eplerenone [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Due to the risk of decreased eplerenone efficacy, the concomitant use of strong CYP3A4 inducers with eplerenone is not recommended

Erlotinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Erlotinib is metabolised in the liver by the hepatic cytochromes in humans, primarily CYP3A4 and to a lesser extent by CYP1A2. Potent inducers of CYP3A4 activity increase erlotinib metabolism and significantly decrease erlotinib plasma concentrations.

Erythromycin, strong CYP3A4 inductors

The CYP3A4 induction may increase the metabolism of erythromycin and decrease its plasma concentrations and effect

Esomeprazole [1], strong CYP2C19 inductors ---> SmPC of [1] of EMA

Medicinal products known to induce CYP2C19 or CYP3A4 or both (such as rifampicin and St. John's wort (Hypericum perforatum)) may lead to decreased esomeprazole serum levels by increasing the esomeprazole metabolism.

Estrogens, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of estrogen and therefore decrease the contraceptive effect

Ethinylestradiol/norgestimate [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Drugs or herbal products that induce enzymes, especially CYP3A4, may decrease the plasma concentrations of contraceptive hormones, and may decrease their effectiveness and/or increase breakthrough bleeding.

Ethosuximide, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma levels of ethosuximide

Etravirine [1], strong CYP2C19 inductors ---> SmPC of [1] of EMA

Etravirine is metabolised by CYP3A4, CYP2C9 and CYP2C19. Medicinal products that induce CYP3A4, CYP2C9 or CYP2C19 may increase the clearance of etravirine, resulting in lowered plasma concentrations of etravirine.

Etravirine [1], strong CYP2C9 inductors ---> SmPC of [1] of EMA

Etravirine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Everolimus [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Decreased exposure of everolimus expected. Avoid the use of concomitant potent CYP3A4 inducers.

Everolimus [1], strong P-gp inductors ---> SmPC of [1] of EMA

Substances that are inducers of PgP may decrease everolimus blood concentrations by increasing metabolism or the efflux of everolimus from intestinal cells.

Exemestane [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

The co-administration of drugs known to induce CYP3A4 may reduce the efficacy of exemestane.

Ezetimibe/atorvastatin [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Concomitant administration of atorvastatin with inducers of cytochrome P450 3A4 (e.g., efavirenz, rifampicin, St. John's Wort) can lead to variable reductions in plasma concentrations of atorvastatin.

Febuxostat [1], strong glucuronidation inductors ---> SmPC of [1] of EMA

Potent inducers of UGT enzymes might possibly lead to increased metabolism and decreased efficacy of febuxostat.

Fedratinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Agents that strongly or moderately induce CYP3A4 (e.g. phenytoin, rifampicin, efavirenz) can decrease Inrebic exposure and should be avoided in patients receiving Inrebic

Felbamate, strong CYP3A4 inductors

The strong CYP3A4 induction enhances the metabolism of felbamate

Felodipine, strong CYP3A4 inductors ---> SmPC of [felodipine/metoprolol] of eMC

The strong CYP3A4 induction may decrease the plasma concentrations of felodipine

Felodipine/metoprolol, strong CYP3A4 inductors

It has been shown that inductors of cytochrome P450-3A4 system decrease the plasma concentrations of felodipine. The concomitant use with strong CYP3A4 inductors should be avoided

Felodipine/ramipril [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

The CYP3A4 induction may decrease the plasma levels of felodipine. The co-administration of felodipine with CYP3A4 inductors should be avoided

Fenfluramine [1], strong CYP1A2 inductors ---> SmPC of [1] of EMA

Co-administration with strong CYP1A2 inducers or CYP2B6 inducers may decrease fenfluramine plasma concentrations

Fenfluramine [1], strong CYP2B6 inductors ---> SmPC of [1] of EMA

Co-administration with strong CYP1A2 inducers or CYP2B6 inducers may decrease fenfluramine plasma concentrations

Fentanyl [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of fentanyl with medicinal products that induce 3A4 activity may reduce the efficacy of fentanyl.

Fesoterodine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Induction of CYP3A4 may lead to subtherapeutic plasma levels. Concomitant use (of fesoterodine) with CYP3A4 inducers is not recommended

Finasteride [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

It is probable that inhibitors and inducers of CYP3A4 will affect the plasma concentration of finasteride. However, based on established safety margins, any increase due to concomitant use of such inhibitors is unlikely to be of clinical significance.

Fingolimod [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of fingolimod with strong CYP3A4 enzyme inducers may reduce the AUC of fingolimod and its metabolite. The co-administration should be used with caution.

Flecainide [1], strong CYP2D6 inductors ---> SmPC of [1] of eMC

Concurrent use of drugs inducing the iso-enzyme CYP2D6 can decrease plasma concentrations of flecainide

Fludrocortisone, strong CYP3A4 inductors

The strong CYP3A4 induction decreases the plasma concentrations of fludrocortisone

Fluocortolone, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of fluocortolone

Fosamprenavir, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma levels of amprenavir

Fosaprepitant [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant administration of fosaprepitant with active substances that strongly induce CYP3A4 activity should be avoided as the combination could result in reductions of the plasma concentrations of aprepitant

Fosphenytoin [1], strong CYP2C19 inductors ---> SmPC of [1] of eMC

Phenytoin is mainly metabolized in the liver by the cytochrome P450 CYP2C9 and CYP2C19 enzymes. Phenytoin clearance, thus plasma levels, might be affected by inductors of these enzymes.

Fosphenytoin [1], strong CYP2C9 inductors ---> SmPC of [1] of eMC

Phenytoin is mainly metabolized in the liver by the cytochrome P450 CYP2C9 and CYP2C19 enzymes. Phenytoin clearance, thus plasma levels, might be affected by inductors of these enzymes.

Fostamatinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of fostamatinib with strong CYP3A4 inducers decreases exposure to R406, which may result in reduced efficacy. Therefore, concomitant use of fostamatinib with strong CYP3A4 inducers is not recommended.

Fostemsavir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Significant decreases in temsavir plasma concentrations may also occur when fostemsavir is co-administered with other strong CYP3A inducers, and may result in loss of virologic response

Fulvestrant [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Dose adjustment is not necessary in patients who are receiving fulvestrant and CYP3A4 inhibitors or inducers concomitantly.

Gefitinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Substances that are inducers of CYP3A4 activity may increase metabolism and decrease gefitinib plasma concentrations and thereby reduce the efficacy of gefitinib. Concomitant medicinal products that induce CYP3A4 should be avoided.

Gestagens, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma levels of progestagen

Gilteritinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of CYP3A/P-gp inducers may lead to decreased gilteritinib exposure and consequently a risk for lack of efficacy. Therefore, concomitant use of gilteritinib with strong CYP3A4/P-gp inducers should be avoided

Gilteritinib [1], strong P-gp inductors ---> SmPC of [1] of EMA

Glasdegib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use with strong CYP3A4 inducers (e.g., rifampicin, carbamazepine, enzalutamide, mitotane, phenytoin and St. John's Wort) should be avoided, as this is likely to decrease glasdegib plasma concentrations.

Glibenclamide, strong CYP2C9 inductors

The strong CYP2C9 induction may decrease the plasma concentrations of glibenclamide, which has a narrow therapeutic margin

Glimepiride [1], strong CYP2C9 inductors ---> SmPC of [1] of eMC

Glimepiride is metabolized by cytochrome P450 2C9 (CYP2C9). Its metabolism is known to be influenced by concomitant administration of CYP2C9 inducers (e.g. rifampicin)

Granisetron [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

As granisetron is metabolised by hepatic cytochrome P450 drug-metabolising enzymes (CYP1A1 and CYP3A4), inducers of these enzymes may change the clearance and, hence, the half-life of granisetron.

Guanfacin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

There was a significant decrease in the rate and extent of guanfacine exposure when co-administered with rifampin, a CYP3A4 inducer. Other CYP3A4 inducers may have a comparable effect

Hemp extract, strong CYP3A4 inductors

The co-administration may decrease the Cmax and THC and CBD.

Hydrocortisone [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Potent CYP 3A4 inducers can enhance the metabolic clearance of cortisol, decrease terminal half-life and thus reduce circulating levels and increase fluctuations of cortisol (due to shorter terminal half-life).

Ibrutinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Ibrutinib is primarily metabolised by cytochrome P450 enzyme 3A4. Administration with inducers of CYP3A4 can decrease ibrutinib plasma concentrations. Avoid concomitant use of strong CYP3A4 inducers

Ibuprofen, strong CYP2C8 inductors

The strong CYP2C8 induction may decrease the ibuprofen effect

Idelalisib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of idelalisib with moderate or strong CYP3A inducers should be avoided as this may result in decreased efficacy

Iloperidone, strong CYP2D6 inductors

The strong CYP2D6 induction may decrease the plasma concentrations of iloperidone

Iloperidone, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of iloperidone

Imatinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Substances that are inducers of CYP3A4 activity may significantly reduce exposure to imatinib, potentially increasing the risk of therapeutic failure. Concomitant use of strong CYP3A4 inducers and imatinib should be avoided.

Indinavir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The metabolism of indinavir is mediated by the cytochrome P450 enzyme CYP3A4. Therefore, other substances that either share this metabolic pathway or modify CYP3A4 activity may influence the pharmacokinetics of indinavir.

Irinotecan [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of ONIVYDE with inducers of CYP3A4 may reduce systemic exposure of ONIVYDE.

Isavuconazole [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of CRESEMBA with potent/moderate CYP3A4/5 inducers is contraindicated, since these medicinal products can significantly decrease plasma concentrations of isavuconazole

Itraconazol [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Coadministration of itraconazole with potent enzyme inducers of CYP3A4 may decrease the bioavailability of itraconazole and hydroxy-itraconazole to such an extent that efficacy may be largely reduced.

Ivabradine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Ivabradine is metabolised by CYP3A4 only. CYP3A4 inducers may decrease ivabradine exposure and activity. The concomitant use of CYP3A4 inducing medicinal products may require an adjustment of the dose of ivabradine.

Ivacaftor [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of ivacaftor with rifampicin, a strong CYP3A inducer, decreased ivacaftor exposure (AUC) and M1 exposure. Co-administration with strong CYP3A inducers is not recommended

Ivacaftor/tezacaftor/elexacaftor [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Elexacaftor and tezacaftor exposures are also expected to decrease during co-administration with strong CYP3A inducers; therefore, co-administration with strong CYP3A inducers is not recommended.

Ixabepilone, strong CYP3A4 inductors

The strong CYP3A4 induction may reduce plasma concentrations of ixabepilone

Ixazomib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of ixazomib with rifampicin decreased ixazomib Cmax by 54% and AUC by 74%. Therefore, co-administration of strong CYP3A inducers with ixazomib is not recommended

Ketoconazole [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Ketoconazole HRA is mainly metabolised by cytochrome CYP3A4. Enzyme-inducing drugs may significantly reduce the bioavailability of ketoconazole. Use of Ketoconazole HRA with potent enzyme inducers is not recommended.

Lacidipine [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Lacidipine is known to be metabolised by cytochrome CYP3A4 and, therefore, significant inhibitors and inducers of CYP3A4 administered concurrently may interact with the metabolism and elimination of lacidipine.

Lamivudine/zidovudine [1], strong glucuronidation inductors ---> SmPC of [1] of EMA

Zidovudine is primarily metabolised by UGT enzymes; co-administration of inducers or inhibitors of UGT enzymes could alter zidovudine exposure.

Lapatinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Lapatinib is predominantly metabolised by CYP3A. The CYP3A4 induction decreases the exposition to lapatinib. Co-administration of lapatinib with known inducers of CYP3A4 should be avoided.

Larotrectinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of VITRAKVI with strong or moderate CYP3A and P-gp inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifabutin, rifampin, or St. John's Wort) may decrease larotrectinib plasma concentrations and should be avoided

Larotrectinib [1], strong P-gp inductors ---> SmPC of [1] of EMA

Lasofoxifene, strong CYP3A4 inductors

Lasofoxifene clearance may be increased in patients chronically treated with inducers of CYP3A4 and may result in reduced efficacy

Ledipasvir/sofosbuvir [1], strong P-gp inductors ---> SmPC of [1] of EMA

Medicinal products that are potent P-gp inducers may significantly decrease ledipasvir and sofosbuvir plasma concentrations leading to reduced therapeutic effect of ledipasvir/sofosbuvir and thus are contraindicated with Harvoni

Lefamulin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Medicinal products that are moderate/strong CYP3A inducers could significantly decrease lefamulin plasma concentration and may lead to reduced therapeutic effect of lefamulin. Co-administration of such medicinal products with lefamulin is contraindicated

Lercanidipine [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Co-administration of lercanidipine with CYP3A4 inducers should be approached with caution since the antihypertensive effect may be reduced and blood pressure should be monitored more frequently than usual.

Letermovir [1], strong inductors ---> SmPC of [1] of EMA

Co-treatment with moderate and strong inducers may give rise to subtherapeutic letermovir exposure

Levobupivacaine, strong CYP3A4 inductors

The strong CYP3A4 induction may reduce plasma concentrations of levobupivacaine

Linagliptin [1], strong P-gp inductors ---> SmPC of [1] of EMA

The full efficacy of linagliptin in combination with strong P-gp inducers might not be achieved, particularly if these are administered long-term.

Linagliptin/metformin [1], strong P-gp inductors ---> SmPC of [1] of EMA

The full efficacy of linagliptin in combination with strong P-gp inducers might not be achieved, particularly if these are administered long-term.

Lomitapide [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Medicines that induce CYP3A4 would be expected to increase the rate and extent of metabolism of lomitapide. Consequently, this would reduce the effect of lomitapide. Any impact on efficacy is likely to be variable.

Lopinavir, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of lopinavir

Lorlatinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant administration of lorlatinib with strong CYP3A4/5 inducers may decrease lorlatinib plasma concentrations. The use of a strong CYP3A4/5 inducer with lorlatinib is contraindicated

Lornoxicam, strong CYP2C9 inductors

Lornoxicam interacts with known inhibitors and inductors of CYP2C9 isoenzymes

Lumacaftor/ivacaftor [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of lumacaftor/ivacaftor with rifampicin, a strong CYP3A inducer, decreased ivacaftor exposure (AUC) by 57%. Therefore, co-administration of lumacaftor/ivacaftor is not recommended with strong CYP3A inducers.

Lurasidone [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Lurasidone and its active metabolite ID-14283 are primarily metabolised by CYP3A4. Lurasidone is contraindicated with strong CYP3A4 inductors

Macimorelin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Administration of a CYP3A4 inducer may reduce the plasma macimorelin concentrations and may affect the diagnostic performance of the test and therefore should be avoided.

Macitentan [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

In the presence of strong CYP3A4 inducers reduced efficacy of macitentan could occur. The combination of macitentan with strong CYP3A4 inducers should be avoided

Manidipine, strong CYP3A4 inductors

Manidipine should not be administered with CYP3A4 inductors

Maraviroc [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Maraviroc is a substrate of cytochrome P450 CYP3A4. Co-administration of maraviroc with medicinal products that induce CYP3A4 may decrease maraviroc concentrations and reduce its therapeutic effects.

Mefloquine, strong CYP3A4 inductors [2] ---> SmPC of [2] of eMC

Inductors of the isoenzyme CYP3A4 may modify the pharmacokinetics/metabolism of mefloquine, leading to an decrease in mefloquine plasma concentration.

Metformin/saxagliptin/dapagliflozin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The coadministration of saxagliptin and CYP3A4/5 inducers, other than rifampicin has not been studied and may result in decreased plasma concentration of saxagliptin and increased concentration of its major metabolite.

Methadone, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of methadone

Methylergometrine, strong CYP3A4 inductors

Strong CYP3A4 inhibitors may weaken the pharmacological effect of methylergometrine

Methylprednisolone, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of glucocorticoid

Metoprolol, strong CYP2D6 inductors

The strong CYP2D6 induction may decrease the plasma concentrations of metoprolol

Metronidazole, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma levels of metronidazole

Mexiletine [1], strong CYP1A2 inductors ---> SmPC of [1] of EMA

Co-administration of mexiletine with a hepatic enzyme inducer (CYP1A2 inducer; CYP2D6 inducer) may increase the clearance and elimination rate of mexiletine due to an increased hepatic metabolism

Mexiletine [1], strong CYP2D6 inductors ---> SmPC of [1] of EMA

Co-administration of mexiletine with a hepatic enzyme inducer (CYP1A2 inducer; CYP2D6 inducer) may increase the clearance and elimination rate of mexiletine due to an increased hepatic metabolism

Mianserin, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma levels of mianserin

Midazolam [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Midazolam is metabolized by CYP3A4. Inducers of CYP3A4 have the potential to decrease the plasma concentrations and, subsequently, the effects of midazolam thus requiring dose adjustments accordingly.

Midostaurin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of Rydapt with strong inducers of CYP3A4 (e.g. carbamazepine, rifampicin, enzalutamide, phenytoin, St. John's Wort [Hypericum perforatum]) is contraindicated

Mifepristone [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

CYP3A4 inductors may induce mifepristone metabolism (lowering serum levels of mifepristone).

Mirabegron [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Substances that are inducers of CYP3A decrease the plasma concentrations of mirabegron. No dose adjustment is needed for mirabegron when administered with therapeutic doses of rifampicin or other CYP3A inducers.

Mirabegron [1], strong P-gp inductors ---> SmPC of [1] of EMA

Substances that are inducers P-gp decrease the plasma concentrations of mirabegron. No dose adjustment is needed for mirabegron when administered with therapeutic doses of P-gp inducers.

Mirtazapine [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

The strong CYP3A4 induction may decrease the plasma concentrations of mirtazapine

Montelukast [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Decreased montelukast AUC when is coadministered with strong inducers of CYP3A4

Naldemedine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of naldemedine with strong CYP3A inducers leads to a decrease in naldemedine exposure and may reduce the efficacy of naldemedine. Concomitant use with strong CYP3A inducers is not recommended

Naloxegol [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of naloxegol with CYP3A4 inductors decreases naloxegol exposition. Naloxegol is not recommended in patients who are taking strong CYP3A4 inducers

Nelfinavir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Potent inducers of CYP3A4 (e.g., rifampicin, phenobarbital and carbamazepine) may reduce nelfinavir plasma concentrations and their coadministration is contraindicated

Netupitant/palonosetron [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Netupitant is mainly metabolized by CYP3A4; therefore, co-administration with medicinal products that induce CYP3A4 may decrease netupitant plasma concentrations. Consequently, concomitant administration with strong CYP3A4 inducers should be avoided.

Nevirapine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Nevirapine is an inducer of CYP3A. Compounds using this metabolic pathway may have decreased plasma concentrations when co-administered with nevirapine.

Nicardipine, strong CYP3A4 inductors [2] ---> SmPC of [2] of eMC

Nicardipine is metabolized by cytochrome P450 3A4. Concomitant administration of nicardipine with inductors of cytochrome P450 3A4 may alter the plasma levels of nicardipine.

Nifedipine [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Nifedipine is metabolised via the cytochrome P450 3A4 system. Therefore, there are theoretical interactions with drugs that are known to induce this enzyme

Nilotinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant administration of other medicinal products that induce CYP3A4 is likely to reduce exposure to nilotinib to a clinically relevant extent.

Nilutamide, strong CYP2C19 inductors

The strong CYP2C19 induction may decrease plasma concentrations of nilutamide

Nimodipine, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of nimodipine

Nintedanib [1], strong P-gp inductors ---> SmPC of [1] of EMA

Potent P-gp inducers may decrease exposure to nintedanib. Co-administration with nintedanib should be carefully considered.

Nisoldipine, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of nisoldipine

Nitisinone [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Nitisinone is metabolised in vitro by CYP 3A4 and dose-adjustment may therefore be needed when nitisinone is co-administered with inducers of this enzyme.

Nitrendipine, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of nitrendipine

Nomegestrol, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the levels of nomegestrol

Norelgestromin, strong CYP3A4 inductors

The enzymatic induction may accelerate the metabolism of steroid hormones and decrease their plasma levels and effect.

Norgestimate, strong CYP3A4 inductors

The CYP3A4 induction may accelerate the norgestimate metabolism and decrease its plasma levels and effect. The induction lasts at least 4 weeks after dose interruption

Olanzapine [1], strong CYP1A2 inductors ---> SmPC of [1] of EMA

Since olanzapine is metabolised by CYP1A2, substances that can specifically induce this isoenzyme may decrease olanzapine concentration

Olaparib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Known strong inducers of CYP3A4/5 are not recommended with olaparib, as it is possible that the efficacy of olaparib could be substantially reduced

Olaparib [1], strong P-gp inductors ---> SmPC of [1] of EMA

In vitro olaparib is a substrate for the efflux transporter P-gp. Clinical studies to evaluate the impact of known P-gp inhibitors and inducers have not been conducted.

Olmesartan medoxomil/amlodipine [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

The concomitant use of amlodipine and CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.

Omeprazole, strong CYP2C19 inductors

Principle actives known to induce CYP2C19 may increase the omeprazole metabolism and decrease its plasma levels

Omeprazole, strong CYP3A4 inductors

Principle actives known to induce CYP3A4 may increase the omeprazole metabolism and decrease its plasma levels

Ondansetron [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

In patients treated with potent inducers of CYP3A4, the oral clearance of ondansetron was increased and ondansetron blood concentrations were decreased.

Osilodrostat [1], strong inductors ---> SmPC of [1] of EMA

Caution is advised when co-administered medicinal products that strongly induce multiple enzymes (e.g. rifampin) are introduced or discontinued during osilodrostat treatment

Osimertinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

It is recommended that concomitant use of strong CYP3A inducers (e.g. Phenytoin, rifampicin and carbamazepine) with TAGRISSO should be avoided.

Ospemifene [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Rifampicin, strong CYP3A/CYP2C9 enzyme inducer, decreased the ospemifene AUC by 58%. Therefore, co-administration of ospemifene with strong enzyme inducers would be expected to decrease the exposure of ospemifene, which may decrease the clinical effect.

Ozanimod [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

The coadministration of CYP2C8 inducers (i.e., rifampin) with ozanimod is not recommended

Paclitaxel [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

The metabolism of paclitaxel is catalysed, in part, by cytochrome P450 isoenzymes CYP2C8 and CYP3A4. Therefore, caution should be exercised when administering paclitaxel concomitantly with medicines known to induce either CYP2C8 or CYP3A4.

Paclitaxel [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Palbociclib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Coadministration of CYP3A inducers may lead to decreased palbociclib exposure and consequently a risk for lack of efficacy. Therefore, concomitant use of palbociclib with strong CYP3A4 inducers should be avoided.

Panobinostat [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Strong inducers may reduce the efficacy of panobinostat, therefore the concomitant use of strong CYP3A4 inducers should be avoided.

Parecoxib, strong CYP3A4 inductors

The strong CYP3A4 induction may increase the metabolism and decrease the plasma levels of valdecoxib

Pazopanib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant treatment with inducers of CYP3A4 should be avoided due to risk of decreased exposure to pazopanib

Pazopanib [1], strong P-gp inductors ---> SmPC of [1] of EMA

Co-administration of pazopanib with potent P-gp or BCRP inducers may alter the exposure and distribution of pazopanib, including distribution into the central nervous systems (CNS).

Pemigatinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concurrent use of strong CYP3A4 inducers (e.g. carbamazepine, phenytoin, phenobarbital, rifampicin) should be avoided during treatment with pemigatinib

Perampanel [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Strong inducers of cytochrome P450 are expected to decrease perampanel concentrations

Phenobarbital, strong CYP3A4 inductors

The CYP3A4 induction may decrease the plasma concentrations of phenobarbital

Phenytoin, strong CYP2C19 inductors ---> SmPC of [fosphenytoin] of eMC

Phenytoin is mainly metabolized in the liver by the cytochrome P450 CYP2C9 and CYP2C19 enzymes. Phenytoin clearance, thus plasma levels, might be affected by inductors of these enzymes.

Phenytoin, strong CYP2C9 inductors ---> SmPC of [fosphenytoin] of eMC

Phenytoin is mainly metabolized in the liver by the cytochrome P450 CYP2C9 and CYP2C19 enzymes. Phenytoin clearance, thus plasma levels, might be affected by inductors of these enzymes.

Pioglitazone [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

Pioglitazone should be used with caution during concomitant administration of cytochrome P450 2C8 inducers (e.g. rifampicin). Glycaemic control should be monitored closely.

Pioglitazone/metformin [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

Pioglitazone should be used with caution during concomitant administration of cytochrome P450 2C8 inhibitors (e.g. gemfibrozil) or inducers (e.g. rifampicin). Glycaemic control should be monitored closely.

Piperaquine, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of piperaquine. Concomitant treatment is not recommended

Pirfenidone [1], strong CYP1A2 inductors ---> SmPC of [1] of EMA

Concomitant use of strong inducers of CYP1A2 should be avoided during pirfenidone therapy. Concomitant use may result in a lowering of pirfenidone plasma levels.

Pitolisant [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of pitolisant with potent CYP3A4 inducers (e.g. rifampicin, phenobarbital, carbamazepine, phenytoin) should be done with caution.

Pixantrone [1], strong P-gp inductors ---> SmPC of [1] of EMA

Caution should be taken when pixantrone is continuously co-administered with efflux transport inducers, as pixantrone excretion might be increased with a consequent decrease of systemic exposure.

Polatuzumab vedotin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine, phenobarbital, phenytoin, St John's wort [Hypericum perforatum]) may decrease the exposure of unconjugated MMAE.

Pomalidomide [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of pomalidomide with the strong CYP3A4/5 inducer carbamazepine had no clinically relevant effect on exposure to pomalidomide.

Ponatinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Coadministration of ponatinib with strong CYP3A4 inducers (decreases in ponatinib exposure are possible) should be avoided, and alternatives to the CYP3A4 inducer should be sought, unless the benefit outweighs the possible risk of ponatinib underexposure

Ponesimod [1], strong inductors ---> SmPC of [1] of EMA

Co-administration of ponesimod with strong inducers of multiple metabolic pathways of ponesimod (see section 5.2) may decrease the systemic exposure of ponesimod. It is unclear whether this decrease is clinically relevant.

Posaconazole [1], strong glucuronidation inductors ---> SmPC of [1] of EMA

Posaconazole is metabolised via UDP glucuronidation (phase 2 enzymes) and is a substrate for p-glycoprotein (P-gp) efflux in vitro. Therefore, inductors of these clearance pathways may decrease posaconazole plasma concentrations

Posaconazole [1], strong P-gp inductors ---> SmPC of [1] of EMA

Potent P-gp inducers in the intestine, sofosbuvir [2] ---> SmPC of [2] of EMA

Medicinal products that are potent P-gp inducers in the intestine may significantly decrease sofosbuvir plasma concentration leading to reduced therapeutic effect of Sovaldi and thus are contraindicated with Sovaldi

Pralsetinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of pralsetinib with strong CYP3A4 inducers can decrease pralsetinib plasma concentrations, which may decrease the efficacy of pralsetinib. If co-administration cannot be avoided, increase the pralsetinib dose

Prasugrel [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

CYP3A inductors are not anticipated to have a significant effect on the pharmacokinetics of the prasugrel active metabolite.

Pretomanid [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Due to the possibility of a reduction of the therapeutic effect of pretomanid due to a decrease in systemic exposure, co-administration of pretomanid and moderate or strong CYP3A4 inducers used systemically should be avoided

Procarbazine, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the levels of procarbazine

Progesterone, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the levels of progesterone

Propafenone, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the levels of propafenone and its antiarrhythmic effect

Quinidine, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the levels of quinidine

Quinine [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Suboptimal quinine serum levels may result from concomitant use of CYP3A4 inducers

Raltegravir [1], strong UGT1A1 inductors ---> SmPC of [1] of EMA

The strong inducer of UGT1A1 reduces plasma levels of raltegravir. Caution is recommended

Ranolazine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The CYP3A4 induction may decrease the plasma levels of ranolazine. During the treatment with CYP3A4 inductors should not be initiated a therapy with ranolazine

Reboxetine [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Low reboxetine serum levels have been reported with the concurrent administration of CYP3A4 inducers

Regorafenib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The strong CYP3A4 inductor may increase metabolism of regorafenib. The combination of regorafenib with strong CYP3A4 inductors should be avoided

Remdesivir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The use of strong inducers (e.g. rifampicin) may decrease plasma concentrations of remdesivir and is not recommended.

Repaglinide [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

In vitro data indicate that repaglinide is metabolised predominantly by CYP2C8, but also by CYP3A4. Metabolism, and by that clearance of repaglinide, may be altered by substances which influence these cytochrome P-450 enzymes via induction.

Ribociclib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of strong CYP3A4 inducers may therefore lead to decreased exposure and consequently a risk for lack of efficacy. The concomitant use of strong CYP3A4 inducers should be avoided

Rilpivirine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Rilpivirine is primarily metabolised by cytochrome P450 (CYP)3A. Co-administration of rilpivirine and medicinal products that induce CYP3A has been observed to decrease the plasma concentrations of rilpivirine

Riluzole [1], strong CYP1A2 inductors ---> SmPC of [1] of EMA

In vitro studies suggest that CYP1A2 is the principal isozyme involved in the initial oxidative metabolism of riluzole. Inducers of CYP1A2 could increase the rate of riluzole elimination.

Rimegepant [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Inducers of CYP3A4 decrease plasma concentrations of rimegepant. The effect of CYP3A4 induction may last for up to 2 weeks after discontinuation of the strong or moderate CYP3A4 inducer.

Rimonabant [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

It is expected that concomitant administration of potent CYP3A4 inducers may reduce the plasma concentration of rimonabant and may result in loss of efficacy.

Riociguat [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The concomitant use of riociguat with strong CYP3A4 inducers may lead to decreased riociguat plasma concentration.

Ripretinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of QINLOCK with strong CYP3A inducers (e.g. carbamazepine, phenytoin, rifampicin, phenobarbital and St. John's wort) and moderate CYP3A inducers (e.g. efavirenz and etravirine) must therefore be avoided.

Ritonavir, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of ritonavir

Rivaroxaban [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The strong CYP3A4 induction may decrease the plasma concentrations of rivaroxaban. Concomitant administration of strong CYP3A4 inducers should be avoided unless the patient is closely observed for signs and symptoms of thrombosis.

Roflumilast [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The use of strong cytochrome P450 enzyme inducers may reduce the therapeutic efficacy of roflumilast. Thus, roflumilast treatment is not recommended in patients receiving strong cytochrome P450 enzyme inducers.

Rolapitant [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Varuby in patients who require chronic administration of strong inducers (e.g. rifampicin, carbamazepine, enzalutamide, phenytoin) is not recommended

Rosiglitazone [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

Rosiglitazone should be used with caution during concomitant administration of CYP2C8 inducers (e.g. rifampicin). Glycaemic control should be monitored closely.

Roxadustat [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

Roxadustat is a substrate of CYP2C8 and UGT1A9. Monitor Hb levels when initiating or discontinuing concomitant treatment with gemfibrozil, probenecid, other strong inhibitors or inducers of CYP2C8 or other strong inhibitors of UGT1A9.

Rucaparib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Caution should be used for concomitant use of strong CYP3A4 inhibitors or inducers.

Ruxolitinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The strong CYP3A4 induction may reduce the AUC of ruxolitinib. It is possible that an increase of the ruxolitinib dose is needed with strong CYP3A4 inductors

Saquinavir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Medicinal products that induce CYP3A4 may decrease saquinavir concentrations.

Saquinavir/ritonavir, strong CYP3A4 inductors ---> SmPC of [saquinavir] of EMA

Medicinal products that induce CYP3A4 may decrease saquinavir concentrations.

Saxagliptin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

The co-administration of saxagliptin and CYP3A4/5 inducers may result in decreased plasma concentration of saxagliptin and increased concentration of its major metabolite. Glycaemic control should be carefully assessed

Saxagliptin/dapagliflozin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Using CYP3A4 inducers may reduce the glycaemic lowering effect of Qtern. Glycaemic control should be assessed when it is used concomitantly with a potent CYP3A4/5 inducer

Saxagliptin/metformin [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Selexipag [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

In the presence of 600 mg rifampicin, once a day, an inducer of CYP2C8, the exposure to the active metabolite was reduced by half. Dose adjustment of selexipag may be required with concomitant administration of inducers of CYP2C8.

Selexipag [1], strong UGT1A3 inductors ---> SmPC of [1] of EMA

Caution is required when administering these medicinal products concomitantly with Uptravi. A potential pharmacokinetic interaction with strong inhibitors or inducers of these enzymes cannot be excluded.

Selexipag [1], strong UGT2B7 inductors ---> SmPC of [1] of EMA

Selinexor [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of strong CYP3A4 inducer might lead to lower exposure of selinexor.

Selpercatinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of strong CYP3A4 inducers should be avoided due to the risk of decreased efficacy of selpercatinib

Selumetinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant use of strong CYP3A4 inducers (e.g., phenytoin, rifampicin, carbamazepine, St. John's Wort) or moderate CYP3A4 inducers with Koselugo should be avoided.

Sertindole, strong CYP3A4 inductors

The metabolism of sertindole may be significantly enhanced by agents known to induce CYP isozymes, which can decrease the plasma concentrations of sertindole

Sibutramine [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Rifampicin, phenytoin, carbamazepine, phenobarbital and dexamethasone are CYP3A4 enzyme inducers and may accelerate sibutramine metabolism, although this has not been studied experimentally.

Sildenafil [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Concomitant administration of strong CYP3A4 inducers, such as rifampin, is expected to cause greater decreases in plasma concentrations of sildenafil.

Simeprevir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Co-administration of simeprevir with moderate or strong inductors of CYP3A4 may significantly reduce the plasma exposure of simeprevir and lead to loss of efficacy. Co-administration of simeprevir with these inductors is not recommended.

Simvastatine, strong CYP3A4 inductors

The strong CYP3A4 induction may decrease the plasma concentrations of simvastatin

Sirolimus [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Inductors of CYP3A4 increase the metabolism of sirolimus and decrease sirolimus levels. Co-administration of sirolimus with strong inductors of CYP3A4 is not recommended

Sofosbuvir/velpatasvir [1], strong CYP2B6 inductors ---> SmPC of [1] of EMA

Medicinal products that are potent P-glycoprotein or potent cytochrome P450 inducers are contraindicated with Epclusa. Co-administration will significantly decrease sofosbuvir or velpatasvir plasma levels and could result in loss of efficacy of Epclusa

Sofosbuvir/velpatasvir [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

Sofosbuvir/velpatasvir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Sofosbuvir/velpatasvir [1], strong P-gp inductors ---> SmPC of [1] of EMA

Sofosbuvir/velpatasvir/voxilaprevir [1], strong CYP2B6 inductors ---> SmPC of [1] of EMA

Medicinal products that are strong inducers of P-gp or strong inducers of CYP2B6, CYP2C8, or CYP3A4 may decrease plasma levels of sofosbuvir, velpatasvir and/or voxilaprevir. The use of such medicinal products with Vosevi is contraindicated

Sofosbuvir/velpatasvir/voxilaprevir [1], strong CYP2C8 inductors ---> SmPC of [1] of EMA

Sofosbuvir/velpatasvir/voxilaprevir [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Sofosbuvir/velpatasvir/voxilaprevir [1], strong P-gp inductors ---> SmPC of [1] of EMA

Solifenacin [1], strong CYP3A4 inductors ---> SmPC of [1] of eMC

Since solifenacin is metabolised by CYP3A4, pharmacokinetic interactions are possible with CYP3A4 inducers

Sonidegib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Sonidegib undergoes metabolism primarily by CYP3A4, and concomitant administration of strong inducers of CYP3A4 can decrease sonidegib concentrations significantly. Concomitant use of strong CYP3A inducers should be avoided

Sorafenib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Inducers of CYP3A4 activity and/or glucuronidation may increase metabolism of sorafenib and thus decrease sorafenib concentrations.

Sorafenib [1], strong glucuronidation inductors ---> SmPC of [1] of EMA

Inducers of CYP3A4 activity and/or glucuronidation may increase metabolism of sorafenib and thus decrease sorafenib concentrations.

Stiripentol [1], strong CYP1A2 inductors ---> SmPC of [1] of EMA

In vitro studies suggested that stiripentol phase 1 metabolism is catalyzed by CYP1A2, CYP2C19 and CYP3A4. Caution is advised when combining stiripentol with other substances that induce one or more of these enzymes.

Stiripentol [1], strong CYP2C19 inductors ---> SmPC of [1] of EMA

Stiripentol [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA

Strong CYP inducers, tepotinib [2] ---> SmPC of [2] of EMA

Tepotinib is a substrate for P-glycoprotein (P-gp) (see section 5.2). Strong CYP inducers may also decrease tepotinib exposure.

Strong CYP inducers, vismodegib [2] ---> SmPC of [2] of EMA

Concomitant treatment with strong CYP inducers (e.g. rifampicin, carbamazepine or phenytoin) should be avoided, as a risk for decreased plasma concentrations and decreased efficacy of vismodegib cannot be excluded.

Strong CYP1A2 inductors, tizanidine

The co-administration of tizanidine with inductors of CYP1A2 may decrease the plasma levels of tizanidine. Decreased plasma levels of tizanidine may reduce the therapeutic effect of tizanidine

Strong CYP2B6 inductors, treprostinil [2] ---> SmPC of [2] of EMA

Concomitant administration of CYP2C8 enzyme inducers (for example rifampicin) may result in a decreased exposure to treprostinil. At a reduced exposure, it is likely to have decreased clinical efficacy.

Strong CYP2C19 inductors, voriconazole [2] ---> SmPC of [2] of EMA

Voriconazole is metabolised by cytochrome P450 isoenzymes, CYP2C19, CYP2C9, and CYP3A4. Inducers of these isoenzymes may decrease voriconazole plasma concentrations

Strong CYP2C8 inductors [1], tretinoin ---> SmPC of [1] of eMC

As tretinoin is metabolised by the hepatic P450 system, there is the potential for alteration of pharmacokinetics parameters in patients administered concomitant medications that are also inducers or inhibitors of this system.

Strong CYP2C9 inductors, voriconazole [2] ---> SmPC of [2] of EMA

Voriconazole is metabolised by cytochrome P450 isoenzymes, CYP2C19, CYP2C9, and CYP3A4. Inducers of these isoenzymes may decrease voriconazole plasma concentrations

Strong CYP3A4 inductors, sunitinib [2] ---> SmPC of [2] of EMA

Administration of sunitinib with potent CYP3A4 inducers may decrease sunitinib concentrations. Combination with CYP3A4 inducers should therefore be avoided

Strong CYP3A4 inductors, tacrolimus [2] ---> SmPC of [2] of EMA

Concomitant use of substances known to induce CYP3A4 may affect the metabolism of tacrolimus and thereby decrease tacrolimus blood levels.

Strong CYP3A4 inductors, tadalafil [2] ---> SmPC of [2] of EMA

The CYP3A4 induction may decrease the plasma concentrations of tadalafil

Strong CYP3A4 inductors, tamoxifen [2] ---> SmPC of [2] of eMC

As tamoxifen is metabolised by cytochrome P450 3A4 care is required when co-administered with drugs known to induce this enzyme, such as rifampicin, as tamoxifen levels may be reduced.

Strong CYP3A4 inductors, tasimelteon [2] ---> SmPC of [2] of EMA

Use of tasimelteon should be avoided in combination with rifampin or other CYP3A4 inducers because of a potentially large decrease in tasimelteon exposure with reduced efficacy

Strong CYP3A4 inductors, telaprevir [2] ---> SmPC of [2] of EMA

Concomitant administration of telaprevir is contraindicated with active substances that strongly induce CYP3A and thus may lead to lower exposure and loss of efficacy of telaprevir

Strong CYP3A4 inductors, telithromycin [2] ---> SmPC of [2] of EMA

Concomitant administration of CYP3A4 inducers is likely to result in subtherapeutic levels of telithromycin and loss of effect. Telithromycin should not be used during and 2 weeks after treatment with CYP3A4 inducers.

Strong CYP3A4 inductors, telmisartan/amlodipine [2] ---> SmPC of [2] of EMA

The concomitant use of CYP3A4 inducers may lead to a lower plasma concentration of amlodipine.

Strong CYP3A4 inductors, temsirolimus [2] ---> SmPC of [2] of EMA

The strong CYP3A4 induction may decrease exposure of the active moieties, temsirolimus and its metabolite, sirolimus. Concomitant treatment of temsirolimus with agents that have CYP3A4/5 induction potential should be avoided

Strong CYP3A4 inductors, tezacaftor/ivacaftor [2] ---> SmPC of [2] of EMA

Exposure to tezacaftor and ivacaftor may be reduced by the concomitant use of CYP3A inducers, potentially resulting in reduced efficacy of Symkevi and ivacaftor. Therefore, co-administration with strong CYP3A inducers is not recommended

Strong CYP3A4 inductors, thiotepa [2] ---> SmPC of [2] of EMA

Co-administration of inducers of Cytochrome P450 may increase the metabolism of thiotepa leading to increased plasma concentrations of the active metabolite.

Strong CYP3A4 inductors, tiagabine

The strong CYP3A4 induction enhances the metabolism of tiagabine

Strong CYP3A4 inductors, tibolone [2] ---> SmPC of [2] of eMC

CYP3A4 inducing compounds such as barbiturates, carbamazepine, hydantoins and rifampicin may enhance the metabolism of tibolone and thus affect its therapeutic effect.

Strong CYP3A4 inductors, ticagrelor [2] ---> SmPC of [2] of EMA

Co-administration of ticagrelor with strong CYP3A4 inducers is discouraged, as co-administration may lead to a decrease in exposure and efficacy of ticagrelor

Strong CYP3A4 inductors, tipranavir [2] ---> SmPC of [2] of EMA

Co-administration of tipranavir and medicinal products that induce CYP3A may decrease tipranavir plasma concentrations.

Strong CYP3A4 inductors, tivozanib [2] ---> SmPC of [2] of EMA

It is recommended that concomitant administration of tivozanib with strong CYP3A4 inducers, if used, should be undertaken with caution.

Strong CYP3A4 inductors, tolvaptan [2] ---> SmPC of [2] of EMA

Tolvaptan plasma concentrations have been decreased by up to 87% (AUC) after the administration of CYP3A4 inducers. Caution should be exercised in co-administering CYP3A4 inducers with tolvaptan.

Strong CYP3A4 inductors, topiramate

The strong CYP3A4 induction enhances the metabolism of topiramate

Strong CYP3A4 inductors, trabectedin [2] ---> SmPC of [2] of EMA

Concomitant use of a strong CYP3A4 inductor with trabectedin may decrease the plasma exposure of trabectedin. Therefore, the concomitant use of trabectedin with strong CYP3A4 inducers should be avoided if possible

Strong CYP3A4 inductors, trandolapril/verapamil [2] ---> SmPC of [2] of eMC

Inducers of CYP3A4 have caused lowering of plasma levels of verapamil. Patients should be monitored for drug interactions.

Strong CYP3A4 inductors, triazolam

The CYP3A4 induction may decrease plasma concentrations of triazolam

Strong CYP3A4 inductors, tucatinib [2] ---> SmPC of [2] of EMA

Co-administration of tucatinib with strong CYP3A or moderate CYP2C8 inducers such as rifampicin, phenytoin, St. John's wort, or carbamazepine should be avoided as this may result in decreased activity of tucatinib

Strong CYP3A4 inductors, ulipristal [2] ---> SmPC of [2] of EMA

Administration of the potent CYP3A4 inducers markedly decreased Cmax and AUC of ulipristal acetate and its active metabolite. Concomitant use of ulipristal acetate and potent CYP3A4 inducers is not recommended

Strong CYP3A4 inductors, upadacitinib [2] ---> SmPC of [2] of EMA

Upadacitinib exposure is decreased when co-administered with strong CYP3A4 inducers (such as rifampin and phenytoin), which may lead to reduced therapeutic effect of upadacitinib.

Strong CYP3A4 inductors, valdecoxib

The strong CYP3A4 induction may increase the metabolism and decrease the plasma levels of valdecoxib

Strong CYP3A4 inductors, vandetanib [2] ---> SmPC of [2] of EMA

In healthy male subjects, the exposure to vandetanib was reduced by 40% when given together with the potent CYP3A4 inducer, rifampicin. Administration of vandetanib with potent CYP3A4 inducers should be avoided.

Strong CYP3A4 inductors, vemurafenib [2] ---> SmPC of [2] of EMA

Concomitant administration of vemurafenib and potent inducers of CYP3A4 may lead to suboptimal exposure to vemurafenib and should be avoided.

Strong CYP3A4 inductors, venetoclax [2] ---> SmPC of [2] of EMA

Concomitant use of Venclyxto with strong CYP3A inducers or moderate CYP3A inducers should be avoided. Alternative treatments with less CYP3A induction should be considered.

Strong CYP3A4 inductors, verapamil [2] ---> SmPC of [2] of eMC

Clinically significant interactions have been reported with inducers of CYP3A4 that have caused a lowering of plasma levels of verapamil, therefore, patients should be monitored for drug interactions.

Strong CYP3A4 inductors, vincristine

The CYP3A4 induction may decrease plasma concentrations of vincristine

Strong CYP3A4 inductors, vinflunine [2] ---> SmPC of [2] of EMA

The concomitant use of vinflunine and potent CYP3A4 inducers should be avoided since they may decrease vinflunine and DVFL concentrations

Strong CYP3A4 inductors, vinorelbine [2] ---> SmPC of [2] of eMC

CYP3A4 is the main enzyme involved in the metabolism of vinorelbine, and the combination with a drug that induces this iso-enzyme can affect the concentration of vinorelbine

Strong CYP3A4 inductors, vorapaxar [2] ---> SmPC of [2] of EMA

Co-administration of rifampin with vorapaxar substantially decreased the vorapaxar mean Cmax and AUC. Concomitant use of vorapaxar with strong (potent) inducers of CYP3A should be avoided.

Strong CYP3A4 inductors, voriconazole [2] ---> SmPC of [2] of EMA

Voriconazole is metabolised by cytochrome P450 isoenzymes, CYP2C19, CYP2C9, and CYP3A4. Inducers of these isoenzymes may decrease voriconazole plasma concentrations

Strong CYP3A4 inductors, voxelotor [2] ---> SmPC of [2] of EMA

Coadministration of strong CYP3A4 inducers may decrease voxelotor exposures and may lead to reduced efficacy. Coadministration of voxelotor with strong CYP3A4 inducers should be avoided.

Strong CYP3A4 inductors, zaleplon [2] ---> SmPC of [2] of EMA

Co-administration of zaleplon together with inducers of CYP3A4 may result in a reduction of zaleplon efficacy.

Strong CYP3A4 inductors, zanubrutinib [2] ---> SmPC of [2] of EMA

Concomitant use with strong CYP3A inducers (e.g., carbamazepine, phenytoin, rifampin, St. John's wort) and moderate CYP3A inducers (e.g., bosentan, efavirenz, etravirine, modafinil, nafcillin) should be avoided

Strong CYP3A4 inductors, zolpidem

The strong CYP3A4 induction may reduce plasma concentrations and de hypnotic effects of zolpidem

Strong CYP3A4 inductors, zonisamide [2] ---> SmPC of [2] of EMA

The strong CYP3A4 induction decreases the zonisamide exposition. This effect is unlikely to be of clinical significance when zonisamide is added to existing therapy

Strong CYP3A4 inductors, zopiclone [2] ---> SmPC of [2] of eMC

Plasma levels of zopiclone may be decreased when co-administered with CYP3A4 inducers

Strong glucuronidation inductors, vemurafenib [2] ---> SmPC of [2] of EMA

Concomitant administration of vemurafenib and potent inducers of glucuronidation may lead to suboptimal exposure to vemurafenib and should be avoided.

Strong glucuronidation inductors, zidovudine ---> SmPC of [lamivudine/zidovudine] of EMA

Zidovudine is primarily metabolised by UGT enzymes; co-administration of inducers or inhibitors of UGT enzymes could alter zidovudine exposure.

Strong P-gp inductors, telaprevir [2] ---> SmPC of [2] of EMA

Co-administration of telaprevir and medicinal products that induce P-gp may decrease telaprevir plasma concentrations.

Strong P-gp inductors, tenofovir alafenamide [2] ---> SmPC of [2] of EMA

Co-administration of Vemlidy with inducers of P-glycoprotein (P-gp) may decrease tenofovir alafenamide plasma concentrations and is not recommended.

Strong P-gp inductors, tepotinib [2] ---> SmPC of [2] of EMA

Tepotinib is a substrate for P-glycoprotein (P-gp) (see section 5.2). Strong P-gp inducers may have the potential to decrease tepotinib exposure.

Strong P-gp inductors, tipranavir [2] ---> SmPC of [2] of EMA

Co-administration of tipranavir and medicinal products that induce P-gp may decrease tipranavir plasma concentrations.

Strong P-gp inductors, vemurafenib [2] ---> SmPC of [2] of EMA

Concomitant administration of vemurafenib and potent inducers of P-gp may lead to suboptimal exposure to vemurafenib and should be avoided.

Strong P-gp inductors, ziprasidone

The co-administration of ziprasidone with P glycoprotein inductors may decrease the plasma concentrations of ziprasidone

Page updated

Google Sites

Report abuse