Drug-herb-gene CYP2D6 interactions

Several pain medications require the liver enzyme CYP2D6 to become active. But some herbal supplements & medications can interfere with this enzyme. Patients on these medications should consult with a doctor before starting herbal supplements.

Drugs activated by CYP2D6

• Hydrocodone
• Oxycodone
• Codeine
• Tramadol

Drugs deactivated by CYP2D6

• Amitriptyline
• Nortriptyline
• Desipramine
• Duloxetine
• Venlafaxine

CYP2D6 inhibitors

Drugs:

• Bupropion
• Cimetidine
• Duloxetine
• Paroxetine
• Fluoxetine
• Sertraline
• Quinidine
• Terbinafine

Herbs:

• Resveratrol
• Goldenseal
• Black cumin seed
• Tumeric

Inflammation

Genes:

• Poor metabolizer genotype

CYP2D6 inducers

Drugs:

• Butalbital
• Dexamethasone

Herbs:

• St. John’s Wort

Genes:

• High metabolizer genotype