title: The pharmacological importance of cytochrome CYP3A4 in the palliation of symptoms: review and recommendations for avoiding adverse drug interactions.
abstract: BACKGROUND
  Adverse drug interactions are major causes of morbidity, hospitalizations, and mortality. The greatest risk of drug interactions occurs through in the cytochrome system. CYP3A4, the most prevalent cytochrome, accounts for 30-50% of drugs metabolized through type I enzymes.
  
  
  METHODS
  Palliative patients received medications for symptoms and co-morbidities, many of which are substrate, inhibitors, or promoters of CYP3A4 activity and expression. A literature review on CYP3A4 was performed pertinent to palliative medicine.
  
  
  CONCLUSIONS
  In this state of the art review, we discuss the CYP3A4 genetics, and kinetics and common medications, which are substrates or inhibitor/promoters of CYP3A4.
  
  
  CONCLUSIONS
  We made some recommendations for drug choices to avoid clinically important drug interaction.
authors.affiliation: Palliative Medicine Fellowship Faculty, The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, OH 44195, USA.
authors.forename: Abdo
authors.initials: A
authors.lastname: Haddad
authors.forename: Mellar
authors.initials: M
authors.lastname: Davis
authors.forename: Ruth
authors.initials: R
authors.lastname: Lagman
mesh_terms: D000305:Adrenal Cortex Hormones / Q000378:metabolism / Q000494:pharmacology; D000701:Analgesics, Opioid / Q000378:metabolism / Q000494:pharmacology; D000928:Antidepressive Agents / Q000378:metabolism / Q000494:pharmacology; D014150:Antipsychotic Agents / Q000378:metabolism / Q000494:pharmacology; D001569:Benzodiazepines / Q000378:metabolism / Q000494:pharmacology; D051544:Cytochrome P-450 CYP3A; D065607:Cytochrome P-450 Enzyme Inhibitors; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics / Q000378:metabolism*; D004347:Drug Interactions; D004791:Enzyme Inhibitors / Q000378:metabolism / Q000494:pharmacology; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000201:enzymology*; D010166:Palliative Care
chemical_list: D000305:Adrenal Cortex Hormones; D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D065607:Cytochrome P-450 Enzyme Inhibitors; D004791:Enzyme Inhibitors; D001569:Benzodiazepines; D003577:Cytochrome P-450 Enzyme System; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human