Cytochrome P450 3A (including 3A4) inhibitors and inducers

Strong inhibitors	Moderate inhibitors	Strong inducers	Moderate inducers
Adagrasib Atazanavir Ceritinib Clarithromycin Cobicistat and cobicistat-containing coformulations Darunavir Idelalisib Indinavir Itraconazole Ketoconazole Levoketoconazole Lonafarnib Lopinavir Mifepristone^* Nefazodone Nelfinavir Nirmatrelvir-ritonavir Ombitasvir-paritaprevir-ritonavir Ombitasvir-paritaprevir-ritonavir plus dasabuvir Posaconazole Ritonavir and ritonavir-containing coformulations Saquinavir Tucatinib Voriconazole	Amiodarone^¶ Aprepitant Avacopan Berotralstat Cimetidine^¶ Conivaptan Crizotinib Cyclosporine^¶ Diltiazem Duvelisib Dronedarone Erythromycin Fedratinib Fluconazole Fosamprenavir Fosaprepitant^¶ Fosnetupitant-palonosetron Grapefruit juice Imatinib Isavuconazole (isavuconazonium sulfate) Lefamulin Letermovir Netupitant Nilotinib Nirogecestat Ribociclib Schisandra Verapamil	Apalutamide Carbamazepine Encorafenib Enzalutamide Fosphenytoin Lumacaftor Lumacaftor-ivacaftor Mitotane Phenytoin Rifampin (rifampicin)	Bexarotene Bosentan Cenobamate Dabrafenib Dexamethasone^Δ Dipyrone Efavirenz Elagolix, estradiol, and norethindrone therapy pack^◊ Eslicarbazepine Etravirine Fexinidazole Lorlatinib Mitapivat Modafinil Nafcillin Pacritinib Pexidartinib Phenobarbital Primidone Repotrectinib Rifabutin Rifapentine Sotorasib St. John's wort

For drug interaction purposes, the inhibitors and inducers of CYP3A metabolism listed above can alter serum concentrations of drugs that are dependent upon the CYP3A subfamily of liver enzymes, including CYP3A4, for elimination or activation.
These classifications are based upon US Food and Drug Administration (FDA) guidance.^[1,2] Other sources may use a different classification system, resulting in some agents being classified differently.
Data are for systemic drug forms. Degree of inhibition or induction may be altered by dose, method, and timing of administration.
Weak inhibitors and inducers are not listed in this table with exception of a few examples. Clinically significant interactions can occasionally occur due to weak inhibitors and inducers (eg, target drug is highly dependent on CYP3A4 metabolism and has a narrow therapeutic index). Accordingly, specific interactions should be checked using a drug interaction program such as the drug interactions program included within UpToDate.
Refer to UpToDate topics on specific agents and indications for further details.

CYP: cytochrome P450.

* Mifepristone is a strong inhibitor of CYP3A4 when used chronically (eg, for hyperglycemia in patients with Cushing syndrome). The CYP3A4 inhibitory effect of a single 200 mg mifepristone dose is likely to be weaker and transient; however, specific data are lacking.

¶ Classified as a weak inhibitor of CYP3A4, according to FDA system.^[1]

Δ Classified as a weak inducer of CYP3A4, according to FDA system.^[1]

◊ The fixed-dose combination therapy pack taken in the approved regimen has moderate CYP3A4 induction effects. When elagolix is used as a single agent, it is a weak CYP3A4 inducer. Norethindrone and estradiol are not CYP3A4 inducers.

Data from: UpToDate Lexidrug. More information available at https://online.lexi.com/.

References:

M12 drug interaction studies: Guidance for industry. US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research (CDER), Center for Biologics Evaluation and Research (CBER). https://www.fda.gov/media/161199/download (Accessed on June 12, 2025). Summary available at https://www.fda.gov/media/135586/download (Accessed on June 12, 2025).
US Food and Drug Administration. Drug development and drug interactions: Table of substrates, inhibitors and inducers. https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and-drug-interactions-table-substrates-inhibitors-and-inducers (Accessed on June 12, 2025).

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Cytochrome P450 3A (including 3A4) inhibitors and inducers