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102 FOCUS ON PHARMACOLOGY PEER REVIEWED TABLE 3 Behavioral Medications That Act as Substrates to Inhibit or Induce the CYP Enzyme in Humans P-450 ENZYME SUBSTRATE INHIBITOR INDUCER CYP 1A2 TCAs Fluvoxamine Mirtazapine Duloxetine Fluvoxamine Fluoxetine Paroxetine Sertraline Some TCAs Fluoroquinolones a Phenobarbital a Carbamazepine a Phenytoin a CYP 2A6 Barbiturates a CYP 2B6 Phenobarbital a 2 CYP C9/ CYP 2C9/10 Sertraline Fluoxetine Amitriptyline Fluvoxamine Fluoxetine Sertraline Fluconazole a Sulfaphenazole a Carbamazepine a Phenobarbital a Phenytoin a 2C19/CYP 2C19 Citaprolam Sertraline Clomipramine Imipramine Fluvoxamine Fluoxetine Sertraline Omeprazole a Carbamazepine a CYP 2D6 Fluoxetine Fluvoxamine Citalopram Duloxetine Paroxetine Venlafaxine Trazodone Nefazodone TCAs Duloxetine Fluoxetine Paroxetine Norfluoxetine Citalopram Sertraline Some TCAs CYP 2E1 CYP 3A4 Nefazodone Sertraline Venlafaxine Trazodone TCAs Fluvoxamine Norfluoxetine TCAs, barbiturates Dexamethasone/long-term glucocorticoids Phenytoin St. John's wort b Flucloxacillin Nefazodone a Fluconazole a Ketoconazole a Cimetidine a Macrolides: clarithromycin, erythromycin a Propofol Carbamazepine a Barbiturates a Dexamethasone/long-term glucocorticoids a Phenytoin a St. John's wort a,b Flucloxacillin a Inducers slow the rate at which the substrate medication is available and lower the amount available. Inhibitors increase the rate at which the substrate medication is available and increase the amount available. There are few detailed studies for dogs, but the patterns identified to date do not deviate from these, so consideration should be given to monitoring patients carefully when medications from these classes are combined. TCA, tricyclic antidepressant. Adapted from Overall. 5 a Medications used for nonbehavioral conditions. b Hyperforin is the compound that is the inducer.