Cytochrome P450 2B6

Excerpt from Cafer's Mood Stabilizers and Antiepileptics

Cytochrome P450 2B6 (CYP2B6)

“Tube Socks”

3% of individuals are 2B6 ultrarapid metabolizers; 

7% are poor metabolizers

inDuction = Down 

Decreased substrate levels

induction onsets and reverses slowly, over 2 - 4 weeks =  Delayed

There are no strong 2B6 inducers.

 inHibition = High 

inHibition happens within Hours = Hurried and reverses as soon as the inhibitor is cleared from the body (five half-lives of the inhibitor)

There are no strong 2B6 inhibitors.

Here are the 2B6 inducers:

 Here are the 2B6 inhibitors:

Here are the 2B6 substrates:

       

3% of the population are 2B6 ultrarapid metabolizers (UMs). Methadone efficacy for these individuals will be poor, and their methadone drug screen may be negative. 

Conclusion: Fortunately, there are no strong inhibitors or inducers of 2B6. For psychiatrists, 2B6 is of minimal significance, unless methadone is being prescribed (see above). You will want to run an interaction check (e.g., ePocrates or Lexicomp) whenever a medication regimen includes a shredder, cancer medication, HIV medication, or systemic antifungal.

These interactions featuring the mascots found elsewhere in the book (click image to expand):

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