Differential induction of prehepatic and hepatic metabolism of verapamil by rifampin
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M F Fromm, D Busse, H K Kroemer, M Eichelbaum – 1 October 1996 – Cytochrome P450 (CYP) enzymes, which metabolize numerous drugs, are expressed both in liver and in extrahepatic tissues. CYP3A4 for example is present and inducible by rifampin in epithelial cells of the gastrointestinal tract. It has been shown that such prehepatic metabolism contributes substantially to total clearance of CYP3A4 substrates (e.g., cyclosporine) before and even more pronounced during enzyme induction.