Her Patients Never Wake Up on Time

Fatal Forty DDI: midazolam, diltiazem, alfentanil, CYP3A4, CYP3A5, CYP3A7
  • Toby N. Weingarten
  • Erica D. Wittwer
  • Wayne T. Nicholson


This is an example of one drug (diltiazem hydrochloride) suppressing hepatic metabolism of two other drugs (midazolam hydrochloride and alfentanil hydrochloride) through inhibition of several isoenzymes in the cytochrome P450 3A family


Pharmacokinetic Cytochrome P450 3A4 3A5 3A7 CYP CYP3A CYP3A4 CYP3A5 CYP3A7 Inhibitor Inhibition Diltiazem Alfentanil Midazolam Extubation Cardiac anesthesia Noralfentanil N-phenylpropionamide N-demethylation Hydroxymidazolam 4 –hydroxymidazolam Fast-track Fast-track anesthesia 


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Toby N. Weingarten
    • 1
  • Erica D. Wittwer
    • 1
  • Wayne T. Nicholson
    • 1
  1. 1.Department of AnesthesiologyMayo ClinicRochesterUSA

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