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Interactions by alterations in the metabolism are most frequently related to have clinical impact. Hepatic impact Enzyme induction : phenobarbital induces the synthesis pathway of enzymes responsible for the metabolism and therefore decrease the half life and plasma drug concentration Enzyme inhibition: cimetidine , ciprofloxacin , ketoconazole . Inhibit drug metabolism , increased half life and plasma concentration . Increase toxic effects . Most often , the inhibition of cytochrome P-450

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