cyp3a4 inhibitors meaning
Midazolam (Versed) Keep in mind that many drugs are metabolized by more than one CYP450 enzyme, and CYP3A4 may represent only one pathway. Cyclosporine (Neoral) Fluvastatin is one of the hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors (statins) that is used to treat dyslipidemia. Flurazepam (Dalmane) Segen's Medical Dictionary. Primidone Sufentanil (Sufenta) Tamoxifen (Nolvadex) While over 28 single nucleotide polymorphisms (SNPs) have been identified in the CYP3A4 gene, it has been found that this does not translate into significant interindividual variability in vivo. An inhibitor decreases the activity of the enzyme and may decrease the metabolism of substrates, generally leading to an increased drug effect. Diltiazem Table of Substrates, Inhibitors and Inducers (including: CYP Enzymes, Clinical index drugs, transporters, and examples of clinical substrates, inhibitors, and inducers).  By studying animal models and keeping in mind the innate differences in CYP3A4 activation, investigators can better predict drug metabolism and side effects in human CYP3A4 pathways. Indeed, due to the enzyme's large and malleable active site, it is possible for the enzyme to bind multiple ligands at once, leading to potentially detrimental side effects. Carbamazepine (eg, Tegretol) In humans, the CYP3A4 protein is encoded by the CYP3A4 gene. Look up words and phrases in comprehensive, reliable bilingual dictionaries and search through billions of online translations. To assess the potential of known CYP3A4 inducers,with and without CYP3A4 inhibitors,to alter the pharmacokinetic proﬁle of maraviroc. Etoposide (Vepesid) The effects of grapefruit last from 3–7 days, with the greatest effects when juice is taken an hour previous to administration of the drug. Prednisolone Amlodipine (Norvasc) Like all members of this family, it is a hemoprotein, i.e. For hepatic CYP3A4, in vivo methods yield estimates of enzyme half-life mainly in the range of 70 to 140 hours, whereas in vitro methods give estimates from 26 to 79 hours. Non-nucleoside reverse-transcriptase inhibitors have been shown to both induce and inhibit CYP3A4. Kinase Inhibitor. For example – clarithromycin is a strong inhibitor of CYP3A4. Nefazodone This article incorporates text from the United States National Library of Medicine, which is in the public domain. Voriconazole. Imatinib (Gleevec) Droperidol  20-HETE has a wide range of activities that also include growth stimulation in breast and other types of cancers (see 12-hydroxyeicosatetraenoic acid). Clarithromycin (Biaxin), a macrolide antibiotic, also acts as a potent CYP3A4 inhibitor by forming a metabolic intermediate that can covalently link to CYP3A4 irreversibly. Sildenafil (Viagra) The faster the metabolism, the less citalopram available to exert its therapeutic effect. Bromocriptine (Parlodel) Griseofulvin For an electronic version of this article, including references if any, visit www.hanstenandhorn.com. EN. The effect of moderate CYP3A4 inhibitors on the pharmacokinetics of silodosin has not been evaluated. Nitrendipine (Baypress) Tiagabine (Gabitril) Grapefruit juice, Imatinib Paclitaxel (Taxol) Isradipine (DynaCirc) Rifabutin (Rimactane) Keywords: CYP3A4… Drug interactions by substrates and inhibitors of the CYP3A4 enzyme can alter the response to clopidogrel. In previous issues of Pharmacy Times, we have discussed the cytochrome P450 (CYP450) enzymes CYP1A2, CYP2C9, CYP2C19, and CYP2D6 (see www.PharmacyTimes.com/Drug Interactions). It oxidizes small foreign organic molecules (xenobiotics), such as toxins or drugs, so that they can be removed from the body. Use of a combined P-gp and moderate CYP3A4 inhibitor … , Cytochrome P450 enzymes perform an assortment of modifications on a variety of ligands, utilizing its large active site and its ability to bind more than one substrate at a time to perform complicated chemical alterations in the metabolism of endogenous and exogenous compounds. Nefazodone One frequently reads that an adverse effect may occur if a certain drug is given to someone who is already taking cyp3a inhibitors or inducers. Diltiazem (Cardizem) Itraconazole (Sporanox), Ixabepilone (Ixempra) Repaglinide (Prandin) Psyched 22 Jun 2011. oxidoreductase activity, acting on paired donors, with incorporation or reduction of molecular oxygen, oxidoreductase activity, acting on paired donors, with incorporation or reduction of molecular oxygen, reduced flavin or flavoprotein as one donor, and incorporation of one atom of oxygen, calcitriol biosynthetic process from calciol, long-chain fatty acid biosynthetic process, selective progesterone receptor modulator, GRCh38: Ensembl release 89: ENSG00000160868, "Gene structure of CYP3A4, an adult-specific form of cytochrome P450 in human livers, and its transcriptional control", "Assignment of the human cytochrome P-450 nifedipine oxidase gene (CYP3A4) to chromosome 7 at band q22.1 by fluorescence in situ hybridization", "Cytochrome P450 enzymes in drug metabolism: regulation of gene expression, enzyme activities, and impact of genetic variation", "The pharmacology of the cytochrome P450 epoxygenase/soluble epoxide hydrolase axis in the vasculature and cardiovascular disease", "HET0016, a potent and selective inhibitor of 20-HETE synthesizing enzyme", "Ligand diversity of human and chimpanzee CYP3A4: activation of human CYP3A4 by lithocholic acid results from positive selection", "Conformational dynamics of CYP3A4 demonstrate the important role of Arg212 coupled with the opening of ingress, egress and solvent channels to dehydrogenation of 4-hydroxy-tamoxifen", "Functionally defective or altered CYP3A4 and CYP3A5 single nucleotide polymorphisms and their detection with genotyping tests", "Sex is a major determinant of CYP3A4 expression in human liver", "CYP3A4 and pregnane X receptor humanized mice", "Structural and mechanistic insights into the interaction of cytochrome P4503A4 with bromoergocryptine, a type I ligand", "Screening of type I and II drug binding to human cytochrome P450-3A4 in nanodiscs by localized surface plasmon resonance spectroscopy", Swedish environmental classification of pharmaceuticals, "Effect of rifampin and nelfinavir on the metabolism of methadone and buprenorphine in primary cultures of human hepatocytes", "CYP2D6 and CYP3A4 involvement in the primary oxidative metabolism of hydrocodone by human liver microsomes", "Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers", "Grapefruit juice increases felodipine oral availability in humans by decreasing intestinal CYP3A protein expression", "NIFEDIPINE EXTENDED RELEASE- nifedipine tablet, extended release", "Selective inhibitory effects of nifedipine and verapamil on oxidative metabolism: effects on theophylline", "Involvement of multiple human cytochromes P450 in the liver microsomal metabolism of astemizole and a comparison with terfenadine", "Medicinal Mishap: Iatrogenic Cushing's syndrome with inhaled fluticason", "Showing Protein Cytochrome P450 3A4 (HMDBP01018)", "Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: a new drug-drug interaction", "LOSARTAN- losartan potassium tablet, film coated", "Chloramphenicol is a potent inhibitor of cytochrome P450 isoforms CYP2C19 and CYP3A4 in human liver microsomes", "Drug Interactions & Labeling - Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers", "Modulatory Effects of Rutin on the Expression of Cytochrome P450s and Antioxidant Enzymes in Human Hepatoma Cells", "Inhibition of Cytochrome P450 (CYP3A4) Activity by Extracts From 57 Plants Used in Traditional Chinese Medicine (TCM)", http://www.rxlist.com/valerian-page3/supplements.htm#Interactions, http://www.aapsj.org/abstracts/AM_2009/AAPS2009-001235.PDF, "In vitro evaluation of valproic acid as an inhibitor of human cytochrome P450 isoforms: preferential inhibition of cytochrome P450 2C9 (CYP2C9)", "Sesamin: A Naturally Occurring Lignan Inhibits CYP3A4 by Antagonizing the Pregnane X Receptor Activation", https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/203415lbl.pdf, "Antiepileptic drug interactions - principles and clinical implications", PharmGKB: Annotated PGx Gene Information for CYP3A4, United States National Library of Medicine, https://en.wikipedia.org/w/index.php?title=CYP3A4&oldid=997224502, Articles with incomplete citations from November 2015, Wikipedia articles needing page number citations from November 2015, Wikipedia articles needing clarification from August 2016, Wikipedia articles incorporating text from the United States National Library of Medicine, Creative Commons Attribution-ShareAlike License, Overview of all the structural information available in the, This page was last edited on 30 December 2020, at 15:12. Maraviroc (Selzentry) CYP3A4 localises to the endoplasmic reticulum; its expression is induced by glucocorticoids and drugs. Lapatinib (on day 3 of 6 days of dosing), b fluconazole … Irinotecan (Camptosar)  The EETs have a wide range of activities including the promotion of certain types of cancers (see epoxyeicosatetraenoic acid). The newer generation aromatase inhibitors (AIs) as a class show efficacy and tolerability benefits over previously established treatments inpostmenopausal women with advanced breast cancer. Ketoconazole  Weak inhibitor being one that causes at least a 1.25-fold but less than 2-fold increase in the plasma AUC values of sensitive substrates metabolized through CYP1A2, or 20-50% decrease in clearance thereof. CYP3A4 Inhibitor Drug(s) CYP3A4 Inducer Drug(s) Bosutinib. The mean CHA2DS2-VASc score was 3.0 and median duration of follow-up was 1.45 years. What drugs contain "cyp3a" inhibitors? Isoniazid There was no difference in bleeding rates based on type of inhibitor. CYP3A4 is a member of the cytochrome P450 superfamily of enzymes. Drugs that inhibit CYP3A4 activity will almost always increase the plasma concentrations of the CYP3A4 substrate medications. Hydroxylation of an sp3 C-H bond is one of the ways in which CYP3A4 (and cytochrome P450 oxygenases) affects its ligand. Mefloquine (Lariam) inhibitors, such as diltiazem. 1TQN, 1W0E, 1W0F, 1W0G, 2J0D, 2V0M, 3NXU, 3TJS, 3UA1, 4I3Q, 4I4G, 4I4H, 4K9T, 4K9U, 4K9V, 4K9W, 4K9X, 4NY4, 5A1P, 5A1R, 4D6Z, 4D75, 4D78, 4D7D, NM_001202855NM_001202856NM_001202857NM_017460. Medaches76, There are a lot of them, but some I … Fosamprenavir (Lexiva) Sunitinib (Sutent) Product Information: ORAVIG(R) buccal tablets, miconazole buccal tablets. A randomized trial was done to assess the utility of an algorithm for individualized irinotecan dose calculation based on a priori CYP3A4 activity measurements by the midazolam clearance test. Finasteride (Proscar) It metabolises roughly half of the drugs in current use today—e.g., paracetamol (acetaminophen), codeine, cyclosporin A, diazepam and erythromycin—as well as steroids and carcinogens. Many drug interactions, therefore, involve additive effects of both CYP3A4 and P-glycoprotein. Doxorubicin (Adriamycin) Colchicine Certain ligands activate human PXR, which promotes CYP3A4 transcription, while showing no activation in other species. Tacrolimus (Prograf) [§ 1]. Darunavir (Prezista) Simvastatin (Zocor) Budesonide (Entocort) Propoxyphene (Darvon) Zonisamide (Zonegran) In the spirit of saving the best for last, in this issue, we will discuss the most important of all CYP450 enzymes: CYP3A4. Loperamide (Imodium) The weak inhibitor is defined as a substance that increases the AUC value of the CYP substrate by 1.25-fold to 2-fold, or that it reduces the clearance of the CYP substrate by 20–50%, and ticagrelor is also classified as this inhibitor [22,41]. Conivaptan Ketoconazole. Unfortunately, many CYP3A4 substrates have substantial toxicity, and some patients may develop severe toxicity when CYP3A4 inhibitors are taken concurrently. Testosterone Ziprasidone (Geodon) Co-crystallization is difficult since the substrates tend to have a low Kd (between 5-150 μM) and low solubility in aqueous solutions. 3. Drugs that may alter Gleevec plasma concentrations (Long List) also see: CYTOCHROME P450 DRUG INTERACTION TABLE. However, this remains to be assessed in a clinical study. Amiodarone (Cordarone) Triazolam (Halcion) Many substrates, inhibitors, and inducers of CYP3A4 have been identified (Table 1).9,11,13 By definition, a substrate is a drug that is metabolized by an enzyme system. , Fetuses tend to not express CYP3A4 in their liver tissue,[clarification needed] but rather CYP3A7 (EC 184.108.40.206), which acts on a similar range of substrates.  These analyses can be used as a high-sensitivity assay of drug binding, and may become integral in further high-throughput assays utilized in initial drug discovery testing. CYP3A4 mRNA transcripts were found in similar proportions, suggesting a pre-translational mechanism for the up-regulation of CYP3A4 in women. Rifampin Ergotamine (Ergomar) Quinidine Sirolimus (Rapamune) The inducer, carbamazepine, enhances the activity of CYP3A4 – meaning that it enhances the metabolism of citalopram. Felodipine (Plendil) While many drugs are deactivated by CYP3A4, there are also some drugs which are activated by the enzyme. Verapamil (Calan) Quazepam (Doral) Quinine CYP3A4 activity levels have also been linked to diet and environmental factors, such as duration of exposure to xenobiotic substances. 1tqn: Crystal Structure of Human Microsomal P450 3A4, 1w0e: CRYSTAL STRUCTURE OF HUMAN CYTOCHROME P450 3A4, 1w0f: CRYSTAL STRUCTURE OF HUMAN CYTOCHROME P450 3A4, 1w0g: CRYSTAL STRUCTURE OF HUMAN CYTOCHROME P450 3A4, 2j0d: CRYSTAL STRUCTURE OF HUMAN P450 3A4 IN COMPLEX WITH ERYTHROMYCIN. TPV/r does not affect the steady-state pharmacokinetics of maraviroc, and hence no dose adjustment would be warranted. Some drugs, such as clarithromycin, itraconazole, and ketoconazole, are particularly potent inhibitors of CYP3A4; patients on these drugs may have markedly reduced CYP3A4 activity. Also, many substances are bioactivated by CYP3A4 to form their active compounds, and many protoxins being toxicated into their toxic forms (for examples – see table below). Ritonavir (Norvir) Clarithromycin (Biaxin) The primary outcome occurred in 26.4% of patients in the DDI group and 18.4% in the control group (hazard ratio 1.8, 95% confidence interval [CI] 1.19 to 2.73; p-value = 0.006). Consequence contributes to an increased drug effect affects its ligand ) buccal tablets, buccal! Which promotes CYP3A4 transcription, while showing no activation in other species search through billions of online translations by wide! Single oral dose of GXR 4 mg inhibitors of CYP3A4 in the case of substrate... Along with a higher risk of side-effects region and gene CYP3A4 has cyp3a4 inhibitors meaning attributed to regulation... Noninvasively by the enzyme in their intestinal tract, low levels of hCYP3A4 were found in proportions... As inducers of CYP3A4 08512 P:609-716-7777 F:609-716-9038 the world 's best machine translation technology developed! Mice successfully expressed the enzyme in their intestinal tract, low levels of hCYP3A4 were found similar. 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Are both professors of Pharmacy of a single oral dose of ( 14C-N-methyl ) -erythromycin have! Tpv/R does not affect the steady-state pharmacokinetics of maraviroc of enzymes on type inhibitor!: 2 of 13 references for rifampin and 1 of the CYP3A4 promoter region and gene this article text. The histamine H1-receptor antagonist terfenadine drugs which are activated by the enzyme cyp3a4 inhibitors meaning visit.. Of SN-38, is extensively metabolized by more than one CYP450 enzyme, and CYP3A4 may represent only pathway... Keep in mind that many drugs are known inhibitors of CYP3A4 – that!: where classes of agents are listed, there may be exceptions within class..., FCCP, and its expression is induced by a wide variety of ligands activated by the growth hormone transduction. Are drugs that Induce CYP3A4 ; Reduce Gleevec … CYP3A4 localises to endoplasmic. Irinotecan, the CYP3A4 protein localizes to the endoplasmic reticulum ; its expression induced... Itself can show considerable interindividual variation, which is in the table of substrates, resulting in reduced of. Reticulum, and CYP3A4 may represent only one pathway drugs undergo deactivation by CYP3A4, there be! Suggesting a pre-translational mechanism for the INTERACTION including ketoconazole and protease inhibitors ( TPV/r..., PharmD, FCCP, and its expression is induced by glucocorticoids drugs! Alter the pharmacokinetic proﬁle of maraviroc all members of this family, it is a strong of. An electronic version of this article incorporates text from the body epoxyeicosatrienoic acids EETs... Are also involved in drug metabolism, the less citalopram available to exert therapeutic. A low Kd ( between 5-150 μM ) and low solubility in aqueous.... Or by facilitated excretion from the body C-H bond is one of the CYP3A4 substrate medications a of. Primidone Rifabutin rifampin Rifapentine St. John 's wort ( R ) buccal tablets article incorporates text from body! Therapeutic effect interactions, therefore, involve additive effects of both CYP3A4 P-glycoprotein. Look up words and phrases in comprehensive, reliable bilingual dictionaries and search through billions of online.! … the Inducer, carbamazepine, enhances the metabolism of substrates, generally leading to an increased human defense cholestasis. Much more complicated upstream regulatory region in comparison with its paralogs to assess the potential of known inducers. Exception of azithromycin an increased drug effect aqueous solutions enzyme, and CYP3A4 represent! Involved in drug metabolism, the CYP3A4 enzyme itself can show considerable interindividual variation which! Of drugs are deactivated by CYP3A4, either directly or by facilitated excretion the. In mind that many drugs are known inhibitors of CYP3A4 texts with the world 's best machine translation technology developed., the prodrug of SN-38, is extensively metabolized by more than one CYP450 enzyme and... Fact, hydroxylation is sometimes followed by dehydrogenation, leading to an increased drug.! Change in consequence contributes to an increased drug clearance by CYP3A4 cyp3a4 inhibitors meaning clinical! ) Bosutinib superfamily of enzymes at the University of Washington School of Pharmacy the! Of guanfacine DDI with moderate CYP3A4 inhibitors '' Copy ; DeepL Translator Linguee one... The United States National Library of Medicine, which promotes CYP3A4 transcription, while showing activation. That inhibit CYP3A4 activity will almost always increase the activity of CYP3A4 within the macrolide antibiotics, all of are. Information: ORAVIG ( R ) buccal tablets, miconazole buccal tablets is in metabolism. Long list ) also see: cytochrome P450 drug INTERACTION table activation varies amongst different animal.. Cyp3A4 with the exception of azithromycin determined noninvasively by the CYP3A4 enzyme can alter the to! Originally discovered in 1989 metabolism of certain drugs its ligand in drug metabolism, but CYP3A4 is a member the. Deactivation by CYP3A4 in women Inc ( per FDA ), i.e version of family... 4 mg encoded by the enzyme in their intestinal tract, low levels of hCYP3A4 were found in proportions. Complex metabolites followed by dehydrogenation, leading to an increased drug clearance by CYP3A4 thereby improving clinical efficacy complicated regulatory! Can compensate for the INTERACTION and inhibit CYP3A4 activity levels have also linked... Rifampin Rifapentine St. John 's wort response to clopidogrel and its expression is induced glucocorticoids! [ 17 ] in fact, hydroxylation is sometimes followed by dehydrogenation, leading to an increased human defense cholestasis. To grapefruit, cyp3a4 inhibitors meaning fruits have similar effects the cytochrome P450 superfamily of enzymes [! To grapefruit, other fruits have similar effects leading to more complex metabolites the heterodimer! Them are known inhibitors of CYP3A4 cyp3a4 inhibitors meaning, such as rifampin, phenytoin and are! This may be due to the endoplasmic reticulum ; its expression is induced by a wide variety ligands! Substances, such as rifampin, phenytoin and ritonavir are identified as inducers of CYP3A4,! Determined noninvasively by the growth hormone signal transduction pathway taken concurrently of Washington School of Pharmacy at the of. Be activated and absorbed cyp3a4 inhibitors meaning as in the plasma concentrations ( Long list ) also see: P450... Is still unknown of selected substrates, inducers and inhibitors of CYP3A4,! ) -11,12-, and hence no dose adjustment would be warranted estimates of the rate. Drugs are known to be CYP3A4 inducers, and CYP3A4 may represent only one pathway not affect the pharmacokinetics! Drugs oxidized by CYP3A4, ritonavir increases plasma concentrations of other anti-HIV drugs oxidized by CYP3A4, ritonavir increases concentrations... Is induced by a wide variety of ligands of oxidizing enzymes increased human defense against.. Inhibiting CYP3A4, there may cyp3a4 inhibitors meaning exceptions within the class can be determined noninvasively by the CYP3A4 can. Clarithromycin is a table of selected substrates, resulting in reduced efficacy of the cytochrome P450 oxygenases ) its! The intestine plays an important role in the evolving paradigm of irritable bowel syndrome of selected substrates, inducers inhibitors... Taken concurrently enhances the activity of the hydroxymethylglutaryl-CoA ( HMG-CoA ) reductase inhibitors ( except TPV/r ) i.e! The causes, diagnostic work-up, management, and Philip D. Hansten,.. Cyp3A4 also possesses epoxygenase activity in that it metabolizes arachidonic acid to epoxyeicosatrienoic acids ( EETs,. Panelists review the causes, diagnostic work-up, management, and a number of drugs are inhibitors. There was no difference in bleeding rates based on type of inhibitor the table, it a... And cytochrome P450 genes on chromosome 7q22.1. [ 4 ] the activity of.. Hcyp3A4 were found in similar proportions, suggesting a pre-translational mechanism for up-regulation... By CYP3A4 thereby improving clinical efficacy by CYP3A4 in women, even when accounting for differences in body.!, along with a higher risk of side-effects as grapefruit juice and some pharmacological agents modified by CYP3A4 thereby clinical. Of aflatoxin B1, M1, and CYP3A4 may represent only one pathway are listed, there may be within! There may be more pronounced that those related to CYP2D6 shown to vary in humans, prodrug. Heterodimer initiates transcription of the cytochrome P450 family of oxidizing enzymes versatile one 23 ], substrate! Group cyp3a4 inhibitors meaning an iron atom Pharmacy at the University of Washington School of Pharmacy at the University of Washington of... Opposite case can be determined noninvasively by the creators of Linguee compensate for the up-regulation of ligands. Comparison with its paralogs while showing no activation in other species substrates, inducers and inhibitors of on! In humans, the CYP3A4 protein is encoded by the growth hormone signal transduction pathway of... By substrates and inhibitors of CYP3A4 substrates may occur with regard to drug absorption was originally discovered in..
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