▶ Aprepitant

o

is predicted to increase the exposure to sunitinib.

Theoretical

▶ Calcium channel blockers (diltiazem, verapamil) are predicted to

increase the exposure to sunitinib.oTheoretical

▶ Cobicistat is predicted to slightly increase the exposure to

sunitinib. Avoid or adjust sunitinib dose, p. 999.oStudy

▶ Sunitinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Crizotinib

o

is predicted to increase the exposure to sunitinib.

Theoretical → Also see TABLE 15 p. 1378 → Also see TABLE 9

p. 1377

▶ Elbasvir is predicted to increase the concentration of sunitinib.

Use with caution and adjust dose.oTheoretical

▶ Enzalutamide is predicted to decrease the exposure to

sunitinib. Avoid or adjust sunitinib dose, p. 999.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

sunitinib. Avoid.oTheoretical

▶ Grazoprevir is predicted to increase the concentration of

sunitinib

Theoretical

. Use with caution and adjust dose.o ▶ HIV-protease inhibitors are predicted to slightly increase the

o

exposure to sunitinib. Avoid or adjust sunitinib dose, p. 999.

Study → Also see TABLE 9 p. 1377

▶ Idelalisib is predicted to slightly increase the exposure to

sunitinib

Study → Also see

. Avoid or adjust

TABLE 15 p. 1378

sunitinib dose, p. 999.o ▶ Imatinib

o

is predicted to increase the exposure to sunitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Macrolides (clarithromycin) are predicted to slightly increase

the exposure to

o

sunitinib. Avoid or adjust sunitinib dose, p. 999.

Study → Also see TABLE 9 p. 1377

▶ Macrolides (erythromycin) are predicted to increase the

exposure to sunitinib.oTheoretical → Also see TABLE 9

p. 1377

BNF 78 Sulfasalazine — Sunitinib 1537

Interactions | Appendix 1

A1

Sunitinib (continued)

▶ Mitotane is predicted to decrease the exposure to sunitinib.

Avoid or adjust sunitinib dose, p. 999.oStudy → Also see

TABLE 15 p. 1378

▶ Netupitant

o

is predicted to increase the exposure to sunitinib.

Theoretical

▶ Nilotinib

o

is predicted to increase the exposure to sunitinib.

Theoretical → Also see TABLE 15 p. 1378 → Also see TABLE 9

p. 1377

▶ Sunitinib is predicted to increase the risk of bleeding events

when given with phenindione.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to sunitinib.

Avoid or adjust sunitinib dose, p. 999.oStudy

Suxamethonium → see TABLE 20 p. 1379 (neuromuscular blocking

effects)

▶ Alkylating agents (cyclophosphamide) increase the risk of

prolonged neuromuscular blockade when given with

suxamethonium.oStudy

▶ Antiarrhythmics (lidocaine) are predicted to increase the effects

of suxamethonium.oStudy

▶ Anticholinesterases, centrally acting increase the effects of

suxamethonium.oTheoretical

▶ Antiepileptics (carbamazepine) increase the risk of prolonged

neuromuscular blockade when given with

o

suxamethonium.

Study

▶ Antiepileptics (fosphenytoin, phenytoin) increase the effects of

suxamethonium.oStudy

▶ Clindamycin

Anecdotal

increases the effects of suxamethonium.r

▶ Corticosteroids are predicted to decrease the effects of

suxamethonium.rAnecdotal

▶ Suxamethonium is predicted to increase the risk of

cardiovascular side-effects when given with

Anecdotal

digoxin.r

▶ Irinotecan is predicted to increase the risk of prolonged

neuromuscular blockade when given with

o

suxamethonium.

Theoretical

▶ Intravenous magnesium is predicted to increase the effects of

suxamethonium.oStudy

▶ Metoclopramide

o

increases the effects of suxamethonium.

Study

▶ Penicillins

o

(piperacillin) increase the effects of suxamethonium.

Study

▶ SSRIs potentially increase the risk of prolonged

q

neuromuscular blockade when given with suxamethonium.

Theoretical

Sympathomimetics, inotropic

dobutamine . dopamine. ▶ Sympathomimetics, inotropic are predicted to decrease the

effects of apraclonidine. Avoid.rTheoretical

▶ Beta blockers, non-selective increase the risk of hypertension

Theoretical

and bradycardia when given with dobutamine.r

▶ Beta blockers, selective increase the risk of hypertension and

bradycardia when given with dobutamine.oTheoretical

▶ Entacapone is predicted to increase the risk of cardiovascular

o

side-effects when given with sympathomimetics, inotropic.

Theoretical

▶ Ergometrine potentially increases the risk of peripheral

vasoconstriction when given with

Anecdotal

dopamine. Avoid.r

▶ Guanethidine

r

is predicted to increase the effects of dopamine.

Theoretical

▶ Sympathomimetics, inotropic are predicted to increase the risk

of elevated blood pressure when given with

r

linezolid. Avoid.

Theoretical

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of a hypertensive crisis when

given with sympathomimetics, inotropic. Avoid and for 14 days

after stopping the MAOI.rTheoretical

▶ Monoamine-oxidase B inhibitors are predicted to increase the

risk of a hypertensive crisis when given with

sympathomimetics, inotropic. Avoid.rAnecdotal

▶ Opicapone is predicted to increase the risk of cardiovascular

side-effects when given with

r

sympathomimetics, inotropic.

Theoretical

▶ Tolcapone is predicted to increase the risk of cardiovascular

o

side-effects when given with sympathomimetics, inotropic.

Theoretical

Sympathomimetics, vasoconstrictor

adrenaline/epinephrine . ephedrine .isometheptene . metaraminol . midodrine . noradrenaline/norepinephrine . phenylephrine . pseudoephedrine . xylometazoline.

ROUTE-SPECIFIC INFORMATION Since systemic absorption can

follow topical application, the possibility of interactions

should be borne in mind.

▶ Ephedrine increases the risk of side-effects when given with

aminophylline. Avoid in children.oStudy

▶ Sympathomimetics, vasoconstrictor are predicted to decrease

the effects of apraclonidine. Avoid.rTheoretical

▶ Atropine increases the risk of severe hypertension when given

with phenylephrine.rStudy

▶ Beta blockers, non-selective are predicted to increase the risk

of hypertension and bradycardia when given with

sympathomimetics, vasoconstrictor (adrenaline/epinephrine,

noradrenaline/norepinephrine).rStudy

▶ Beta blockers, selective are predicted to increase the risk of

hypertension and bradycardia when given with

sympathomimetics, vasoconstrictor (adrenaline/epinephrine,

noradrenaline/norepinephrine).rStudy

▶ Isometheptene potentially increases the risk of side-effects

when given with dopamine receptor agonists (bromocriptine).

Avoid.rAnecdotal

▶ Entacapone is predicted to increase the risk of cardiovascular

side-effects when given with sympathomimetics, vasoconstrictor

(adrenaline/epinephrine, noradrenaline/norepinephrine)

o .

Study

▶ Ergometrine is predicted to increase the risk of peripheral

vasoconstriction when given with

noradrenaline/norepinephrine.rAnecdotal

▶ Guanethidine

Anecdotal

increases the effects of metaraminol.r

▶ Guanethidine

Study

increases the effects of phenylephrine.r

▶ Guanethidine is predicted to increase the effects of

sympathomimetics, vasoconstrictor (adrenaline/epinephrine,

noradrenaline/norepinephrine).oStudy

▶ Pseudoephedrine increases the risk of elevated blood pressure

when given with linezolid. Avoid.rStudy

▶ Sympathomimetics, vasoconstrictor (adrenaline/epinephrine,

ephedrine, isometheptene, noradrenaline/norepinephrine,

phenylephrine) are predicted to increase the risk of elevated

blood pressure when given with

Theoretical

linezolid. Avoid.r

▶ Mianserin decreases the effects of ephedrine.rAnecdotal

▶ Moclobemide is predicted to increase the risk of a hypertensive

crisis when given with sympathomimetics, vasoconstrictor

(ephedrine, isometheptene, phenylephrine, pseudoephedrine).

Avoid.rStudy

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of a hypertensive crisis when

given with sympathomimetics, vasoconstrictor. Avoid and for

14 days after stopping the MAOI.rStudy

▶ Monoamine-oxidase B inhibitors are predicted to increase the

risk of a hypertensive crisis when given with

sympathomimetics, vasoconstrictor. Avoid.rAnecdotal

▶ Opicapone is predicted to increase the risk of cardiovascular

side-effects when given with sympathomimetics, vasoconstrictor

(adrenaline/epinephrine, noradrenaline/norepinephrine)

r .

Theoretical

▶ Ephedrine increases the risk of side-effects when given with

theophylline. Avoid in children.oStudy

▶ Tolcapone is predicted to increase the effects of

sympathomimetics, vasoconstrictor (adrenaline/epinephrine,

noradrenaline/norepinephrine).oTheoretical

▶ Tricyclic antidepressants are predicted to decrease the effects

of ephedrine. Avoid.rStudy

1538 Sunitinib — Sympathomimetics, vasoconstrictor BNF 78

Interactions | Appendix 1

A1

▶ Tricyclic antidepressants increase the effects of

sympathomimetics, vasoconstrictor (adrenaline/epinephrine,

noradrenaline/norepinephrine, phenylephrine)

Study

. Avoid.r

Tacalcitol → see vitamin D substances

Tacrolimus → see TABLE 2 p. 1375 (nephrotoxicity), TABLE 16 p. 1379

(increased serum potassium)

▶ Pomelo and pomegranate juices might greatly increase the

concentration of tacrolimus.

▶ Since systemic absorption can follow topical application,

the possibility of interactions should be borne in mind.

▶ Alcohol (beverage) increases the risk of facial flushing and skin

irritation when given with topical tacrolimus.oStudy

▶ Antiarrhythmics (amiodarone) are predicted to increase the

concentration of tacrolimus.rAnecdotal

▶ Antiarrhythmics (dronedarone) are predicted to increase the

concentration of tacrolimus.rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) decrease the concentration of

tacrolimus. Monitor and adjust dose.rStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the concentration of

r

tacrolimus.

Study

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the concentration of tacrolimus. Monitor

and adjust dose.rStudy

▶ Antifungals, azoles (miconazole) are predicted to increase the

concentration of

Theoretical

tacrolimus. Monitor and adjust dose.r

▶ Aprepitant is predicted to increase the concentration of

tacrolimus.rStudy

▶ Bosentan is predicted to decrease the concentration of

tacrolimus and tacrolimus potentially increases the

concentration of bosentan. Avoid.rTheoretical

▶ Brigatinib potentially decreases the concentration of

tacrolimus. Avoid.oTheoretical

▶ Calcium channel blockers (diltiazem, verapamil) are predicted to

increase the concentration of tacrolimus.rStudy

▶ Calcium channel blockers (nicardipine) potentially increase the

concentration of tacrolimus. Monitor concentration and

adjust dose.rAnecdotal

▶ Ceritinib is predicted to increase the exposure to tacrolimus.

Avoid.rTheoretical

▶ Chloramphenicol

r

increases the concentration of tacrolimus.

Study

▶ Ciclosporin

r

increases the concentration of tacrolimus. Avoid.

Study → Also see TABLE 2 p. 1375 → Also see TABLE 16 p. 1379

▶ Cobicistat is predicted to increase the concentration of

tacrolimus. Monitor and adjust dose.rStudy

▶ Crizotinib is predicted to increase the concentration of

tacrolimus.rStudy

▶ Tacrolimus is predicted to increase the exposure to dabigatran.

Avoid.rTheoretical

▶ Danazol

r

potentially increases the concentration of tacrolimus.

Anecdotal

▶ Doravirine is predicted to decrease the exposure to tacrolimus.

Monitor

o

tacrolimus concentration and adjust dose, p. 841.

Theoretical

▶ Efavirenz is predicted to decrease the concentration of

tacrolimus. Monitor and adjust dose.oTheoretical

▶ Enzalutamide decreases the concentration of tacrolimus.

Monitor and adjust dose.rStudy

▶ Glecaprevir (with pibrentasvir) slightly increases the exposure

to tacrolimus. Monitor and adjust dose.nStudy

▶ Grapefruit juice greatly increases the concentration of

tacrolimus. Avoid.rStudy

▶ Grazoprevir

Study

increases the exposure to tacrolimus.o ▶ HIV-protease inhibitors are predicted to increase the

concentration of

Study

tacrolimus. Monitor and adjust dose.r

▶ Idelalisib is predicted to increase the concentration of

tacrolimus. Monitor and adjust dose.rStudy

▶ Imatinib is predicted to increase the concentration of

tacrolimus.rStudy

▶ Letermovir moderately increases the exposure to tacrolimus.

Monitor and adjust dose.rStudy

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

tacrolimus. Public Health England advises avoid (refer to

Green Book).rTheoretical

▶ Tacrolimus is predicted to increase the exposure to lomitapide.

Separate administration by 12 hours.oTheoretical

▶ Lumacaftor is predicted to decrease the exposure to

tacrolimus. Avoid.rTheoretical

▶ Macrolides (clarithromycin) are predicted to increase the

concentration of

Study

tacrolimus. Monitor and adjust dose.r

▶ Macrolides (erythromycin) are predicted to increase the

concentration of tacrolimus.rStudy

▶ Tacrolimus is predicted to affect the efficacy of mifamurtide.

Avoid.rTheoretical

▶ Mitotane decreases the concentration of tacrolimus. Monitor

and adjust dose.rStudy

▶ Monoclonal antibodies (sarilumab) potentially affect the

exposure to

Theoretical

tacrolimus. Monitor and adjust dose.o ▶ Netupitant is predicted to increase the concentration of

tacrolimus.rStudy

▶ Nevirapine is predicted to decrease the concentration of

tacrolimus. Monitor and adjust dose.oTheoretical

▶ Nilotinib is predicted to increase the concentration of

tacrolimus.rStudy

▶ Palbociclib is predicted to increase the exposure to tacrolimus.

Adjust dose.oTheoretical

▶ Pibrentasvir (with glecaprevir) slightly increases the exposure

to tacrolimus. Monitor and adjust dose.nStudy

▶ Pitolisant is predicted to decrease the exposure to tacrolimus.

Avoid.rTheoretical

▶ Ranolazine increases the concentration of tacrolimus. Adjust

dose.rAnecdotal

▶ Ribociclib is predicted to increase the exposure to tacrolimus.

Use with caution and adjust dose.oTheoretical

▶ Rifampicin decreases the concentration of tacrolimus. Monitor

and adjust dose.rStudy

▶ Rucaparib is predicted to increase the exposure to tacrolimus.

Monitor and adjust dose.oStudy

▶ Sirolimus is predicted to decrease the concentration of

tacrolimus

r

and tacrolimus increases the exposure to sirolimus.

Study

▶ St John’s Wort decreases the concentration of tacrolimus.

Avoid.rStudy

▶ Tacrolimus

Study

increases the exposure to tofacitinib. Avoid.r

▶ Tacrolimus potentially increases the risk of serotonin

syndrome when given with venlafaxine.rAnecdotal

Tadalafil → see phosphodiesterase type-5 inhibitors

Tamoxifen → see TABLE 5 p. 1375 (thromboembolism)

▶ Bupropion is predicted to decrease the efficacy of tamoxifen.

Avoid.rStudy

▶ Cinacalcet is predicted to decrease the efficacy of tamoxifen.

Avoid.rStudy

▶ Tamoxifen

r

increases the anticoagulant effect of coumarins.

Study

▶ Rifampicin

q

markedly decreases the exposure to tamoxifen.

Study

▶ Rolapitant

r

is predicted to increase the exposure to tamoxifen.

Study

▶ SSRIs (fluoxetine, paroxetine) are predicted to decrease the

efficacy of tamoxifen. Avoid.rStudy

▶ Terbinafine is predicted to decrease the efficacy of tamoxifen.

Avoid.rStudy

Tamsulosin → see alpha blockers

Tapentadol → see opioids

Taxanes → see TABLE 15 p. 1378 (myelosuppression), TABLE 12 p. 1378

(peripheral neuropathy)

cabazitaxel . docetaxel . paclitaxel.

BNF 78 Sympathomimetics, vasoconstrictor —Taxanes 1539

Interactions | Appendix 1

A1

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to cabazitaxel.oTheoretical

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to paclitaxel.rTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to docetaxel.rTheoretical → Also see TABLE 12 p. 1378

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to taxanes (cabazitaxel, paclitaxel). Avoid.rStudy → Also

see TABLE 12 p. 1378

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Theoretical

cabazitaxel.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

r

cabazitaxel. Avoid.

Study

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to moderately increase the exposure to docetaxel.

Avoid or adjust dose.rStudy

▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

Theoretical

paclitaxel.r

▶ Antifungals, azoles (miconazole) are predicted to increase the

concentration of

o

docetaxel. Use with caution and adjust dose.

Theoretical

▶ Aprepitant

o

is predicted to increase the exposure to cabazitaxel.

Theoretical

▶ Bosentan is predicted to decrease the exposure to cabazitaxel.

Avoid.rStudy

▶ Calcium channel blockers (diltiazem, verapamil) are predicted to

increase the exposure to cabazitaxel.oTheoretical

▶ Ceritinib

o

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