Avoid moderate inhibitors of CYP3A4 or adjust olaparib dose,

p. 1005.oTheoretical

▶ Netupitant is predicted to increase the exposure to opioids

(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and

adjust dose.oStudy

▶ Netupitant is predicted to increase the exposure to opioids

(methadone, sufentanil).oTheoretical

▶ Netupitant is predicted to increase the exposure to oxybutynin.

nTheoretical

▶ Netupitant

o

is predicted to increase the exposure to pazopanib.

Theoretical

▶ Netupitant is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors (avanafil). Adjust avanafil

dose, p. 812.oTheoretical

▶ Netupitant is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors (sildenafil). Monitor or

adjust sildenafil dose with moderate inhibitors of CYP3A4,

p. 813.oStudy

▶ Netupitant is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors (tadalafil).rTheoretical

▶ Netupitant is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors

r

(vardenafil). Adjust dose.

Theoretical

▶ Netupitant is predicted to increase the exposure to pimozide.

Avoid.rTheoretical

▶ Netupitant is predicted to increase the exposure to quetiapine.

Avoid.oStudy

▶ Netupitant

r

is predicted to increase the exposure to ranolazine.

Study

▶ Netupitant

o

is predicted to increase the exposure to ribociclib.

Study

▶ Rifampicin is predicted to decrease the exposure to netupitant.

Avoid.rStudy

▶ Netupitant

o

is predicted to increase the exposure to ruxolitinib.

Theoretical

▶ Netupitant is predicted to increase the exposure to saxagliptin.

nStudy

▶ Netupitant increases the concentration of sirolimus. Monitor

and adjust dose.oStudy

▶ Netupitant is predicted to increase the exposure to SSRIs

(dapoxetine). Adjust dapoxetine dose with moderate inhibitors

of CYP3A4, p. 821.oTheoretical

▶ St John’s Wort is predicted to decrease the exposure to

netupitant.oTheoretical

▶ Netupitant is predicted to increase the exposure to statins

(atorvastatin). Monitor and adjust dose.rStudy

▶ Netupitant is predicted to increase the exposure to statins

(simvastatin). Use with caution and adjust simvastatin dose,

p. 205.rStudy

▶ Netupitant

o

is predicted to increase the exposure to sunitinib.

Theoretical

▶ Netupitant is predicted to increase the concentration of

tacrolimus.rStudy

▶ Netupitant is predicted to increase the exposure to taxanes

(cabazitaxel).oTheoretical

▶ Netupitant slightly increases the exposure to taxanes

(docetaxel).oStudy

▶ Netupitant is predicted to increase the exposure to taxanes

(paclitaxel).oStudy

▶ Netupitant is predicted to increase the concentration of

temsirolimus.oTheoretical

▶ Netupitant is predicted to increase the exposure to tezacaftor.

Adjust tezacaftor with ivacaftor p. 295 dose with moderate

inhibitors of CYP3A4.rStudy

▶ Netupitant given with a potent CYP2C19 inhibitor is predicted

to increase the exposure to tofacitinib. Adjust tofacitinib dose,

p. 1105.oStudy

▶ Netupitant is predicted to increase the exposure to tolterodine.

nTheoretical

▶ Netupitant is predicted to increase the exposure to tolvaptan.

Manufacturer advises caution or adjust tolvaptan dose with

moderate inhibitors of CYP3A4, p. 669.oStudy

▶ Netupitant

o

is predicted to increase the exposure to trazodone.

Theoretical

▶ Netupitant is predicted to increase the exposure to ulipristal.

Avoid if used for uterine fibroids.oStudy

▶ Netupitant is predicted to increase the exposure to venetoclax.

Avoid or adjust dose—consult product literature.rStudy

▶ Netupitant is predicted to increase the exposure to vinca

alkaloids.rTheoretical

▶ Netupitant is predicted to increase the exposure to zopiclone.

Adjust dose.oStudy

Neuromuscular blocking drugs, non-depolarising → see TABLE 6

p. 1376 (bradycardia), TABLE 20 p. 1379 (neuromuscular blocking effects)

atracurium . cisatracurium. mivacurium . pancuronium. rocuronium. ▶ Anticholinesterases, centrally acting are predicted to decrease

the effects of

o

neuromuscular blocking drugs, non-depolarising.

Theoretical → Also see TABLE 6 p. 1376

▶ Antiepileptics (carbamazepine) are predicted to decrease the

effects of (but acute use increases the effects of) neuromuscular

blocking drugs, non-depolarising (atracurium, cisatracurium,

pancuronium, rocuronium)

Study

. Monitor and adjust dose.o ▶ Antiepileptics (fosphenytoin, phenytoin) decrease the effects of

(but acute use increases the effects of) neuromuscular blocking

drugs, non-depolarising (atracurium, cisatracurium,

pancuronium, rocuronium).oStudy

▶ Clindamycin increases the effects of neuromuscular blocking

drugs, non-depolarising.rAnecdotal

▶ Corticosteroids are predicted to decrease the effects of

neuromuscular blocking drugs, non-depolarising

Anecdotal

.r

1500 Netupitant — Neuromuscular blocking drugs, non-depolarising BNF 78

Interactions | Appendix 1

A1

▶ Pancuronium is predicted to increase the risk of cardiovascular

side-effects when given with digoxin.rAnecdotal

▶ Irinotecan is predicted to decrease the effects of

neuromuscular blocking drugs, non-depolarising

Theoretical

.o ▶ Intravenous magnesium increases the effects of neuromuscular

blocking drugs, non-depolarising.oStudy

▶ Metoclopramide is predicted to increase the effects of

neuromuscular blocking drugs, non-depolarising

Theoretical

.o ▶ Penicillins (piperacillin) increase the effects of neuromuscular

blocking drugs, non-depolarising.oStudy

▶ SSRIs potentially increase the risk of prolonged

q

neuromuscular blockade when given with mivacurium.

Theoretical

Nevirapine

▶ Nevirapine is predicted to decrease the exposure to

antiarrhythmics (dronedarone).rTheoretical

▶ Nevirapine is predicted to decrease the concentration of

antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) and antiepileptics (carbamazepine,

fosphenytoin, phenobarbital, phenytoin, primidone) are

predicted to decrease the concentration of

Study

nevirapine.r

▶ Antifungals, azoles (fluconazole) slightly to moderately increase

the exposure to nevirapine.oStudy

▶ Nevirapine is predicted to decrease the exposure to antifungals,

azoles (isavuconazole). Avoid.rTheoretical

▶ Nevirapine moderately decreases the exposure to antifungals,

azoles (itraconazole). Avoid and for 14 days after stopping

nevirapine.oStudy

▶ Nevirapine moderately decreases the exposure to antifungals,

azoles (ketoconazole). Avoid.rStudy

▶ Nevirapine is predicted to decrease the exposure to antifungals,

azoles (voriconazole) and antifungals, azoles (voriconazole)

increase the exposure to

r

nevirapine. Monitor and adjust dose.

Theoretical

▶ Nevirapine

o

is predicted to decrease the exposure to aprepitant.

Study

▶ Nevirapine

o

is predicted to decrease the exposure to axitinib.

Theoretical

▶ Nevirapine is predicted to decrease the exposure to

bedaquiline. Avoid.rStudy

▶ Bosentan

r

is predicted to decrease the exposure to nevirapine.

Theoretical

▶ Nevirapine is predicted to decrease the exposure to bosutinib.

Avoid.rTheoretical

▶ Nevirapine is predicted to decrease the exposure to brigatinib.

Avoid.rStudy

▶ Nevirapine is predicted to decrease the exposure to

cabozantinib.oTheoretical

▶ Nevirapine is predicted to decrease the exposure to calcium

channel blockers (amlodipine, felodipine, lacidipine,

lercanidipine, nicardipine, nifedipine, nimodipine). Monitor and

adjust dose.oTheoretical

▶ Nevirapine is predicted to decrease the exposure to calcium

channel blockers (diltiazem, verapamil).oTheoretical

▶ Nevirapine is predicted to decrease the exposure to

cariprazine. Avoid.rTheoretical

▶ Nevirapine is predicted to decrease the concentration of

caspofungin. Adjust dose.oTheoretical

▶ Nevirapine is predicted to decrease the concentration of

ciclosporin.oStudy

▶ Nevirapine is predicted to decrease the exposure to cobicistat.

Avoid.rTheoretical

▶ Nevirapine is predicted to decrease the exposure to

cobimetinib. Avoid.rTheoretical

▶ Nevirapine is predicted to decrease the efficacy of combined

hormonal contraceptives. For FSRH guidance, see

Contraceptives, interactions p. 794.rStudy

▶ Nevirapine potentially alters the anticoagulant effect of

coumarins.rAnecdotal

▶ Nevirapine is predicted to decrease the exposure to crizotinib.

Avoid.rTheoretical

▶ Nevirapine is predicted to decrease the exposure to dasabuvir.

Avoid.rTheoretical

▶ Nevirapine

r

is predicted to decrease the exposure to dasatinib.

Study

▶ Nevirapine is predicted to decrease the efficacy of desogestrel.

For FSRH guidance, see

r

Contraceptives, interactions p. 794.

Theoretical

▶ Nevirapine decreases the exposure to dolutegravir. Adjust

dose.rStudy

▶ Nevirapine is predicted to decrease the exposure to doravirine.

Avoid or adjust doravirine dose, p. 644.rTheoretical

▶ Nevirapine

r

decreases the concentration of efavirenz. Avoid.

Study

▶ Nevirapine is predicted to moderately decrease the exposure

to elbasvir. Avoid.rStudy

▶ Nevirapine

o

is predicted to decrease the exposure to eliglustat.

Theoretical

▶ Nevirapine is predicted to decrease the concentration of

elvitegravir. Avoid.rTheoretical

▶ Enzalutamide is predicted to decrease the exposure to

nevirapine.rTheoretical

▶ Nevirapine

o

is predicted to decrease the effects of ergotamine.

Theoretical

▶ Nevirapine

r

is predicted to decrease the exposure to erlotinib.

Theoretical

▶ Nevirapine is predicted to decrease the efficacy of etonogestrel.

For FSRH guidance, see

r

Contraceptives, interactions p. 794.

Theoretical

▶ Nevirapine is predicted to decrease the exposure to etravirine.

Avoid.rStudy

▶ Nevirapine is predicted to decrease the concentration of

everolimus. Avoid or adjust dose.rStudy

▶ Nevirapine is predicted to decrease the exposure to

fosaprepitant.oTheoretical

▶ Nevirapine is predicted to decrease the exposure to gefitinib.

Avoid.rTheoretical

▶ Nevirapine is predicted to decrease the exposure to

glecaprevir. Avoid.rStudy

▶ Nevirapine is predicted to markedly decrease the exposure to

grazoprevir. Avoid.rStudy

▶ Nevirapine is predicted to decrease the concentration of

guanfacine. Adjust dose.oTheoretical

▶ Nevirapine decreases the exposure to HIV-protease inhibitors.

Refer to specialist literature.oStudy

▶ Nevirapine is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ Nevirapine is predicted to decrease the exposure to idelalisib.

Avoid.oTheoretical

▶ Nevirapine

o

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