. Monitor and adjust dose.

Study

▶ Mitotane is predicted to decrease the exposure to

corticosteroids (fluticasone).qTheoretical

▶ Mitotane is predicted to markedly decrease the exposure to

crizotinib. Avoid.rStudy → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to dabrafenib.

Avoid.oTheoretical → Also see TABLE 15 p. 1378

▶ Mitotane

o

is predicted to decrease the exposure to darifenacin.

Theoretical

▶ Mitotane is predicted to decrease the exposure to dasabuvir.

Avoid.rTheoretical

▶ Mitotane is predicted to markedly decrease the exposure to

dasatinib. Avoid.rStudy → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to slightly decrease the exposure to

delamanid. Avoid.oStudy

▶ Mitotane

r

decreases the exposure to dolutegravir. Adjust dose.

Study

▶ Mitotane is predicted to decrease the exposure to doravirine.

Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to elbasvir.

Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to eliglustat.

Avoid.rStudy

▶ Mitotane is predicted to decrease the concentration of

elvitegravir. Avoid.rTheoretical

▶ Mitotane

r

is predicted to decrease the exposure to encorafenib.

Theoretical

▶ Mitotane

o

is predicted to decrease the effects of ergotamine.

Theoretical

▶ Mitotane is predicted to decrease the exposure to erlotinib.

Avoid or adjust erlotinib dose, p. 979.rStudy

▶ Mitotane is predicted to decrease the exposure to esketamine.

Adjust dose.oTheoretical

▶ Mitotane is predicted to decrease the exposure to etravirine.

Avoid.rTheoretical

▶ Mitotane is predicted to decrease the concentration of

everolimus. Avoid or adjust dose.rStudy → Also see

TABLE 15 p. 1378

▶ Mitotane

o

moderately decreases the exposure to exemestane.

Study

▶ Mitotane is predicted to decrease the exposure to fesoterodine.

Avoid.oStudy

▶ Mitotane

o

is predicted to decrease the exposure to fingolimod.

Study

▶ Mitotane is predicted to decrease the exposure to

fosaprepitant. Avoid.oTheoretical

▶ Mitotane is predicted to decrease the exposure to gefitinib.

Avoid.rStudy → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to greatly decrease the concentration of

glecaprevir. Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to grazoprevir.

Avoid.rStudy

▶ Mitotane is predicted to decrease the concentration of

guanfacine. Adjust guanfacine dose, p. 352.oStudy

▶ Mitotane decreases the concentration of haloperidol. Adjust

dose.oStudy

▶ Mitotane is predicted to decrease the exposure to ibrutinib.

Avoid or adjust ibrutinib dose, p. 983.rStudy → Also see

TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to idelalisib.

Avoid.rStudy → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to imatinib.

Avoid.oStudy → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to irinotecan.

Avoid.rStudy → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to ivabradine.

Adjust dose.oTheoretical

▶ Mitotane is predicted to moderately to markedly decrease the

exposure to ivacaftor. Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to ixazomib.

Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to lapatinib.

Avoid.rStudy

▶ Mitotane

o

is predicted to decrease the exposure to linagliptin.

Study

▶ Mitotane is predicted to decrease the exposure to lomitapide.

Monitor and adjust dose.oTheoretical

▶ Mitotane is predicted to decrease the exposure to lurasidone.

Avoid.oStudy

▶ Mitotane is predicted to decrease the exposure to macitentan.

Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to maraviroc.

Adjust dose.rStudy

▶ Mitotane is predicted to decrease the exposure to midazolam.

Monitor and adjust dose.oStudy

▶ Mitotane is predicted to decrease the exposure to midostaurin.

Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to mirtazapine.

Adjust dose.oStudy

▶ Mitotane is predicted to decrease the exposure to montelukast.

nStudy

BNF 78 Mitotane — Mitotane 1493

Interactions | Appendix 1

A1

Mitotane (continued)

▶ Mitotane is predicted to markedly decrease the exposure to

naloxegol. Avoid.oStudy

▶ Mitotane is predicted to slightly decrease the exposure to

nateglinide.nStudy

▶ Mitotane is predicted to decrease the exposure to netupitant.

Avoid.rStudy

▶ Mitotane

r

is predicted to decrease the exposure to nevirapine.

Theoretical

▶ Mitotane is predicted to moderately decrease the exposure to

nilotinib. Avoid.rStudy → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to nitisinone.

Adjust dose.oTheoretical

▶ Mitotane is predicted to decrease the exposure to olaparib.

Avoid.oTheoretical → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to ombitasvir.

Avoid.rTheoretical

▶ Mitotane

o

is predicted to decrease the exposure to ondansetron.

Study

▶ Mitotane is predicted to decrease the exposure to opioids

(alfentanil, fentanyl).oStudy

▶ Mitotane is predicted to decrease the exposure to opioids

(buprenorphine). Monitor and adjust dose.oTheoretical

▶ Mitotane decreases the exposure to opioids (methadone).

Monitor and adjust dose.rStudy

▶ Mitotane is predicted to decrease the exposure to opioids

(oxycodone). Monitor and adjust dose.oStudy

▶ Mitotane is predicted to moderately decrease the exposure to

osimertinib. Avoid.oStudy

▶ Mitotane is predicted to moderately decrease the exposure to

ospemifene.oStudy

▶ Mitotane is predicted to decrease the exposure to palbociclib.

Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to paliperidone.

Monitor and adjust dose.rStudy

▶ Mitotane is predicted to decrease the exposure to

panobinostat. Avoid.oTheoretical → Also see TABLE 15

p. 1378

▶ Mitotane is predicted to decrease the exposure to paritaprevir

(with ritonavir and ombitasvir). Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to pazopanib.

Avoid.rTheoretical → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to

phosphodiesterase type-5 inhibitors

r

(avanafil, tadalafil). Avoid.

Study

▶ Mitotane is predicted to decrease the exposure to

phosphodiesterase type-5 inhibitors

o

(sildenafil, vardenafil).

Theoretical

▶ Mitotane is predicted to moderately to markedly decrease the

exposure to pibrentasvir. Avoid.rStudy

▶ Mitotane is predicted to moderately decrease the exposure to

pitolisant.oStudy

▶ Mitotane is predicted to decrease the exposure to ponatinib.

Avoid.oTheoretical

▶ Mitotane is predicted to markedly decrease the exposure to

praziquantel. Avoid.oStudy

▶ Mitotane

o

is predicted to decrease the exposure to quetiapine.

Study

▶ Mitotane is predicted to decrease the exposure to ranolazine.

Avoid.rStudy

▶ Mitotane

o

is predicted to decrease the exposure to reboxetine.

Anecdotal

▶ Mitotane is predicted to decrease the exposure to regorafenib.

Avoid.oStudy → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to repaglinide.

Monitor blood glucose and adjust dose.oStudy

▶ Mitotane is predicted to markedly decrease the exposure to

ribociclib. Avoid.rStudy

▶ Mitotane markedly decreases the exposure to rilpivirine.

Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to risperidone.

Adjust dose.oStudy

▶ Mitotane is predicted to moderately decrease the exposure to

rivaroxaban. Avoid unless patient can be monitored for signs

of thrombosis.rStudy

▶ Mitotane is predicted to decrease the exposure to roflumilast.

Avoid.oStudy

▶ Mitotane is predicted to markedly decrease the exposure to

rolapitant. Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to ruxolitinib.

Monitor and adjust dose.oStudy → Also see TABLE 15

p. 1378

▶ Mitotane is predicted to moderately decrease the exposure to

saxagliptin.oStudy

▶ Mitotane is predicted to decrease the concentration of

sirolimus. Avoid.rStudy

▶ Mitotane

o

is predicted to decrease the exposure to solifenacin.

Theoretical

▶ Mitotane

o

is predicted to decrease the exposure to sorafenib.

Theoretical → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to statins

(simvastatin).rStudy

▶ Mitotane is predicted to decrease the exposure to sunitinib.

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

TABLE 15 p. 1378

▶ Mitotane decreases the concentration of tacrolimus. Monitor

and adjust dose.rStudy

▶ Mitotane is predicted to decrease the exposure to taxanes

(cabazitaxel, paclitaxel). Avoid.rStudy → Also see TABLE 15

p. 1378

▶ Mitotane is predicted to decrease the exposure to taxanes

(docetaxel).rTheoretical → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the concentration of

temsirolimus. Avoid.rStudy → Also see TABLE 15 p. 1378

▶ Mitotane decreases the exposure to tetracyclines (doxycycline).

Monitor and adjust dose.oStudy

▶ Mitotane is predicted to decrease the exposure to tezacaftor.

Avoid.rTheoretical

▶ Mitotane is predicted to markedly decrease the exposure to

ticagrelor. Avoid.rStudy

▶ Mitotane

r

is predicted to decrease the exposure to tivozanib.

Study

▶ Mitotane is predicted to decrease the exposure to tofacitinib.

Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to tolvaptan.

Use with caution or avoid depending on indication.

Study

r

▶ Mitotane is predicted to decrease the exposure to toremifene.

Adjust dose.oStudy

▶ Mitotane is predicted to decrease the exposure to trabectedin.

Avoid.rTheoretical → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to vandetanib.

Avoid.oStudy

▶ Mitotane is predicted to moderately decrease the exposure to

velpatasvir. Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to vemurafenib.

Avoid.rTheoretical

▶ Mitotane is predicted to decrease the exposure to venetoclax.

Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to vinca

alkaloids (vinblastine, vincristine, vindesine).rTheoretical →

Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to vinca

alkaloids (vinflunine). Avoid.rTheoretical → Also see

TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to vinca

alkaloids

Theoretical

(vinorelbine)

→ Also see TABLE 15

. Use with caution or avoid.

p. 1378

r

▶ Mitotane is predicted to decrease the exposure to vismodegib.

Avoid.oTheoretical → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to vortioxetine.

Monitor and adjust dose.oStudy

▶ Mitotane is predicted to decrease the concentration of

voxilaprevir. Avoid.rStudy

▶ Mitotane is predicted to decrease the exposure to zopiclone.

Adjust dose.oStudy

Mitoxantrone → see anthracyclines

Mivacurium → see neuromuscular blocking drugs, non-depolarising

Mizolastine → see antihistamines, non-sedating

1494 Mitotane — Mizolastine BNF 78

Interactions | Appendix 1

A1

Moclobemide → see TABLE 13 p. 1378 (serotonin syndrome)

FOOD AND LIFESTYLE Moclobemide is claimed to cause less

potentiation of the pressor effect of tyramine than the

traditional (irreversible) MAOIs, but patients should avoid

consuming large amounts of tyramine-rich foods (such as

mature cheese, salami, pickled herring, Bovril ®, Oxo ®,

Marmite ® or any similar meat or yeast extract or fermented

soya bean extract, and some beers, lagers or wines).

▶ Moclobemide is predicted to increase the risk of a hypertensive

crisis when given with

Theoretical → Also see TABLE 13

amfetamines

p. 1378

. Avoid.r

▶ Apalutamide is predicted to decrease the exposure to

moclobemide. Avoid or monitor.nStudy

▶ Moclobemide is predicted to increase the risk of severe

hypertension when given with

Theoretical → Also see TABLE 13 p. 1378

bupropion. Avoid.r

▶ Moclobemide is predicted to increase the exposure to

cilostazol.oTheoretical

▶ Moclobemide potentially increases the exposure to clobazam.

Adjust dose.oTheoretical

▶ Moclobemide is predicted to decrease the efficacy of

clopidogrel. Avoid.oStudy

▶ Moclobemide is predicted to increase the exposure to

eliglustat

r

. Avoid or adjust dose—consult product literature.

Theoretical

▶ H2 receptor antagonists (cimetidine) increase the exposure to

moclobemide. Adjust moclobemide dose, p. 362.nStudy

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

moclobemide.oStudy

▶ Moclobemide is predicted to increase the risk of side-effects

when given with linezolid. Avoid and for 14 days after

stopping moclobemide.rTheoretical → Also see TABLE 13

p. 1378

▶ Methylphenidate is predicted to increase the risk of a

hypertensive crisis when given with

Theoretical

moclobemide.r

▶ Mianserin is predicted to increase the risk of toxicity when

given with moclobemide. Avoid and for 1 week after stopping

mianserin.rTheoretical → Also see TABLE 13 p. 1378

▶ Moclobemide is predicted to increase the effects of monoamineoxidase B inhibitors

Theoretical → Also see

(rasagiline, selegiline)

TABLE 13 p. 1378

. Avoid.r

▶ Moclobemide is predicted to increase the risk of side-effects

when given with monoamine-oxidase B inhibitors (safinamide).

Avoid and for 1 week after stopping

Theoretical → Also see TABLE 13 p. 1378

safinamide.r

▶ Opicapone is predicted to increase the risk of elevated blood

pressure when given with

Theoretical

moclobemide. Avoid.r

▶ Moclobemide increases the risk of side-effects when given

with phenothiazines (levomepromazine).oStudy

▶ Reboxetine is predicted to increase the risk of a hypertensive

crisis when given with moclobemide. Avoid.rTheoretical

▶ Moclobemide moderately increases the exposure to rizatriptan.

Avoid.oStudy → Also see TABLE 13 p. 1378

▶ Moclobemide moderately increases the exposure to

sumatriptan. Avoid.oStudy → Also see TABLE 13 p. 1378

▶ Moclobemide is predicted to increase the risk of a hypertensive

crisis when given with sympathomimetics, vasoconstrictor

(ephedrine, isometheptene, phenylephrine, pseudoephedrine).

Avoid.rStudy

▶ Tricyclic antidepressants are predicted to increase the risk of

r

severe toxic reaction when given with moclobemide. Avoid.

Theoretical → Also see TABLE 13 p. 1378

▶ Moclobemide slightly increases the exposure to zolmitriptan.

Adjust zolmitriptan dose, p. 482.oStudy → Also see

TABLE 13 p. 1378

Modafinil

▶ Antiepileptics (carbamazepine, phenobarbital, primidone) are

predicted to decrease the exposure to modafinil.n Theoretical

▶ Antiepileptics (fosphenytoin, phenytoin) are predicted to

decrease the exposure to modafinil and modafinil is predicted

to increase the concentration of antiepileptics (fosphenytoin,

Theoretical

phenytoin). Monitor concentration and adjust dose.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to modafinil.nTheoretical

▶ Modafinil is predicted to decrease the exposure to bosutinib.

Avoid.rTheoretical

▶ Cobicistat is predicted to increase the exposure to modafinil.

nTheoretical

▶ Modafinil is predicted to decrease the efficacy of combined

hormonal contraceptives. For FSRH guidance, see

Contraceptives, interactions p. 794.rStudy

▶ Modafinil is predicted to decrease the efficacy of desogestrel.

For FSRH guidance, see

r

Contraceptives, interactions p. 794.

Theoretical

▶ Modafinil is predicted to decrease the exposure to doravirine.

Avoid or adjust doravirine dose, p. 644.rTheoretical

▶ Modafinil is predicted to decrease the exposure to elbasvir.

Avoid.qTheoretical

▶ Modafinil is predicted to decrease the efficacy of etonogestrel.

For FSRH guidance, see

r

Contraceptives, interactions p. 794.

Theoretical

▶ Modafinil is predicted to decrease the exposure to grazoprevir.

Avoid.rTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to modafinil.nTheoretical

▶ Modafinil is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ Idelalisib is predicted to increase the exposure to modafinil.

nTheoretical

▶ Modafinil is predicted to decrease the concentration of

letermovir.oTheoretical

▶ Modafinil is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to modafinil.nTheoretical

▶ Modafinil is predicted to decrease the efficacy of

norethisterone. For FSRH guidance, see Contraceptives,

interactions p. 794.rAnecdotal

▶ Rifampicin

o

is predicted to decrease the exposure to modafinil.

Theoretical

▶ Modafinil is predicted to decrease the exposure to sofosbuvir.

Avoid.rTheoretical

▶ Modafinil decreases the efficacy of ulipristal. For FSRH

guidance, see

Anecdotal

Contraceptives, interactions p. 794.r

▶ Modafinil is predicted to decrease the exposure to velpatasvir.

Avoid.rTheoretical

▶ Modafinil is predicted to decrease the concentration of

voxilaprevir. Avoid.rTheoretical

Mometasone → see corticosteroids

Monoamine-oxidase A and B inhibitors, irreversible → see

TABLE 8 p. 1376 (hypotension), TABLE 13 p. 1378 (serotonin syndrome)

isocarboxazid . phenelzine .tranylcypromine.

FOOD AND LIFESTYLE Potentially life-threatening hypertensive

crisis can develop in those taking MAOIs who eat tyraminerich food (such as mature cheese, salami, pickled herring,

Bovril ®, Oxo ®, Marmite ® or any similar meat or yeast extract

or fermented soya bean extract, and some beers, lagers or

wines) or foods containing dopa (such as broad bean

pods). Avoid tyramine-rich or dopa-rich food or drinks with,

or for 2 to 3 weeks after stopping, the MAOI.

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the effects of alpha blockers (indoramin).

Avoid.rTheoretical → Also see TABLE 8 p. 1376

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of a hypertensive crisis when

given with amfetamines. Avoid and for 14 days after stopping

the MAOI.rAnecdotal → Also see TABLE 13 p. 1378

▶ Antiepileptics (carbamazepine) are predicted to increase the risk

of severe toxic reaction when given with monoamine-oxidase A

and B inhibitors, irreversible. Avoid and for 14 days after

stopping the MAOI.rTheoretical

BNF 78 Moclobemide — Monoamine-oxidase A and B inhibitors, irreversible 1495

Interactions | Appendix 1

A1

Monoamine-oxidase A and B inhibitors, irreversible (continued)

▶ Antiepileptics (phenobarbital, primidone) are predicted to

increase the effects of monoamine-oxidase A and B inhibitors,

irreversible.rTheoretical

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of antimuscarinic side-effects

when given with

Theoretical

antihistamines, non-sedating. Avoid.r

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of antimuscarinic side-effects

when given with

Theoretical

antihistamines, sedating. Avoid.r

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of side-effects when given with

atomoxetine

r

. Avoid and for 2 weeks after stopping the MAOI.

Theoretical

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of cardiovascular side-effects

when given with beta2 agonists.oAnecdotal

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of severe hypertension when

given with bupropion. Avoid and for 14 days after stopping the

MAOI.rTheoretical → Also see TABLE 13 p. 1378

▶ Buspirone is predicted to increase the risk of elevated blood

pressure when given with monoamine-oxidase A and B

inhibitors, irreversible. Avoid.rAnecdotal → Also see

TABLE 13 p. 1378

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the effects of

Theoretical

doxapram.o ▶ Entacapone is predicted to increase the risk of elevated blood

pressure when given with monoamine-oxidase A and B

inhibitors, irreversible. Avoid.rTheoretical

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to decrease the antihypertensive effects of

guanethidine

r

. Avoid and for 14 days after stopping the MAOI.

Theoretical → Also see TABLE 8 p. 1376

▶ Levodopa increases the risk of a hypertensive crisis when

given with monoamine-oxidase A and B inhibitors, irreversible.

Avoid and for 14 days after stopping the MAOI.rStudy →

Also see TABLE 8 p. 1376

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of side-effects when given with

linezolid

r

. Avoid and for 14 days after stopping the MAOI.

Theoretical → Also see TABLE 13 p. 1378

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to alter the antihypertensive effects of methyldopa.

Avoid.rTheoretical → Also see TABLE 8 p. 1376

▶ Methylphenidate is predicted to increase the risk of a

hypertensive crisis when given with monoamine-oxidase A and

B inhibitors, irreversible. Avoid and for 14 days after stopping

the MAOI.rTheoretical

▶ Mianserin is predicted to increase the risk of toxicity when

given with monoamine-oxidase A and B inhibitors, irreversible.

Avoid and for 14 days after stopping the MAOI.

Theoretical → Also see TABLE 13 p. 1378

r

▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are

predicted to increase the risk of side-effects when given with

monoamine-oxidase A and B inhibitors, irreversible. Avoid and

for 14 days after stopping the MAOI.rTheoretical → Also

see TABLE 8 p. 1376 → Also see TABLE 13 p. 1378

▶ Monoamine-oxidase B inhibitors (safinamide) are predicted to

increase the risk of side-effects when given with monoamineoxidase A and B inhibitors, irreversible. Avoid and for 1 week

after stopping safinamide.rTheoretical → Also see TABLE 13

p. 1378

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