. Separate administration by at least 2 hours.
▶ Oral magnesium decreases the absorption of bisphosphonates
(sodium clodronate). Avoid magnesium for 2 hours before or
1 hour after sodium clodronate.oStudy
▶ Intravenous magnesium potentially increases the risk of
hypotension when given with calcium channel blockers
(amlodipine, clevidipine, felodipine, lacidipine, lercanidipine,
nicardipine, nifedipine, nimodipine, verapamil) (in pregnant
▶ Intravenous magnesium increases the effects of neuromuscular
blocking drugs, non-depolarising.oStudy
▶ Intravenous magnesium is predicted to increase the effects of
Magnesium carbonate → see antacids
Magnesium trisilicate → see antacids
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to maraviroc. Adjust dose.rStudy
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to markedly increase the exposure to maraviroc.
▶ Apalutamide is predicted to decrease the exposure to
maraviroc. Avoid or monitor.oStudy
is predicted to increase the exposure to maraviroc.
▶ Bosentan is predicted to decrease the exposure to maraviroc.
▶ Cobicistat markedly increases the exposure to maraviroc. Refer
to specialist literature.rStudy
▶ Efavirenz decreases the exposure to maraviroc. Refer to
specialist literature.rTheoretical
▶ Enzalutamide is predicted to decrease the exposure to
▶ Etravirine (with a boosted protease inhibitor) increases the
exposure to maraviroc. Avoid or adjust dose.oStudy
▶ HIV-protease inhibitors (atazanavir, saquinavir) moderately to
markedly increase the exposure to maraviroc. Refer to
▶ HIV-protease inhibitors (darunavir boosted with ritonavir)
markedly increase the exposure to maraviroc. Refer to
▶ HIV-protease inhibitors (lopinavir boosted with ritonavir)
moderately increase the exposure to maraviroc. Refer to
▶ HIV-protease inhibitors (ritonavir) markedly increase the
maraviroc. Refer to specialist literature.r
▶ Maraviroc potentially decreases the exposure to HIV-protease
inhibitors (fosamprenavir) and HIV-protease inhibitors
(fosamprenavir) potentially decrease the exposure to
▶ Idelalisib markedly increases the exposure to maraviroc.
▶ Macrolides (clarithromycin) are predicted to markedly increase
the exposure to maraviroc. Adjust dose.rStudy
▶ Mitotane is predicted to decrease the exposure to maraviroc.
is predicted to increase the exposure to maraviroc.
▶ Rifampicin is predicted to decrease the exposure to maraviroc.
▶ St John’s Wort is predicted to decrease the exposure to
Measles, mumps and rubella vaccine, live → see live vaccines
▶ H2 receptor antagonists (cimetidine) increase the concentration
▶ Sugammadex is predicted to decrease the exposure to
medroxyprogesterone. Use additional contraceptive
Mefloquine → see antimalarials
Melatonin → see TABLE 11 p. 1377 (CNS depressant effects)
▶ Antiepileptics (phenytoin) are predicted to decrease the
exposure to melatonin.oTheoretical
▶ Combined hormonal contraceptives are predicted to increase
the exposure to melatonin.oTheoretical
▶ HIV-protease inhibitors (ritonavir) are predicted to decrease the
exposure to melatonin.oTheoretical
1488 Macrolides — Melatonin BNF 78
▶ Leflunomide is predicted to decrease the exposure to
is predicted to increase the exposure to melatonin.
▶ Quinolones (ciprofloxacin) are predicted to increase the
exposure to melatonin.oTheoretical
is predicted to decrease the exposure to melatonin.
▶ SSRIs (fluvoxamine) very markedly increase the exposure to
▶ Teriflunomide is predicted to decrease the exposure to
Melphalan → see alkylating agents
▶ Dopamine receptor agonists (amantadine) increase the risk of
CNS toxicity when given with memantine. Use with caution or
▶ Memantine is predicted to increase the effects of dopamine
receptor agonists (apomorphine, bromocriptine, cabergoline,
pergolide, pramipexole, quinagolide, ropinirole, rotigotine)
▶ Memantine is predicted to increase the risk of CNS side-effects
when given with ketamine. Avoid.rTheoretical
is predicted to increase the effects of levodopa.
▶ Mepacrine is predicted to increase the concentration of
antimalarials (primaquine). Avoid.oTheoretical
Mepivacaine → see anaesthetics, local
Meprobamate → see TABLE 11 p. 1377 (CNS depressant effects)
Mercaptopurine → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 15
▶ Allopurinol potentially increases the risk of haematological
toxicity when given with mercaptopurine. Adjust
mercaptopurine dose, p. 912.rStudy
▶ Mercaptopurine decreases the anticoagulant effect of
▶ Febuxostat is predicted to increase the exposure to
mercaptopurine. Avoid.rTheoretical
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
mercaptopurine (high-dose). Public Health England advises
avoid (refer to Green Book).rTheoretical
ROUTE-SPECIFIC INFORMATION The manufacturers of some
mesalazine gastro-resistant and modified-release medicines
(Asacol MR tablets, Ipocol, Salofalk granules) suggest that
preparations that lower stool pH (e.g. lactulose) might
prevent the release of mesalazine.
Metaraminol → see sympathomimetics, vasoconstrictor
Metformin → see TABLE 14 p. 1378 (antidiabetic drugs)
▶ Alcohol (beverage)(excessive consumption) potentially
increases the risk of lactic acidosis when given with
. Avoid excessive alcohol consumption.o ▶ Bictegravir
slightly increases the exposure to metformin.
▶ Dolutegravir increases the exposure to metformin. Use with
caution and adjust dose.rStudy
▶ Guanfacine is predicted to increase the concentration of
▶ H2 receptor antagonists (cimetidine) increase the exposure to
metformin. Monitor and adjust dose.oStudy
is predicted to affect the exposure to metformin.
▶ Pitolisant is predicted to increase the exposure to metformin.
is predicted to increase the exposure to metformin.
▶ Vandetanib increases the exposure to metformin. Monitor and
▶ Acetazolamide is predicted to decrease the efficacy of
methenamine. Avoid.oTheoretical
▶ Potassium citrate is predicted to decrease the efficacy of
methenamine. Avoid.oTheoretical
▶ Sodium bicarbonate is predicted to decrease the efficacy of
methenamine. Avoid.oTheoretical
▶ Sodium citrate is predicted to decrease the efficacy of
methenamine. Avoid.oTheoretical
Methocarbamol → see TABLE 11 p. 1377 (CNS depressant effects)
Methotrexate → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 15 p. 1378
(myelosuppression), TABLE 2 p. 1375 (nephrotoxicity), TABLE 5 p. 1375
▶ Acetazolamide increases the urinary excretion of
▶ Methotrexate is predicted to decrease the clearance of
▶ Antiepileptics (levetiracetam) decrease the clearance of
▶ Antimalarials (pyrimethamine) are predicted to increase the risk
of side-effects when given with
Theoretical → Also see TABLE 15 p. 1378
▶ Apalutamide is predicted to decrease the exposure to
▶ Aspirin (high-dose) is predicted to increase the risk of toxicity
when given with methotrexate.rStudy
▶ Brigatinib potentially increases the concentration of
▶ Eltrombopag is predicted to increase the concentration of
▶ Methotrexate potentially increases the risk of severe skin
reaction when given with topical
Anecdotal → Also see TABLE 15 p. 1378
▶ Leflunomide is predicted to increase the exposure to
methotrexate.oTheoretical → Also see TABLE 1 p. 1375 →
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
methotrexate (high-dose). Public Health England advises
avoid (refer to Green Book).rTheoretical
▶ Nitrous oxide potentially increases the risk of methotrexate
toxicity when given with methotrexate. Avoid.rStudy
▶ NSAIDs are predicted to increase the risk of toxicity when
given with methotrexate.rStudy → Also see TABLE 2 p. 1375
▶ Penicillins are predicted to increase the risk of toxicity when
given with methotrexate.rAnecdotal → Also see TABLE 1
▶ Potassium aminobenzoate increases the concentration of
▶ Proton pump inhibitors decrease the clearance of methotrexate
(high-dose). Use with caution or avoid.rStudy
▶ Quinolones (ciprofloxacin) potentially increase the risk of
toxicity when given with methotrexate.rAnecdotal
▶ Regorafenib is predicted to increase the exposure to
methotrexate.oTheoretical → Also see TABLE 15 p. 1378
▶ Retinoids (acitretin) are predicted to increase the
concentration of methotrexate. Avoid.oAnecdotal
▶ Rolapitant is predicted to increase the exposure to
methotrexate. Avoid or monitor.oStudy
▶ Methotrexate is predicted to decrease the efficacy of
▶ Sulfonamides are predicted to increase the exposure to
methotrexate. Use with caution or avoid.rTheoretical →
▶ Tedizolid is predicted to increase the exposure to
methotrexate. Avoid.oTheoretical
▶ Methotrexate is predicted to increase the risk of toxicity when
given with tegafur.rTheoretical
BNF 78 Melatonin — Methotrexate 1489
▶ Teriflunomide is predicted to increase the exposure to
decreases the clearance of theophylline.
▶ Trimethoprim is predicted to increase the risk of side-effects
when given with methotrexate. Avoid.rTheoretical → Also
Methoxyflurane → see volatile halogenated anaesthetics
Methyldopa → see TABLE 8 p. 1376 (hypotension)
▶ Entacapone is predicted to increase the exposure to
▶ Iron (oral) decreases the effects of methyldopa.oStudy
▶ Methyldopa increases the risk of neurotoxicity when given
▶ 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 decrease the effects of
apraclonidine. Avoid.rTheoretical
▶ Methylphenidate is predicted to increase the risk of elevated
blood pressure when given with
▶ Methylphenidate is predicted to increase the risk of a
hypertensive crisis when given with
▶ 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
▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are
predicted to increase the risk of a hypertensive crisis when
given with methylphenidate. Avoid.rTheoretical
▶ Methylphenidate increases the risk of dyskinesias when given
with paliperidone.rTheoretical
▶ Risperidone increases the risk of dyskinesias when given with
Methylprednisolone → see corticosteroids
Methylthioninium chloride → see TABLE 13 p. 1378 (serotonin
▶ Methylthioninium chloride is predicted to increase the risk of
severe hypertension when given with bupropion. Avoid.
Theoretical → Also see TABLE 13 p. 1378
▶ Metoclopramide is predicted to increase the risk of
methaemoglobinaemia when given with topical anaesthetics,
local (prilocaine). Avoid.rTheoretical
▶ Metoclopramide potentially decreases the absorption of
(posaconazole) (oral suspension).o ▶ Metoclopramide decreases the concentration of antimalarials
▶ Metoclopramide is predicted to decrease the effects of
dopamine receptor agonists (apomorphine, bromocriptine,
cabergoline, pergolide, pramipexole, quinagolide, ropinirole,
decreases the effects of levodopa. Avoid.
▶ Metoclopramide is predicted to increase the effects of
neuromuscular blocking drugs, non-depolarising
increases the effects of suxamethonium.
Metolazone → see thiazide diuretics
Metoprolol → see beta blockers, selective
Metronidazole → see TABLE 12 p. 1378 (peripheral neuropathy)
ROUTE-SPECIFIC INFORMATION Since systemic absorption can
follow topical application, the possibility of interactions
▶ Alcohol (beverage) potentially causes a disulfiram-like
reaction when given with metronidazole. Avoid for at least
48 hours stopping treatment.oStudy
▶ Metronidazole increases the risk of toxicity when given with
alkylating agents (busulfan).rStudy
▶ Antiepileptics (phenobarbital, primidone) are predicted to
decrease the exposure to metronidazole.oStudy
▶ Metronidazole is predicted to increase the risk of capecitabine
toxicity when given with capecitabine.rTheoretical
▶ Metronidazole increases the anticoagulant effect of coumarins.
Monitor INR and adjust dose.rStudy
▶ Disulfiram increases the risk of acute psychoses when given
with metronidazole.rStudy → Also see TABLE 12 p. 1378
▶ Metronidazole increases the risk of toxicity when given with
▶ Antiepileptics (fosphenytoin, phenobarbital, phenytoin,
primidone) are predicted to decrease the effects of
▶ Antihistamines, sedating (cyproheptadine) decrease the effects of
decreases the effects of metyrapone. Avoid.
▶ Combined hormonal contraceptives decrease the effects of
metyrapone. Avoid.oTheoretical
▶ Phenothiazines (chlorpromazine) decrease the effects of
metyrapone. Avoid.oTheoretical
▶ Propylthiouracil is predicted to decrease the effects of
metyrapone. Avoid.oTheoretical
▶ Tricyclic antidepressants (amitriptyline) decrease the effects of
metyrapone. Avoid.oTheoretical
FOOD AND LIFESTYLE Dose adjustment might be necessary if
smoking started or stopped during treatment.
▶ Mexiletine is predicted to increase the exposure to
▶ Mexiletine is predicted to increase the exposure to
aminophylline. Adjust dose.oTheoretical
is predicted to increase the exposure to anagrelide.
▶ Mexiletine increases the risk of torsade de pointes when given
with antiarrhythmics. Avoid.rTheoretical
▶ Antiepileptics (phenytoin) are predicted to increase the
mexiletine. Monitor and adjust dose.o ▶ Mexiletine potentially increases the risk of cardiovascular
side-effects when given with beta blockers, non-selective.
▶ Mexiletine potentially increases the risk of cardiovascular
side-effects when given with beta blockers, selective. Avoid or
is predicted to increase the exposure to mexiletine.
▶ Mexiletine increases the risk of cardiovascular side-effects
when given with calcium channel blockers (diltiazem). Avoid or
▶ Mexiletine potentially increases the risk of cardiovascular
side-effects when given with calcium channel blockers
(verapamil). Avoid or monitor.rTheoretical
is predicted to increase the exposure to mexiletine.
▶ Mexiletine increases the concentration of clozapine. Monitor
side effects and adjust dose.rStudy
potentially increases the exposure to mexiletine.
▶ Mexiletine potentially affects the exposure to coumarins
(warfarin). Avoid.qTheoretical
▶ Mexiletine is predicted to increase the exposure to dopamine
receptor agonists (ropinirole). Adjust dose.oStudy
▶ Mexiletine slightly increases the exposure to erlotinib. Monitor
side effects and adjust dose.oStudy
▶ HIV-protease inhibitors (ritonavir) are predicted to increase the
mexiletine. Monitor and adjust dose.o ▶ Leflunomide is predicted to increase the clearance of
mexiletine. Monitor and adjust dose.oStudy
potentially affects the exposure to lithium. Avoid.
▶ Mexiletine is predicted to increase the exposure to loxapine.
1490 Methotrexate — Mexiletine BNF 78
is predicted to increase the exposure to melatonin.
is predicted to affect the exposure to metformin.
▶ Mexiletine slightly increases the exposure to monoamineoxidase B inhibitors (rasagiline).oStudy
▶ Mexiletine is predicted to increase the exposure to olanzapine.
potentially decrease the absorption of oral mexiletine.
▶ Mexiletine is predicted to increase the exposure to pirfenidone.
Use with caution and adjust dose.oStudy
▶ Rifampicin is predicted to increase the clearance of mexiletine.
Monitor and adjust dose.oStudy
is predicted to increase the exposure to riluzole.
is predicted to increase the exposure to roflumilast.
▶ SSRIs (fluoxetine, fluvoxamine, paroxetine) are predicted to
increase the exposure to mexiletine.oStudy
is predicted to increase the exposure to mexiletine.
▶ Teriflunomide is predicted to increase the clearance of
mexiletine. Monitor and adjust dose.oStudy
▶ Mexiletine is predicted to increase the exposure to
theophylline. Monitor and adjust dose.oTheoretical
increases the exposure to tizanidine. Avoid.
▶ Mexiletine is predicted to increase the exposure to
. Adjust zolmitriptan dose, p. 482.o
Mianserin → see TABLE 13 p. 1378 (serotonin syndrome), TABLE 11 p. 1377
▶ Antiepileptics (carbamazepine) markedly decrease the exposure
to mianserin. Adjust dose.oStudy
▶ Antiepileptics (phenobarbital, primidone) are predicted to
decrease the exposure to mianserin.oStudy → Also see
▶ 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
▶ 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
is predicted to decrease the efficacy of pitolisant.
▶ Mianserin decreases the effects of sympathomimetics,
vasoconstrictor (ephedrine).rAnecdotal
Micafungin → see TABLE 1 p. 1375 (hepatotoxicity)
▶ Micafungin slightly increases the exposure to amphotericin.
Avoid or monitor toxicity.oStudy
Miconazole → see antifungals, azoles
Midazolam → see TABLE 11 p. 1377 (CNS depressant effects)
▶ Antiarrhythmics (dronedarone) are predicted to increase the
midazolam. Monitor side effects and adjust dose.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to midazolam. Monitor and adjust dose.oStudy → Also
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to midazolam. Monitor
side effects and adjust dose.rStudy
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to markedly to very markedly increase the exposure
to midazolam. Avoid or adjust dose.rStudy
▶ Antifungals, azoles (miconazole) are predicted to increase the
exposure to intravenous midazolam. Use with caution and
▶ Antifungals, azoles (miconazole) are predicted to increase the
exposure to oral midazolam. Avoid.oTheoretical
▶ Apalutamide markedly decreases the exposure to midazolam.
▶ Aprepitant is predicted to increase the exposure to midazolam.
Monitor side effects and adjust dose.rStudy
▶ Bosentan is predicted to decrease the concentration of
midazolam. Monitor and adjust dose.oTheoretical
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to midazolam. Monitor side effects and
▶ Cobicistat is predicted to markedly to very markedly increase
the exposure to midazolam. Avoid or adjust dose.rStudy
▶ Crizotinib is predicted to increase the exposure to midazolam.
Monitor side effects and adjust dose.rStudy
▶ Dabrafenib decreases the exposure to midazolam. Monitor and
is predicted to alter the effects of midazolam. Avoid.
▶ Enzalutamide is predicted to decrease the exposure to
midazolam. Monitor and adjust dose.oStudy
slightly increases the exposure to midazolam.
▶ HIV-protease inhibitors are predicted to markedly to very
markedly increase the exposure to midazolam. Avoid or adjust
▶ Idelalisib is predicted to markedly to very markedly increase
the exposure to midazolam. Avoid or adjust dose.rStudy
▶ Imatinib is predicted to increase the exposure to midazolam.
Monitor side effects and adjust dose.rStudy
▶ Letermovir slightly to moderately increases the exposure to
midazolam. Monitor and adjust dose.oStudy
▶ Lumacaftor is predicted to decrease the exposure to
▶ Macrolides (clarithromycin) are predicted to markedly to very
markedly increase the exposure to midazolam. Avoid or adjust
▶ Macrolides (erythromycin) are predicted to increase the
midazolam. Monitor side effects and adjust dose.
▶ Mitotane is predicted to decrease the exposure to midazolam.
Monitor and adjust dose.oStudy
▶ Monoclonal antibodies (tocilizumab) are predicted to decrease
Monitor side effects and adjust dose.rStudy
▶ Nevirapine decreases the concentration of midazolam. Monitor
▶ Nilotinib is predicted to increase the exposure to midazolam.
Monitor side effects and adjust dose.rStudy
increases the exposure to midazolam.o ▶ Ribociclib moderately increases the exposure to midazolam.
▶ Rifampicin is predicted to decrease the exposure to midazolam.
Monitor and adjust dose.oStudy
▶ Rucaparib slightly increases the exposure to midazolam.
Monitor and adjust dose.rStudy
▶ St John’s Wort moderately decreases the exposure to
midazolam. Monitor and adjust dose.oStudy
decreases the exposure to midazolam.
Midodrine → see sympathomimetics, vasoconstrictor
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to midostaurin.oTheoretical
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to very markedly increase the exposure to
midostaurin. Avoid or monitor for toxicity.rStudy
▶ Aprepitant is predicted to increase the exposure to
BNF 78 Mexiletine — Midostaurin 1491
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to midostaurin.oTheoretical
▶ Cobicistat is predicted to very markedly increase the exposure
to midostaurin. Avoid or monitor for toxicity.rStudy
is predicted to increase the exposure to midostaurin.
▶ Enzalutamide is predicted to decrease the exposure to
▶ HIV-protease inhibitors are predicted to very markedly increase
midostaurin. Avoid or monitor for toxicity.
▶ Idelalisib is predicted to very markedly increase the exposure
to midostaurin. Avoid or monitor for toxicity.rStudy
is predicted to increase the exposure to midostaurin.
▶ Macrolides (clarithromycin) are predicted to very markedly
increase the exposure to midostaurin. Avoid or monitor for
▶ Macrolides (erythromycin) are predicted to increase the
exposure to midostaurin.oTheoretical
▶ Mitotane is predicted to decrease the exposure to midostaurin.
▶ Netupitant is predicted to increase the exposure to
is predicted to increase the exposure to midostaurin.
▶ Rifampicin is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
midostaurin. Avoid.rTheoretical
▶ Ciclosporin is predicted to decrease the efficacy of
mifamurtide. Avoid.rTheoretical
▶ Corticosteroids are predicted to decrease the efficacy of
mifamurtide. Avoid.rTheoretical
▶ NSAIDs (high-dose) are predicted to decrease the efficacy of
mifamurtide. Avoid.rTheoretical
▶ Pimecrolimus is predicted to decrease the efficacy of
mifamurtide. Avoid.rTheoretical
▶ Sirolimus is predicted to decrease the efficacy of mifamurtide.
▶ Tacrolimus is predicted to affect the efficacy of mifamurtide.
▶ Mifepristone is predicted to decrease the efficacy of
. Use with caution and adjust dose.o
Minocycline → see tetracyclines
Minoxidil → see TABLE 8 p. 1376 (hypotension)
ROUTE-SPECIFIC INFORMATION Since systemic absorption can
follow topical application, the possibility of interactions
▶ Mirabegron is predicted to increase the exposure to aliskiren.
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to mirabegron. Adjust
dose in hepatic and renal impairment, p. 781.
▶ Mirabegron is predicted to increase the exposure to
antihistamines, non-sedating (fexofenadine).nTheoretical
▶ Mirabegron is predicted to increase the exposure to beta
blockers, selective (metoprolol).oStudy
▶ Cobicistat is predicted to increase the exposure to mirabegron.
Adjust mirabegron dose in hepatic and renal impairment,
▶ Mirabegron is predicted to increase the exposure to colchicine.
▶ Mirabegron is predicted to increase the exposure to
▶ Mirabegron slightly increases the exposure to digoxin. Monitor
concentration and adjust dose.rStudy
▶ Mirabegron is predicted to increase the exposure to edoxaban.
▶ Mirabegron is predicted to increase the exposure to eliglustat.
Avoid or adjust dose—consult product literature.rStudy
▶ Mirabegron is predicted to increase the exposure to
▶ HIV-protease inhibitors are predicted to increase the exposure
to mirabegron. Adjust mirabegron dose in hepatic and renal
▶ Idelalisib is predicted to increase the exposure to mirabegron.
Adjust mirabegron dose in hepatic and renal impairment,
▶ Mirabegron is predicted to increase the exposure to
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to mirabegron. Adjust mirabegron dose in hepatic
and renal impairment, p. 781.oStudy
▶ Mirabegron is predicted to increase the exposure to sirolimus.
▶ Mirabegron is predicted to increase the exposure to taxanes
▶ Mirabegron is predicted to increase the exposure to topotecan.
Mirtazapine → see TABLE 13 p. 1378 (serotonin syndrome), TABLE 11
p. 1377 (CNS depressant effects)
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to mirtazapine. Adjust dose.oStudy → Also see TABLE 11
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to
is predicted to increase the exposure to mirtazapine.
▶ Enzalutamide is predicted to decrease the exposure to
mirtazapine. Adjust dose.oStudy
▶ H2 receptor antagonists (cimetidine) slightly increase the
mirtazapine. Use with caution and adjust dose.
▶ HIV-protease inhibitors are predicted to increase the exposure
is predicted to increase the exposure to mirtazapine.
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to mirtazapine.oStudy
▶ Mitotane is predicted to decrease the exposure to mirtazapine.
is predicted to decrease the efficacy of pitolisant.
▶ Rifampicin is predicted to decrease the exposure to
mirtazapine. Adjust dose.oStudy
Mitomycin → see TABLE 15 p. 1378 (myelosuppression), TABLE 5 p. 1375
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
mitomycin. Public Health England advises avoid (refer to
Mitotane → see TABLE 15 p. 1378 (myelosuppression)
▶ Mitotane is predicted to markedly decrease the exposure to
▶ Mitotane is predicted to decrease the exposure to abiraterone.
▶ Aldosterone antagonists (spironolactone) are predicted to
decrease the effects of mitotane. Avoid.rAnecdotal
▶ Mitotane is predicted to decrease the exposure to aldosterone
antagonists (eplerenone). Avoid.oTheoretical
▶ Mitotane is predicted to decrease the exposure to alprazolam.
▶ Mitotane is predicted to decrease the exposure to
(disopyramide, dronedarone). Avoid.r
▶ Mitotane is predicted to decrease the efficacy of antiarrhythmics
▶ Mitotane is predicted to decrease the exposure to
anticholinesterases, centrally acting (donepezil).nStudy
▶ Mitotane is predicted to decrease the exposure to antiepileptics
(perampanel). Monitor and adjust dose.oStudy
1492 Midostaurin — Mitotane BNF 78
▶ Mitotane is predicted to decrease the exposure to antifungals,
azoles (isavuconazole). Avoid.rStudy
▶ Mitotane is predicted to decrease the exposure to antimalarials
(artemether) (with lumefantrine). Avoid.rStudy
▶ Mitotane is predicted to decrease the concentration of
antimalarials (piperaquine). Avoid.oTheoretical
▶ Mitotane is predicted to moderately decrease the exposure to
apixaban. Use with caution or avoid.rStudy
▶ Mitotane moderately decreases the exposure to apremilast.
▶ Mitotane is predicted to markedly decrease the exposure to
▶ Mitotane is predicted to moderately decrease the exposure to
aripiprazole. Adjust aripiprazole dose, p. 395.oStudy
▶ Mitotane is predicted to decrease the exposure to axitinib.
Avoid or adjust dose.oStudy → Also see TABLE 15 p. 1378
decreases the exposure to bedaquiline. Avoid.r
▶ Mitotane is predicted to decrease the exposure to bictegravir.
slightly decreases the exposure to bortezomib. Avoid.
Study → Also see TABLE 15 p. 1378
▶ Mitotane affects the exposure to bosentan. Avoid.rStudy
▶ Mitotane is predicted to very markedly decrease the exposure
to bosutinib. Avoid.rStudy → Also see TABLE 15 p. 1378
▶ Mitotane is predicted to decrease the exposure to brigatinib.
▶ Mitotane is predicted to decrease the exposure to buspirone.
Use with caution and adjust dose.rStudy
▶ Mitotane moderately decreases the exposure to cabozantinib.
Avoid.oStudy → Also see TABLE 15 p. 1378
▶ Mitotane is predicted to decrease the exposure to calcium
channel blockers (amlodipine, felodipine, lacidipine,
lercanidipine, nicardipine, nimodipine). Monitor and adjust
▶ Mitotane is predicted to decrease the exposure to cannabis
▶ Mitotane is predicted to decrease the exposure to cariprazine.
▶ Mitotane is predicted to decrease the exposure to ceritinib.
Avoid.rStudy → Also see TABLE 15 p. 1378
decreases the concentration of ciclosporin.r
Monitor and adjust dose.oStudy
▶ Mitotane decreases the exposure to clomethiazole. Monitor
▶ Mitotane is predicted to decrease the exposure to cobicistat.
▶ Mitotane is predicted to decrease the exposure to cobimetinib.
▶ Mitotane is predicted to decrease the exposure to
corticosteroids (budesonide, deflazacort, dexamethasone,
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