▶ Idelalisib is predicted to increase the exposure to vinca
alkaloids.rTheoretical → Also see TABLE 15 p. 1378
▶ Imatinib is predicted to increase the exposure to vinca
alkaloids.rTheoretical → Also see TABLE 15 p. 1378
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with vinca
alkaloids. Public Health England advises avoid (refer to Green
▶ Macrolides (clarithromycin, erythromycin) are predicted to
increase the exposure to vinca alkaloids.rTheoretical →
▶ Mitotane is predicted to decrease the exposure to vinca
alkaloids (vinblastine, vincristine, vindesine).rTheoretical →
▶ Mitotane is predicted to decrease the exposure to vinflunine.
Avoid.rTheoretical → Also see TABLE 15 p. 1378
▶ Mitotane is predicted to decrease the exposure to vinorelbine.
Use with caution or avoid.rTheoretical → Also see TABLE 15
▶ Netupitant is predicted to increase the exposure to vinca
▶ Nilotinib is predicted to increase the exposure to vinca
alkaloids.rTheoretical → Also see TABLE 15 p. 1378 → Also see
▶ Pegaspargase potentially increases the risk of neurotoxicity
when given with vincristine.Vincristine should be taken
3 to 24 hours before pegaspargase.rAnecdotal → Also see
TABLE 1 p. 1375 → Also see TABLE 15 p. 1378
▶ Rifampicin is predicted to decrease the exposure to vinca
alkaloids (vinblastine, vincristine, vindesine).rTheoretical
▶ Rifampicin is predicted to decrease the exposure to vinflunine.
▶ Rifampicin is predicted to decrease the exposure to
vinorelbine. Use with caution or avoid.rTheoretical
Vincristine → see vinca alkaloids
Vindesine → see vinca alkaloids
Vinflunine → see vinca alkaloids
Vinorelbine → see vinca alkaloids
Vismodegib → see TABLE 15 p. 1378 (myelosuppression)
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to vismodegib. Avoid.oTheoretical
▶ Enzalutamide is predicted to decrease the exposure to
vismodegib. Avoid.oTheoretical
▶ Mitotane is predicted to decrease the exposure to vismodegib.
Avoid.oTheoretical → Also see TABLE 15 p. 1378
▶ Rifampicin is predicted to decrease the exposure to
vismodegib. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
vismodegib. Avoid.oTheoretical
▶ Retinoids (acitretin, alitretinoin, isotretinoin) are predicted to
increase the risk of vitamin A toxicity when given with vitamin
▶ Retinoids (bexarotene) are predicted to increase the risk of
▶ Retinoids (tretinoin) are predicted to increase the risk of
vitamin A toxicity when given with
ROUTE-SPECIFIC INFORMATION Since systemic absorption can
follow topical application, the possibility of interactions with
topical calcitriol should be borne in mind.
▶ Antiepileptics (carbamazepine) are predicted to decrease the
effects of vitamin D substances.oStudy
▶ Antiepileptics (fosphenytoin, phenytoin) decrease the effects of
▶ Antiepileptics (phenobarbital, primidone) are predicted to
vitamin D substances.o ▶ Antifungals, azoles (clotrimazole, ketoconazole) are predicted to
decrease the exposure to colecalciferol.oTheoretical
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to
is predicted to increase the exposure to paricalcitol.
▶ Vitamin D substances are predicted to increase the risk of
toxicity when given with digoxin.rTheoretical
▶ HIV-protease inhibitors are predicted to increase the exposure
is predicted to increase the exposure to paricalcitol.
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to paricalcitol.oStudy
▶ Thiazide diuretics increase the risk of hypercalcaemia when
given with vitamin D substances.oTheoretical
alpha tocopherol . alpha tocopheryl acetate. ▶ Vitamin E substances
affect the exposure to ciclosporin.
Volatile halogenated anaesthetics → see TABLE 8 p. 1376
(hypotension), TABLE 11 p. 1377 (CNS depressant effects)
the risk of nephrotoxicity when given with methoxyflurane.
Avoid.rTheoretical → Also see TABLE 11 p. 1377
▶ Isoniazid potentially increases the risk of nephrotoxicity when
given with methoxyflurane. Avoid.rTheoretical
▶ Rifampicin potentially increases the risk of nephrotoxicity
when given with methoxyflurane. Avoid.rTheoretical
Voriconazole → see antifungals, azoles
Vortioxetine → see TABLE 13 p. 1378 (serotonin syndrome), TABLE 4
p. 1375 (antiplatelet effects)
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to vortioxetine. Monitor and adjust dose.oStudy
▶ Bupropion is predicted to increase the exposure to
vortioxetine. Monitor and adjust dose.oStudy → Also
▶ Cinacalcet is predicted to increase the exposure to vortioxetine.
Monitor and adjust dose.oStudy
▶ Enzalutamide is predicted to decrease the exposure to
vortioxetine. Monitor and adjust dose.oStudy
▶ Mitotane is predicted to decrease the exposure to vortioxetine.
Monitor and adjust dose.oStudy
▶ Rifampicin is predicted to decrease the exposure to
vortioxetine. Monitor and adjust dose.oStudy
▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the
o ▶ Terbinafine is predicted to increase the exposure to
vortioxetine. Monitor and adjust dose.oStudy
1552 Vinca alkaloids — Vortioxetine BNF 78
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the
concentration of voxilaprevir. Avoid.rStudy
▶ Antiepileptics (oxcarbazepine) are predicted to decrease the
concentration of voxilaprevir. Avoid.rTheoretical
▶ Bosentan is predicted to decrease the concentration of
voxilaprevir. Avoid.rTheoretical
increases the concentration of voxilaprevir. Avoid.
▶ Combined hormonal contraceptives (containing
ethinylestradiol) are predicted to increase the risk of
increased ALT concentrations when given with voxilaprevir
(with sofosbuvir and velpatasvir). Avoid.rStudy
▶ Voxilaprevir (with sofosbuvir and velpatasvir) increases the
concentration of dabigatran. Avoid.rStudy
▶ Voxilaprevir (with sofosbuvir and velpatasvir) is predicted to
digoxin. Monitor and adjust dose.
▶ Voxilaprevir (with sofosbuvir and velpatasvir) is predicted to
▶ Efavirenz is predicted to decrease the concentration of
voxilaprevir. Avoid.rTheoretical
▶ Enzalutamide is predicted to decrease the concentration of
▶ HIV-protease inhibitors (atazanavir boosted with ritonavir)
increase the concentration of voxilaprevir. Avoid.rStudy
▶ HIV-protease inhibitors (lopinavir boosted with ritonavir) are
predicted to increase the concentration of
▶ HIV-protease inhibitors (tipranavir boosted with ritonavir) are
predicted to increase the concentration of
▶ Mitotane is predicted to decrease the concentration of
▶ Modafinil is predicted to decrease the concentration of
voxilaprevir. Avoid.rTheoretical
▶ Nevirapine is predicted to decrease the concentration of
voxilaprevir. Avoid.rTheoretical
▶ Proton pump inhibitors are predicted to decrease the exposure
to voxilaprevir. Adjust dose, see sofosbuvir with velpatasvir
and voxilaprevir p. 630.oStudy
▶ Rifabutin is predicted to decrease the concentration of
voxilaprevir. Avoid.rTheoretical
▶ Rifampicin is predicted to decrease the concentration of
▶ St John’s Wort is predicted to decrease the concentration of
voxilaprevir. Avoid.rTheoretical
▶ Voxilaprevir is predicted to increase the exposure to statins
(atorvastatin). Avoid.oTheoretical
▶ Voxilaprevir (with sofosbuvir and velpatasvir) is predicted to
increase the exposure to statins (fluvastatin, simvastatin).
▶ Voxilaprevir (with sofosbuvir and velpatasvir) moderately
increases the exposure to statins (pravastatin). Monitor and
adjust pravastatin dose.oStudy
▶ Voxilaprevir (with sofosbuvir and velpatasvir) markedly
statins (rosuvastatin). Avoid.r
▶ Voxilaprevir is predicted to increase the concentration of
sulfasalazine. Avoid.rTheoretical
▶ Voxilaprevir (with sofosbuvir and velpatasvir) potentially
increases the concentration of
▶ Voxilaprevir is predicted to increase the concentration of
GENERAL INFORMATION Desensitising vaccines should be
avoided in patients taking beta-blockers (adrenaline might be
ineffective in case of a hypersensitivity reaction) or ACE
inhibitors (risk of severe anaphylactoid reactions).
Xipamide → see thiazide diuretics
Xylometazoline → see sympathomimetics, vasoconstrictor
Yellow fever vaccine, live → see live vaccines
Zidovudine → see TABLE 15 p. 1378 (myelosuppression), TABLE 2 p. 1375
▶ Antiepileptics (valproate) slightly increase the exposure to
▶ Antifungals, azoles (fluconazole) slightly increase the exposure
▶ Antimalarials (pyrimethamine) are predicted to increase the risk
of side-effects when given with zidovudine.rTheoretical →
▶ Zidovudine increases the risk of haematological toxicity when
given with aspirin (high-dose).rStudy
▶ Zidovudine increases the risk of haematological toxicity when
flucytosine. Monitor and adjust dose.r
▶ HIV-protease inhibitors (tipranavir) slightly decrease the
exposure to zidovudine. Avoid.oStudy
▶ Zidovudine increases the risk of toxicity when given with
▶ Leflunomide is predicted to increase the exposure to
zidovudine.oTheoretical → Also see TABLE 15 p. 1378
▶ Macrolides (clarithromycin) decrease the absorption of
. Separate administration by at least 2 hours.
▶ Nevirapine is predicted to decrease the concentration of
zidovudine. Refer to specialist literature.rTheoretical
▶ Zidovudine increases the risk of haematological toxicity when
given with NSAIDs.rStudy → Also see TABLE 2 p. 1375
▶ Ribavirin increases the risk of anaemia and/or leucopenia
when given with zidovudine. Avoid.rStudy
▶ Zidovudine is predicted to decrease the efficacy of stavudine.
▶ Teriflunomide is predicted to increase the exposure to
ROUTE-SPECIFIC INFORMATION Interactions do not generally
apply to topical use unless specified.
▶ Oral zinc decreases the absorption of oral bisphosphonates
(alendronic acid). Zinc should be taken at least 30 minutes
▶ Oral zinc is predicted to decrease the absorption of oral
bisphosphonates (ibandronic acid). Avoid zinc for at least
6 hours before or 1 hour after
ibandronic acid.o ▶ Oral zinc decreases the absorption of oral bisphosphonates
. Separate administration by at least 2 hours.
▶ Oral zinc decreases the absorption of oral bisphosphonates
(sodium clodronate). Avoid zinc for 2 hours before or 1 hour
after sodium clodronate.oStudy
eltrombopag. Eltrombopag should be taken 2 hours before or
4 hours after zinc.rTheoretical
▶ Zinc is predicted to decrease the efficacy of iron (oral) and iron
▶ Zinc is predicted to decrease the exposure to quinolones.
Separate administration by 2 hours.oStudy
▶ Oral zinc is predicted to decrease the absorption of
. Separate administration by 2 to 3 hours.
potentially decreases the absorption of zinc.
Zoledronic acid → see bisphosphonates
Zolmitriptan → see TABLE 13 p. 1378 (serotonin syndrome)
▶ Combined hormonal contraceptives are predicted to increase
zolmitriptan. Adjust zolmitriptan dose, p. 482.
▶ H2 receptor antagonists (cimetidine) slightly increase the
exposure to zolmitriptan. Adjust zolmitriptan dose, p. 482.n
BNF 78 Voxilaprevir — Zolmitriptan 1553
▶ Mexiletine is predicted to increase the exposure to
. Adjust zolmitriptan dose, p. 482.o ▶ Moclobemide slightly increases the exposure to zolmitriptan.
Adjust zolmitriptan dose, p. 482.oStudy → Also see
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the exposure to
Theoretical → Also see TABLE 13 p. 1378
▶ Quinolones (ciprofloxacin) are predicted to increase the
zolmitriptan. Adjust zolmitriptan dose, p. 482.
▶ SSRIs (fluvoxamine) are predicted to increase the exposure to
Zolpidem → see TABLE 11 p. 1377 (CNS depressant effects)
▶ Antiepileptics (carbamazepine) moderately decrease the
moderately decreases the exposure to zolpidem.
Zonisamide → see antiepileptics
Zopiclone → see TABLE 11 p. 1377 (CNS depressant effects)
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to zopiclone. Adjust dose.oStudy
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to zopiclone. Adjust dose.oStudy → Also see TABLE 11
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to zopiclone. Adjust
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to
▶ Aprepitant is predicted to increase the exposure to zopiclone.
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to zopiclone. Adjust dose.oStudy
▶ Cobicistat is predicted to increase the exposure to zopiclone.
▶ Crizotinib is predicted to increase the exposure to zopiclone.
▶ Enzalutamide is predicted to decrease the exposure to
▶ HIV-protease inhibitors are predicted to increase the exposure
to zopiclone. Adjust dose.oTheoretical
▶ Idelalisib is predicted to increase the exposure to zopiclone.
▶ Imatinib is predicted to increase the exposure to zopiclone.
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to zopiclone. Adjust dose.oTheoretical
▶ Macrolides (erythromycin) are predicted to increase the
exposure to zopiclone. Adjust dose.oStudy
▶ Mitotane is predicted to decrease the exposure to zopiclone.
▶ Netupitant is predicted to increase the exposure to zopiclone.
▶ Nilotinib is predicted to increase the exposure to zopiclone.
▶ Rifampicin is predicted to decrease the exposure to zopiclone.
Zuclopenthixol → see TABLE 8 p. 1376 (hypotension), TABLE 9 p. 1377
(QT-interval prolongation), TABLE 11 p. 1377 (CNS depressant effects)
▶ Zuclopenthixol is predicted to decrease the effects of dopamine
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