▶ 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

Book).rTheoretical

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the exposure to vinca alkaloids.rTheoretical →

Also see TABLE 9 p. 1377

▶ 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 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

p. 1378

▶ Netupitant is predicted to increase the exposure to vinca

alkaloids.rTheoretical

▶ Nilotinib is predicted to increase the exposure to vinca

alkaloids.rTheoretical → Also see TABLE 15 p. 1378 → Also see

TABLE 9 p. 1377

▶ 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.

Avoid.rTheoretical

▶ 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

Vitamin A

▶ Retinoids (acitretin, alitretinoin, isotretinoin) are predicted to

increase the risk of vitamin A toxicity when given with vitamin

A. Avoid.rTheoretical

▶ Retinoids (bexarotene) are predicted to increase the risk of

toxicity when given with

Theoretical

vitamin A. Adjust dose.o

▶ Retinoids (tretinoin) are predicted to increase the risk of

vitamin A toxicity when given with

Study

vitamin A. Avoid.r

Vitamin D substances

alfacalcidol . calcipotriol . calcitriol . colecalciferol . dihydrotachysterol . ergocalciferol . paricalcitol .tacalcitol.

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

vitamin D substances.oStudy

▶ Antiepileptics (phenobarbital, primidone) are predicted to

decrease the effects of

Theoretical

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

Study

paricalcitol.o ▶ Cobicistat

o

is predicted to increase the exposure to paricalcitol.

Study

▶ 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

to paricalcitol.oStudy

▶ Idelalisib

o

is predicted to increase the exposure to paricalcitol.

Study

▶ 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

Vitamin E substances

alpha tocopherol . alpha tocopheryl acetate. ▶ Vitamin E substances

o

affect the exposure to ciclosporin.

Study

Volatile halogenated anaesthetics → see TABLE 8 p. 1376

(hypotension), TABLE 11 p. 1377 (CNS depressant effects)

desflurane .isoflurane . methoxyflurane . sevoflurane. ▶ Antiepileptics (phenobarbital, primidone) potentially increase

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

see TABLE 13 p. 1378

▶ 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

exposure to

Study → Also see

vortioxetine

TABLE 13 p. 1378

. Monitor and adjust dose.

→ Also see TABLE 4 p. 1375

o ▶ Terbinafine is predicted to increase the exposure to

vortioxetine. Monitor and adjust dose.oStudy

1552 Vinca alkaloids — Vortioxetine BNF 78

Interactions | Appendix 1

A1

Voxilaprevir

▶ 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

▶ Ciclosporin

r

increases the concentration of voxilaprevir. Avoid.

Study

▶ 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

increase the exposure to

r

digoxin. Monitor and adjust dose.

Theoretical

▶ Voxilaprevir (with sofosbuvir and velpatasvir) is predicted to

increase the concentration of

Theoretical

edoxaban. Avoid.r

▶ Efavirenz is predicted to decrease the concentration of

voxilaprevir. Avoid.rTheoretical

▶ Enzalutamide is predicted to decrease the concentration of

voxilaprevir. Avoid.rStudy

▶ 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

r

voxilaprevir. Avoid.

Theoretical

▶ HIV-protease inhibitors (tipranavir boosted with ritonavir) are

predicted to increase the concentration of

Theoretical

voxilaprevir.r

▶ Mitotane is predicted to decrease the concentration of

voxilaprevir. Avoid.rStudy

▶ 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

voxilaprevir. Avoid.rStudy

▶ 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).

Avoid.oTheoretical

▶ Voxilaprevir (with sofosbuvir and velpatasvir) moderately

increases the exposure to statins (pravastatin). Monitor and

adjust pravastatin dose.oStudy

▶ Voxilaprevir (with sofosbuvir and velpatasvir) markedly

increases the exposure to

Study

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

Study

tenofovir disoproxil.r

▶ Voxilaprevir is predicted to increase the concentration of

topotecan. Avoid.rTheoretical

Warfarin → see coumarins

Wasp venom extract

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

(nephrotoxicity)

▶ Antiepileptics (valproate) slightly increase the exposure to

zidovudine.oStudy

▶ Antifungals, azoles (fluconazole) slightly increase the exposure

to zidovudine.oStudy

▶ Antimalarials (pyrimethamine) are predicted to increase the risk

of side-effects when given with zidovudine.rTheoretical →

Also see TABLE 15 p. 1378

▶ Zidovudine increases the risk of haematological toxicity when

given with aspirin (high-dose).rStudy

▶ Zidovudine increases the risk of haematological toxicity when

given with

Theoretical

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

lamivudine.rAnecdotal

▶ Leflunomide is predicted to increase the exposure to

zidovudine.oTheoretical → Also see TABLE 15 p. 1378

▶ Macrolides (clarithromycin) decrease the absorption of

zidovudine

o

. Separate administration by at least 2 hours.

Study

▶ 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.

Avoid.rTheoretical

▶ Teriflunomide is predicted to increase the exposure to

zidovudine.oTheoretical

Zinc

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

before alendronic acid.oStudy

▶ 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

Theoretical

ibandronic acid.o ▶ Oral zinc decreases the absorption of oral bisphosphonates

(risedronate)

o

. Separate administration by at least 2 hours.

Study

▶ Oral zinc decreases the absorption of oral bisphosphonates

(sodium clodronate). Avoid zinc for 2 hours before or 1 hour

after sodium clodronate.oStudy

▶ Oral

Study

calcium salts decrease the absorption of zinc.o ▶ Oral zinc is predicted to decrease the absorption of

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

(oral)

Study

is predicted to decrease the efficacy of zinc.o ▶ Zinc is predicted to decrease the absorption of penicillamine.

nTheoretical

▶ Zinc is predicted to decrease the exposure to quinolones.

Separate administration by 2 hours.oStudy

▶ Oral zinc is predicted to decrease the absorption of

tetracyclines

o

. Separate administration by 2 to 3 hours.

Theoretical

▶ Trientine

o

potentially decreases the absorption of zinc.

Theoretical

Zoledronic acid → see bisphosphonates

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

▶ Combined hormonal contraceptives are predicted to increase

the exposure to

o

zolmitriptan. Adjust zolmitriptan dose, p. 482.

Theoretical

▶ H2 receptor antagonists (cimetidine) slightly increase the

exposure to zolmitriptan. Adjust zolmitriptan dose, p. 482.n

Study

BNF 78 Voxilaprevir — Zolmitriptan 1553

Interactions | Appendix 1

A1

Zolmitriptan (continued)

▶ Mexiletine is predicted to increase the exposure to

zolmitriptan

Theoretical

. Adjust zolmitriptan dose, p. 482.o ▶ Moclobemide slightly increases the exposure to zolmitriptan.

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

TABLE 13 p. 1378

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the exposure to

Theoretical → Also see TABLE 13 p. 1378

zolmitriptan.r

▶ Quinolones (ciprofloxacin) are predicted to increase the

exposure to

o

zolmitriptan. Adjust zolmitriptan dose, p. 482.

Theoretical

▶ SSRIs (fluvoxamine) are predicted to increase the exposure to

zolmitriptan

Theoretical →

. Adjust

Also see TABLE 13

zolmitriptan

p. 1378

dose, p. 482.r

Zolpidem → see TABLE 11 p. 1377 (CNS depressant effects)

▶ Antiepileptics (carbamazepine) moderately decrease the

exposure to zolpidem.oStudy

▶ Rifampicin

o

moderately decreases the exposure to zolpidem.

Study

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

p. 1377

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to zopiclone. Adjust

dose.oStudy

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

predicted to increase the exposure to

o

zopiclone. Adjust dose.

Theoretical

▶ Aprepitant is predicted to increase the exposure to zopiclone.

Adjust dose.oStudy

▶ 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.

Adjust dose.oTheoretical

▶ Crizotinib is predicted to increase the exposure to zopiclone.

Adjust dose.oStudy

▶ Enzalutamide is predicted to decrease the exposure to

zopiclone. Adjust dose.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to zopiclone. Adjust dose.oTheoretical

▶ Idelalisib is predicted to increase the exposure to zopiclone.

Adjust dose.oTheoretical

▶ Imatinib is predicted to increase the exposure to zopiclone.

Adjust dose.oStudy

▶ 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.

Adjust dose.oStudy

▶ Netupitant is predicted to increase the exposure to zopiclone.

Adjust dose.oStudy

▶ Nilotinib is predicted to increase the exposure to zopiclone.

Adjust dose.oStudy

▶ Rifampicin is predicted to decrease the exposure to zopiclone.

Adjust dose.oStudy

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

receptor agonists. Avoid.oTheoretical → Also see TABLE 8

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