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is predicted to affect the exposure to atorvastatin.

Anecdotal

▶ Pazopanib is predicted to affect the exposure to statins

(pravastatin, rosuvastatin, simvastatin).oTheoretical

▶ Rosuvastatin is predicted to increase the anticoagulant effect

of phenindione. Monitor INR and adjust dose.rTheoretical

▶ Pibrentasvir (with glecaprevir) markedly increases the

exposure to atorvastatin. Avoid.rStudy

▶ Pibrentasvir (with glecaprevir) is predicted to increase the

exposure to fluvastatin.oTheoretical

▶ Pibrentasvir (with glecaprevir) increases the exposure to

pravastatin. Use with caution and adjust pravastatin dose,

p. 203.oStudy

▶ Pibrentasvir (with glecaprevir) increases the exposure to

rosuvastatin. Use with caution and adjust rosuvastatin dose,

p. 204.oStudy

▶ Pibrentasvir (with glecaprevir) increases the exposure to

simvastatin. Avoid.oStudy

▶ Ranolazine is predicted to increase the exposure to

atorvastatin.oTheoretical

▶ Ranolazine slightly increases the exposure to simvastatin.

Adjust simvastatin dose, p. 205.oStudy

BNF 78 Statins — Statins 1535

Interactions | Appendix 1

A1

Statins (continued)

▶ Regorafenib is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, rosuvastatin).oStudy

▶ Ribociclib (high-dose) is predicted to increase the exposure to

simvastatin. Avoid.oTheoretical

▶ Ribociclib is predicted to increase the exposure to statins

(pravastatin, rosuvastatin).oTheoretical

▶ Rifampicin markedly decreases the exposure to atorvastatin.

Atorvastatin should be taken at the same time as rifampicin,

p. 202, p. 582.oStudy

▶ Rifampicin moderately decreases the exposure to fluvastatin.

Monitor and adjust dose.oStudy

▶ Rifampicin very markedly decreases the exposure to

simvastatin.oStudy

▶ Rolapitant is predicted to increase the exposure to

rosuvastatin. Monitor and adjust dose.rStudy

▶ Sacubitril

r

is predicted to increase the exposure to statins.

Study

▶ St John’s Wort slightly decreases the exposure to atorvastatin.

nStudy

▶ St John’s Wort moderately decreases the exposure to

simvastatin.oStudy

▶ Fluvastatin slightly increases the exposure to sulfonylureas

(glibenclamide).nStudy

▶ Tedizolid is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, rosuvastatin). Avoid.oStudy

▶ Teriflunomide moderately increases the exposure to

rosuvastatin. Adjust rosuvastatin dose, p. 204.oStudy

▶ Teriflunomide is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, pravastatin, simvastatin)

Study

.o ▶ Ticagrelor slightly increases the exposure to simvastatin.

Adjust simvastatin dose, p. 205.oStudy

▶ Tivozanib is predicted to decrease the exposure to

rosuvastatin.oTheoretical

▶ Velpatasvir is predicted to increase the exposure to

atorvastatin. Avoid.rStudy

▶ Velpatasvir increases the exposure to rosuvastatin. Adjust

rosuvastatin dose and monitor side effects, p. 204.rStudy

▶ Velpatasvir is predicted to increase the exposure to

simvastatin

Theoretical

. Monitor side effects and adjust dose.r

▶ Venetoclax is predicted to increase the exposure to

atorvastatin.oStudy

▶ Venetoclax is predicted to increase the exposure to statins

(fluvastatin, pravastatin, rosuvastatin, simvastatin)

Theoretical

.o ▶ Voxilaprevir is predicted to increase the exposure to

atorvastatin. Avoid.oTheoretical

▶ Voxilaprevir (with sofosbuvir and velpatasvir) moderately

increases the exposure to pravastatin. Monitor and adjust

pravastatin dose, p. 203.oStudy

▶ Voxilaprevir (with sofosbuvir and velpatasvir) markedly

increases the exposure to rosuvastatin. Avoid.rStudy

▶ Voxilaprevir (with sofosbuvir and velpatasvir) is predicted to

increase the exposure to statins (fluvastatin, simvastatin).

Avoid.oTheoretical

Stavudine → see TABLE 12 p. 1378 (peripheral neuropathy)

▶ Didanosine increases the risk of toxicity when given with

stavudine. Avoid.rStudy → Also see TABLE 12 p. 1378

▶ Hydroxycarbamide increases the risk of toxicity when given

with stavudine. Avoid.rStudy

▶ Isoniazid is predicted to increase the risk of peripheral

neuropathy when given with stavudine.rTheoretical →

Also see TABLE 12 p. 1378

▶ Ribavirin increases the risk of toxicity when given with

stavudine. Avoid.rStudy

▶ Zidovudine is predicted to decrease the efficacy of stavudine.

Avoid.rTheoretical

Stiripentol → see antiepileptics

Streptokinase → see TABLE 3 p. 1375 (anticoagulant effects)

Streptomycin → see aminoglycosides

Streptozocin → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 2 p. 1375

(nephrotoxicity)

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

streptozocin. Public Health England advises avoid (refer to

Green Book).rTheoretical

Sucralfate

▶ Sucralfate is predicted to decrease the exposure to bictegravir.

Avoid.oTheoretical

▶ Sucralfate potentially decreases the effects of coumarins

(warfarin)

Anecdotal

. Separate administration by 2 hours.o ▶ Sucralfate decreases the absorption of digoxin. Separate

administration by 2 hours.rAnecdotal

▶ Sucralfate

Study

decreases the absorption of dolutegravir.o ▶ Sucralfate increases the risk of blocked enteral or nasogastric

tubes when given with enteral feeds. Separate administration

by 1 hour.oStudy

▶ Potassium citrate increases the risk of side-effects when given

with sucralfate. Avoid.oTheoretical

▶ Sucralfate decreases the exposure to quinolones. Separate

administration by 2 hours.oStudy

▶ Sodium citrate is predicted to increase the risk of side-effects

when given with sucralfate. Avoid.oTheoretical

▶ Sucralfate decreases the absorption of sulpiride. Separate

administration by 2 hours.oStudy

▶ Sucralfate potentially decreases the absorption of

theophylline

o

. Separate administration by at least 2 hours.

Study

▶ Sucralfate decreases the absorption of thyroid hormones

(levothyroxine)

o

. Separate administration by at least 4 hours.

Study

▶ Sucralfate is predicted to decrease the absorption of tricyclic

antidepressants.oStudy

Sufentanil → see opioids

Sugammadex

▶ Sugammadex is predicted to decrease the exposure to oral

combined hormonal contraceptives. Refer to patient

information leaflet for missed pill advice.rTheoretical

▶ Sugammadex is predicted to decrease the exposure to

desogestrel. Refer to patient information leaflet for missed pill

advice.rTheoretical

▶ Sugammadex is predicted to decrease the efficacy of

etonogestrel

Theoretical

. Use additional contraceptive precautions.r

▶ Sugammadex is predicted to decrease the exposure to

levonorgestrel

r

. Use additional contraceptive precautions.

Theoretical

▶ Sugammadex is predicted to decrease the exposure to

medroxyprogesterone. Use additional contraceptive

precautions.rTheoretical

▶ Sugammadex is predicted to decrease the exposure to

norethisterone

r

. Use additional contraceptive precautions.

Theoretical

Sulfadiazine → see sulfonamides

Sulfadoxine → see sulfonamides

Sulfamethoxazole → see sulfonamides

Sulfasalazine → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 15 p. 1378

(myelosuppression)

▶ Antifungals, azoles (isavuconazole) are predicted to increase the

exposure to sulfasalazine.oTheoretical

▶ Sulfasalazine

Study

decreases the concentration of digoxin.o ▶ Sulfasalazine

o

is predicted to decrease the absorption of folates.

Study

▶ Leflunomide is predicted to increase the exposure to

sulfasalazine.oStudy → Also see TABLE 1 p. 1375 → Also see

TABLE 15 p. 1378

▶ Regorafenib is predicted to increase the exposure to

sulfasalazine.oStudy → Also see TABLE 15 p. 1378

▶ Rolapitant increases the exposure to sulfasalazine.rStudy

▶ Tedizolid is predicted to increase the exposure to sulfasalazine.

Avoid.oStudy

▶ Teriflunomide is predicted to increase the exposure to

sulfasalazine.oStudy

1536 Statins — Sulfasalazine BNF 78

Interactions | Appendix 1

A1

▶ Velpatasvir is predicted to increase the exposure to

sulfasalazine.oTheoretical

▶ Venetoclax is predicted to increase the exposure to

sulfasalazine.oTheoretical

▶ Voxilaprevir is predicted to increase the concentration of

sulfasalazine. Avoid.rTheoretical

Sulfonamides → see TABLE 15 p. 1378 (myelosuppression)

sulfadiazine . sulfadoxine . sulfamethoxazole. ▶ Sulfonamides potentially increase the risk of

methaemoglobinaemia when given with topical anaesthetics,

local (prilocaine). Use with caution or avoid.rAnecdotal

▶ Sulfadiazine is predicted to increase the concentration of

o

antiepileptics (fosphenytoin). Monitor and adjust dose.

Study

▶ Sulfadiazine increases the concentration of antiepileptics

(phenytoin). Monitor and adjust dose.oStudy

▶ Antimalarials (pyrimethamine) increase the risk of side-effects

when given with sulfonamides.rStudy → Also see TABLE 15

p. 1378

▶ Sulfadiazine is predicted to increase the anticoagulant effect

of coumarins.rTheoretical

▶ Sulfamethoxazole increases the anticoagulant effect of

coumarins.rStudy

▶ Sulfonamides are predicted to increase the risk of

Theoretical

methaemoglobinaemia when given with dapsone.r

▶ Sulfonamides are predicted to increase the exposure to

methotrexate. Use with caution or avoid.rTheoretical →

Also see TABLE 15 p. 1378

▶ Potassium aminobenzoate is predicted to affect the efficacy of

sulfonamides. Avoid.rTheoretical

▶ Sulfonamides are predicted to increase the exposure to

sulfonylureas.oStudy

▶ Sulfonamides are predicted to increase the effects of

thiopental.oTheoretical

Sulfonylureas → see TABLE 14 p. 1378 (antidiabetic drugs)

glibenclamide . gliclazide . glimepiride . glipizide .tolbutamide. ▶ Antiarrhythmics (amiodarone) are predicted to increase the

exposure to

o

sulfonylureas. Use with caution and adjust dose.

Study

▶ Antifungals, azoles (fluconazole, miconazole) are predicted to

increase the exposure to sulfonylureas. Use with caution and

adjust dose.oStudy

▶ Antifungals, azoles (voriconazole) are predicted to increase the

concentration of sulfonylureas. Use with caution and adjust

dose.oStudy

▶ Bosentan increases the risk of hepatotoxicity when given with

glibenclamide. Avoid.rStudy

▶ Cephalosporins (ceftobiprole) are predicted to increase the

concentration of glibenclamide.oTheoretical

▶ Ceritinib is predicted to increase the exposure to glimepiride.

Adjust dose.oTheoretical

▶ Chloramphenicol is predicted to increase the exposure to

sulfonylureas.rStudy

▶ Fibrates are predicted to increase the risk of hypoglycaemia

when given with sulfonylureas.oTheoretical

▶ Leflunomide is predicted to increase the exposure to

glibenclamide.oStudy

▶ Letermovir is predicted to increase the concentration of

glibenclamide.oTheoretical

▶ Macrolides (clarithromycin) are predicted to slightly increase

the exposure to sulfonylureas.oTheoretical

▶ Rifampicin is predicted to decrease the exposure to

sulfonylureas.oStudy

▶ Statins (fluvastatin) slightly increase the exposure to

glibenclamide.nStudy

▶ Sulfonamides are predicted to increase the exposure to

sulfonylureas.oStudy

▶ Teriflunomide is predicted to increase the exposure to

glibenclamide.oStudy

▶ Venetoclax is predicted to increase the exposure to

glibenclamide.oTheoretical

Sulindac → see NSAIDs

Sulpiride → see TABLE 8 p. 1376 (hypotension), TABLE 9 p. 1377 (QTinterval prolongation), TABLE 11 p. 1377 (CNS depressant effects)

▶ Antacids decrease the absorption of sulpiride. Separate

administration by 2 hours.oStudy

▶ Sulpiride is predicted to decrease the effects of dopamine

receptor agonists. Avoid.oTheoretical → Also see TABLE 8

p. 1376 → Also see TABLE 9 p. 1377

▶ Sulpiride is predicted to decrease the effects of levodopa.

Avoid.rTheoretical → Also see TABLE 8 p. 1376

▶ Sulpiride potentially increases the risk of neurotoxicity when

given with lithium.rAnecdotal → Also see TABLE 9 p. 1377

▶ Sucralfate decreases the absorption of sulpiride. Separate

administration by 2 hours.oStudy

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

▶ Sumatriptan increases the risk of vasoconstriction when given

with ergotamine. Ergotamine should be taken at least 24 hours

before or 6 hours after sumatriptan.rStudy

▶ Moclobemide moderately increases the exposure to

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

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the exposure to sumatriptan. Avoid and

for 14 days after stopping the MAOI.rTheoretical → Also

see TABLE 13 p. 1378

Sunitinib → see TABLE 15 p. 1378 (myelosuppression), TABLE 9 p. 1377

(QT-interval prolongation)

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to sunitinib.oTheoretical → Also see TABLE 9

p. 1377

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to

Study

sunitinib. Avoid or adjust sunitinib dose, p. 999.o ▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Theoretical → Also see TABLE 9 p. 1377

sunitinib.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to slightly increase the exposure to sunitinib. Avoid

or adjust sunitinib dose, p. 999.oStudy → Also see TABLE 9

p. 1377

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