is predicted to decrease the exposure to reboxetine.

Anecdotal

▶ Rifampicin is predicted to decrease the exposure to

regorafenib. Avoid.oStudy

▶ Rifampicin is predicted to decrease the exposure to

repaglinide

Study

. Monitor blood glucose and adjust dose.o ▶ Rifampicin is predicted to markedly decrease the exposure to

ribociclib. Avoid.rStudy

▶ Rifampicin markedly decreases the exposure to rilpivirine.

Avoid.rStudy

▶ Rifampicin is predicted to decrease the exposure to

risperidone. Adjust dose.oStudy

▶ Rifampicin is predicted to moderately decrease the exposure

to rivaroxaban. Avoid unless patient can be monitored for

signs of thrombosis.rStudy

▶ Rifampicin is predicted to decrease the exposure to roflumilast.

Avoid.oStudy

▶ Rifampicin is predicted to markedly decrease the exposure to

rolapitant. Avoid.rStudy

▶ Rifampicin is predicted to decrease the exposure to ruxolitinib.

Monitor and adjust dose.oStudy

▶ Rifampicin is predicted to moderately decrease the exposure

to saxagliptin.oStudy

▶ Rifampicin moderately decreases the exposure to the active

metabolite of selexipag. Adjust dose.oStudy

▶ Rifampicin is predicted to decrease the concentration of

sirolimus. Avoid.rStudy

▶ Rifampicin is predicted to decrease the exposure to sofosbuvir.

Avoid.rStudy

▶ Rifampicin

o

is predicted to decrease the exposure to solifenacin.

Theoretical

▶ Rifampicin

o

is predicted to decrease the exposure to sorafenib.

Theoretical

▶ Rifampicin markedly decreases the exposure to statins

(atorvastatin). Atorvastatin should be taken at the same time

as rifampicin.oStudy

▶ Rifampicin moderately decreases the exposure to statins

(fluvastatin). Monitor and adjust dose.oStudy

▶ Rifampicin very markedly decreases the exposure to statins

(simvastatin).oStudy

▶ Rifampicin is predicted to decrease the exposure to

sulfonylureas.oStudy

▶ Rifampicin is predicted to decrease the exposure to sunitinib.

Avoid or adjust sunitinib dose, p. 999.oStudy

▶ Rifampicin decreases the concentration of tacrolimus. Monitor

and adjust dose.rStudy

▶ Rifampicin

q

markedly decreases the exposure to tamoxifen.

Study

▶ Rifampicin is predicted to decrease the exposure to taxanes

(cabazitaxel, paclitaxel). Avoid.rStudy

▶ Rifampicin is predicted to decrease the exposure to taxanes

(docetaxel).rTheoretical

▶ Rifampicin is predicted to decrease the concentration of

temsirolimus. Avoid.rStudy

▶ Rifampicin is predicted to decrease the exposure to tenofovir

alafenamide. Avoid.oTheoretical

▶ Rifampicin

o

decreases the exposure to terbinafine. Adjust dose.

Study

▶ Teriflunomide is predicted to increase the exposure to

rifampicin.oTheoretical

▶ Rifampicin decreases the exposure to tetracyclines

(doxycycline). Monitor and adjust dose.oStudy

▶ Rifampicin is predicted to decrease the exposure to tezacaftor.

Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to

theophylline. Adjust dose.oStudy

▶ Rifampicin is predicted to markedly decrease the exposure to

ticagrelor. Avoid.rStudy

▶ Rifampicin

r

is predicted to decrease the exposure to tivozanib.

Study

▶ Rifampicin moderately decreases the exposure to tizanidine.

nStudy

▶ Rifampicin is predicted to decrease the exposure to tofacitinib.

Avoid.rStudy

▶ Rifampicin is predicted to decrease the exposure to tolvaptan.

Use with caution or avoid depending on indication.

Study

r

BNF 78 Rifampicin — Rifampicin 1525

Interactions | Appendix 1

A1

Rifampicin (continued)

▶ Rifampicin is predicted to decrease the exposure to toremifene.

Adjust dose.oStudy

▶ Rifampicin is predicted to decrease the exposure to

trabectedin. Avoid.rTheoretical

▶ Rifampicin

Study

decreases the exposure to trimethoprim.o ▶ Rifampicin decreases the efficacy of ulipristal. For FSRH

guidance, see

Anecdotal

Contraceptives, interactions p. 794.r

▶ Rifampicin is predicted to decrease the exposure to

vandetanib. Avoid.oStudy

▶ Rifampicin is predicted to moderately decrease the exposure

to velpatasvir. Avoid.rStudy

▶ Rifampicin is predicted to decrease the exposure to

vemurafenib. Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to venetoclax.

Avoid.rStudy

▶ Rifampicin is predicted to decrease the exposure to vinca

alkaloids (vinblastine, vincristine, vindesine).rTheoretical

▶ Rifampicin is predicted to decrease the exposure to vinca

alkaloids (vinflunine). Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to vinca

alkaloids

Theoretical

(vinorelbine). Use with caution or avoid.r

▶ Rifampicin is predicted to decrease the exposure to

vismodegib. Avoid.oTheoretical

▶ Rifampicin potentially increases the risk of nephrotoxicity

when given with volatile halogenated anaesthetics

(methoxyflurane). Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to

vortioxetine. Monitor and adjust dose.oStudy

▶ Rifampicin is predicted to decrease the concentration of

voxilaprevir. Avoid.rStudy

▶ Rifampicin

o

moderately decreases the exposure to zolpidem.

Study

▶ Rifampicin is predicted to decrease the exposure to zopiclone.

Adjust dose.oStudy

Rifaximin

▶ Ciclosporin

r

very markedly increases the exposure to rifaximin.

Study

Rilpivirine

▶ Antacids are predicted to decrease the exposure to rilpivirine.

Antacids should be taken 2 hours before or 4 hours after

rilpivirine.rTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) markedly decrease the exposure to

rilpivirine. Avoid.rStudy

▶ Antiepileptics (oxcarbazepine) are predicted to decrease the

concentration of rilpivirine. Avoid.rTheoretical

▶ Bosentan is predicted to decrease the exposure to rilpivirine.

Avoid.rTheoretical

▶ Calcium salts (calcium carbonate) are predicted to slightly

decrease the exposure to rilpivirine. Calcium carbonate should

be taken 2 hours before or 4 hours after

Theoretical

rilpivirine.r

▶ Corticosteroids (dexamethasone) are predicted to decrease the

concentration of rilpivirine. Avoid multiple-dose

dexamethasone.rTheoretical

▶ Efavirenz is predicted to decrease the exposure to rilpivirine.

Avoid.rTheoretical

▶ Enzalutamide markedly decreases the exposure to rilpivirine.

Avoid.rStudy

▶ Etravirine is predicted to decrease the exposure to rilpivirine.

Avoid.rTheoretical

▶ H2 receptor antagonists are predicted to decrease the exposure

to rilpivirine. H2 receptor antagonists should be taken 12 hours

before or 4 hours after rilpivirine.rStudy

▶ Mitotane markedly decreases the exposure to rilpivirine.

Avoid.rStudy

▶ Nevirapine is predicted to decrease the exposure to rilpivirine.

Avoid.rTheoretical

▶ Proton pump inhibitors are predicted to decrease the exposure

to rilpivirine. Avoid.rStudy

▶ Rifabutin slightly decreases the exposure to rilpivirine. Adjust

dose.rStudy

▶ Rifampicin markedly decreases the exposure to rilpivirine.

Avoid.rStudy

▶ St John’s Wort is predicted to decrease the exposure to

rilpivirine. Avoid.rTheoretical

Riluzole

FOOD AND LIFESTYLE Charcoal-grilled foods are predicted to

decrease the exposure to riluzole.

▶ Mexiletine

o

is predicted to increase the exposure to riluzole.

Theoretical

▶ Quinolones (ciprofloxacin) are predicted to increase the

exposure to riluzole.oTheoretical

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

riluzole.oTheoretical

Riociguat → see TABLE 8 p. 1376 (hypotension)

▶ Antacids slightly decrease the exposure to riociguat. Antacids

should be taken 2 hours before or 1 hour after riociguat.n

Study

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

exposure to riociguat. Avoid.oStudy

▶ Antifungals, azoles (ketoconazole) moderately increase the

exposure to riociguat. Avoid.oStudy

▶ Ciclosporin

o

is predicted to increase the exposure to riociguat.

Theoretical

▶ HIV-protease inhibitors (ritonavir) are predicted to increase the

exposure to riociguat. Avoid.oTheoretical

▶ Riociguat is predicted to increase the risk of hypotension

when given with

r

phosphodiesterase type-5 inhibitors. Avoid.

Theoretical → Also see TABLE 8 p. 1376

Risedronate → see bisphosphonates

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

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to risperidone. Adjust dose.oStudy → Also see TABLE 11

p. 1377

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

predicted to increase the exposure to

o

risperidone. Adjust dose.

Study → Also see TABLE 9 p. 1377

▶ Bupropion is predicted to increase the exposure to risperidone.

Adjust dose.oStudy

▶ Cinacalcet is predicted to increase the exposure to risperidone.

Adjust dose.oStudy

▶ Cobicistat is predicted to increase the exposure to risperidone.

Adjust dose.oStudy

▶ Risperidone is predicted to decrease the effects of dopamine

receptor agonists. Avoid.oTheoretical → Also see TABLE 8

p. 1376 → Also see TABLE 9 p. 1377

▶ Enzalutamide is predicted to decrease the exposure to

risperidone. Adjust dose.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to risperidone. Adjust dose.oStudy → Also see TABLE 9

p. 1377

▶ Idelalisib is predicted to increase the exposure to risperidone.

Adjust dose.oStudy

▶ Risperidone is predicted to decrease the effects of levodopa.

Avoid or adjust dose.rAnecdotal → Also see TABLE 8 p. 1376

▶ Risperidone potentially increases the risk of neurotoxicity

when given with lithium.rAnecdotal → Also see TABLE 9

p. 1377

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to risperidone. Adjust dose.oStudy → Also see

TABLE 9 p. 1377

▶ Risperidone increases the risk of dyskinesias when given with

methylphenidate.rAnecdotal

▶ Mitotane is predicted to decrease the exposure to risperidone.

Adjust dose.oStudy

▶ Rifampicin is predicted to decrease the exposure to

risperidone. Adjust dose.oStudy

▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the

exposure to risperidone. Adjust dose.oStudy

▶ Terbinafine is predicted to increase the exposure to

risperidone. Adjust dose.oStudy

Ritonavir → see HIV-protease inhibitors

1526 Rifampicin — Ritonavir BNF 78

Interactions | Appendix 1

A1

Rituximab → see monoclonal antibodies

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

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to rivaroxaban. Avoid.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to moderately decrease

the exposure to rivaroxaban. Avoid unless patient can be

monitored for signs of thrombosis.rStudy

▶ Antifungals, azoles (itraconazole, ketoconazole) are predicted to

moderately increase the exposure to

r

rivaroxaban. Avoid.

Study

▶ Cobicistat is predicted to increase the exposure to rivaroxaban.

Avoid.rTheoretical

▶ Enzalutamide is predicted to moderately decrease the

exposure to rivaroxaban. Avoid unless patient can be

monitored for signs of thrombosis.rStudy

▶ HIV-protease inhibitors (ritonavir) moderately increase the

exposure to rivaroxaban. Avoid.rStudy

▶ Mitotane is predicted to moderately decrease the exposure to

rivaroxaban. Avoid unless patient can be monitored for signs

of thrombosis.rStudy

▶ Rifampicin is predicted to moderately decrease the exposure

to rivaroxaban. Avoid unless patient can be monitored for

signs of thrombosis.rStudy

Rivastigmine → see anticholinesterases, centrally acting

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

▶ Beta blockers, non-selective (propranolol) slightly to moderately

increase the exposure to rizatriptan. Adjust rizatriptan dose

and separate administration by at least 2 hours.oStudy

▶ Rizatriptan is predicted to increase the risk of vasoconstriction

when given with ergotamine. Ergotamine should be taken at

least 24 hours before or 6 hours after

Theoretical

rizatriptan.r

▶ Moclobemide moderately increases the exposure to rizatriptan.

Avoid.oStudy → Also see TABLE 13 p. 1378

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the exposure to rizatriptan. Avoid and

for 14 days after stopping the MAOI.rTheoretical → Also

see TABLE 13 p. 1378

Rocuronium → see neuromuscular blocking drugs, non-depolarising

Roflumilast

▶ Aminophylline is predicted to slightly increase the exposure to

roflumilast. Avoid.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to roflumilast. Avoid.oStudy

▶ Combined hormonal contraceptives are predicted to increase

the exposure to roflumilast.oTheoretical

▶ Enzalutamide is predicted to decrease the exposure to

roflumilast. Avoid.oStudy

▶ H2 receptor antagonists (cimetidine) slightly increase the

exposure to roflumilast.oStudy

▶ Mexiletine

o

is predicted to increase the exposure to roflumilast.

Theoretical

▶ Mitotane is predicted to decrease the exposure to roflumilast.

Avoid.oStudy

▶ Quinolones (ciprofloxacin) are predicted to increase the

exposure to roflumilast.oTheoretical

▶ Rifampicin is predicted to decrease the exposure to roflumilast.

Avoid.oStudy

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

roflumilast.oStudy

▶ Theophylline is predicted to slightly increase the exposure to

roflumilast. Avoid.oTheoretical

Rolapitant

▶ Rolapitant is predicted to increase the exposure to alkylating

agents (bendamustine). Avoid or monitor.oStudy

▶ Rolapitant is predicted to increase the exposure to

o

anthracyclines (doxorubicin, mitoxantrone). Avoid or monitor.

Study

▶ Rolapitant is predicted to increase the exposure to

antiarrhythmics (propafenone).rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to markedly decrease the

exposure to rolapitant. Avoid.rStudy

▶ Rolapitant is predicted to moderately increase the exposure to

beta blockers, selective (metoprolol).rStudy

▶ Bosentan is predicted to decrease the exposure to rolapitant.

Avoid.rStudy

▶ Rolapitant

o

is predicted to increase the exposure to colchicine.

Study

▶ Rolapitant

o

is predicted to increase the exposure to dabigatran.

Study

▶ Rolapitant

Study

slightly increases the exposure to digoxin.o ▶ Efavirenz is predicted to decrease the exposure to rolapitant.

Avoid.rStudy

▶ Enzalutamide is predicted to markedly decrease the exposure

to rolapitant. Avoid.rStudy

▶ Rolapitant is predicted to increase the exposure to irinotecan.

Avoid or monitor.oStudy

▶ Rolapitant is predicted to increase the exposure to

methotrexate. Avoid or monitor.oStudy

▶ Mitotane is predicted to markedly decrease the exposure to

rolapitant. Avoid.rStudy

▶ Nevirapine is predicted to decrease the exposure to rolapitant.

Avoid.rStudy

▶ Rolapitant

r

is predicted to increase the exposure to pimozide.

Study

▶ Rifabutin is predicted to decrease the exposure to rolapitant.

Avoid.oTheoretical

▶ Rifampicin is predicted to markedly decrease the exposure to

rolapitant. Avoid.rStudy

▶ St John’s Wort is predicted to decrease the exposure to

rolapitant. Avoid.rStudy

▶ Rolapitant is predicted to increase the exposure to statins

(rosuvastatin). Monitor and adjust dose.rStudy

▶ Rolapitant increases the exposure to sulfasalazine.rStudy

▶ Rolapitant

r

is predicted to increase the exposure to tamoxifen.

Study

▶ Rolapitant is predicted to increase the exposure to topotecan.

Avoid or monitor.oStudy

Ropinirole → see dopamine receptor agonists

Ropivacaine → see anaesthetics, local

Rosuvastatin → see statins

Rotavirus vaccine → see live vaccines

Rotigotine → see dopamine receptor agonists

Rucaparib

▶ Rucaparib is predicted to increase the exposure to

aminophylline. Monitor and adjust dose.oStudy

▶ Rucaparib is predicted to increase the exposure to antiepileptics

(phenytoin). Monitor and adjust dose.oStudy

▶ Rucaparib is predicted to increase the exposure to ciclosporin.

Monitor and adjust dose.oStudy

▶ Rucaparib slightly increases the exposure to coumarins

(warfarin). Monitor and adjust dose.rStudy

▶ Rucaparib is predicted to increase the exposure to ergotamine.

Monitor and adjust dose.oStudy

▶ Rucaparib slightly increases the exposure to midazolam.

Monitor and adjust dose.rStudy

▶ Rucaparib is predicted to increase the exposure to opioids

(alfentanil, fentanyl). Monitor and adjust dose.oStudy

▶ Rucaparib is predicted to increase the exposure to pimozide.

Monitor and adjust dose.oStudy

▶ Rucaparib is predicted to increase the exposure to sirolimus.

Monitor and adjust dose.oStudy

▶ Rucaparib is predicted to increase the exposure to tacrolimus.

Monitor and adjust dose.oStudy

▶ Rucaparib is predicted to increase the exposure to

theophylline. Monitor and adjust dose.oStudy

▶ Rucaparib is predicted to increase the exposure to tizanidine.

Monitor and adjust dose.oStudy

Rufinamide → see antiepileptics

Rupatadine → see antihistamines, non-sedating

Ruxolitinib → see TABLE 15 p. 1378 (myelosuppression)

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to ruxolitinib.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to ruxolitinib. Monitor and adjust dose.oStudy

BNF 78 Rituximab — Ruxolitinib 1527

Interactions | Appendix 1

A1

Ruxolitinib (continued)

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Theoretical

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

predicted to increase the exposure to ruxolitinib. Adjust dose

and monitor side effects.oStudy

▶ Aprepitant

o

is predicted to increase the exposure to ruxolitinib.

Theoretical

▶ Bosentan is predicted to decrease the exposure to ruxolitinib.

Monitor and adjust dose.oTheoretical

▶ Calcium channel blockers (diltiazem, verapamil) are predicted to

increase the exposure to ruxolitinib.oTheoretical

▶ Cobicistat is predicted to increase the exposure to ruxolitinib.

Adjust dose and monitor side effects.oStudy

▶ Ruxolitinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Crizotinib

o

is predicted to increase the exposure to ruxolitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Efavirenz is predicted to decrease the exposure to ruxolitinib.

Monitor and adjust dose.oTheoretical

▶ Enzalutamide is predicted to decrease the exposure to

ruxolitinib. Monitor and adjust dose.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

ruxolitinib.rTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to

Study

ruxolitinib. Adjust dose and monitor side effects.o ▶ Idelalisib is predicted to increase the exposure to ruxolitinib.

Adjust dose and monitor side effects.oStudy → Also see

TABLE 15 p. 1378

▶ Imatinib

o

is predicted to increase the exposure to ruxolitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to

o

ruxolitinib. Adjust dose and monitor side effects.

Study

▶ Macrolides (erythromycin) are predicted to increase the

exposure to ruxolitinib.oTheoretical

▶ Mitotane is predicted to decrease the exposure to ruxolitinib.

Monitor and adjust dose.oStudy → Also see TABLE 15

p. 1378

▶ Netupitant

o

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