is predicted to decrease the exposure to ospemifene.
▶ Enzalutamide is predicted to moderately decrease the
▶ HIV-protease inhibitors are predicted to increase the exposure
of ospemifene. Avoid.rTheoretical
▶ Idelalisib is predicted to increase the exposure to ospemifene.
Avoid in poor CYP2C9 metabolisers.oStudy
▶ Macrolides (clarithromycin) are predicted to increase the
ospemifene. Avoid in poor CYP2C9 metabolisers.
▶ Mitotane is predicted to moderately decrease the exposure to
▶ Nevirapine is predicted to decrease the exposure to
▶ Rifampicin is predicted to moderately decrease the exposure
▶ St John’s Wort is predicted to decrease the exposure to
Oxaliplatin → see platinum compounds
Oxazepam → see TABLE 11 p. 1377 (CNS depressant effects)
Oxcarbazepine → see antiepileptics
Oxybuprocaine → see anaesthetics, local
Oxybutynin → see TABLE 10 p. 1377 (antimuscarinics)
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to oxybutynin.nTheoretical
▶ Oxybutynin potentially increases the risk of overheating and
dehydration when given with antiepileptics (zonisamide). Avoid
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to oxybutynin.n Theoretical
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to oxybutynin.nStudy
▶ Aprepitant is predicted to increase the exposure to oxybutynin.
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to oxybutynin.nTheoretical
▶ Cobicistat is predicted to increase the exposure to oxybutynin.
▶ Crizotinib is predicted to increase the exposure to oxybutynin.
▶ HIV-protease inhibitors are predicted to increase the exposure
▶ Idelalisib is predicted to increase the exposure to oxybutynin.
▶ Imatinib is predicted to increase the exposure to oxybutynin.
▶ Macrolides (clarithromycin) are predicted to increase the
1508 Opioids — Oxybutynin BNF 78
▶ Macrolides (erythromycin) are predicted to increase the
exposure to oxybutynin.nTheoretical
▶ Netupitant is predicted to increase the exposure to oxybutynin.
▶ Nilotinib is predicted to increase the exposure to oxybutynin.
increases the anticoagulant effect of coumarins.
▶ Oxymetholone increases the anticoagulant effect of
Oxytetracycline → see tetracyclines
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to palbociclib. Avoid or
adjust palbociclib dose, p. 992.rStudy
▶ Palbociclib is predicted to increase the exposure to ciclosporin.
▶ Cobicistat is predicted to increase the exposure to palbociclib.
Avoid or adjust palbociclib dose, p. 992.rStudy
▶ Enzalutamide is predicted to decrease the exposure to
▶ Palbociclib is predicted to increase the exposure to
ergotamine. Adjust dose.oTheoretical
▶ Palbociclib is predicted to increase the exposure to everolimus.
▶ Grapefruit juice is predicted to increase the exposure to
palbociclib. Avoid.rTheoretical
▶ HIV-protease inhibitors are predicted to increase the exposure
palbociclib. Avoid or adjust palbociclib dose, p. 992.r
▶ Idelalisib is predicted to increase the exposure to palbociclib.
Avoid or adjust palbociclib dose, p. 992.rStudy
▶ Macrolides (clarithromycin) are predicted to increase the
palbociclib. Avoid or adjust palbociclib dose, p. 992.
▶ Palbociclib is predicted to increase the exposure to opioids
(alfentanil, fentanyl). Adjust dose.oTheoretical
▶ Palbociclib is predicted to increase the exposure to pimozide.
▶ Rifampicin is predicted to decrease the exposure to palbociclib.
▶ Palbociclib is predicted to increase the exposure to sirolimus.
▶ St John’s Wort is predicted to decrease the exposure to
palbociclib. Avoid.rTheoretical
▶ Palbociclib is predicted to increase the exposure to tacrolimus.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to paliperidone. Monitor and adjust dose.rStudy → Also
▶ Antiepileptics (valproate) slightly increase the exposure to
paliperidone. Adjust dose.oStudy
▶ Paliperidone 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
paliperidone. Monitor and adjust dose.rStudy
is predicted to decrease the effects of levodopa.
Theoretical → Also see TABLE 8 p. 1376
▶ Methylphenidate increases the risk of dyskinesias when given
with paliperidone.rTheoretical
▶ Mitotane is predicted to decrease the exposure to paliperidone.
Monitor and adjust dose.rStudy
▶ Rifampicin is predicted to decrease the exposure to
paliperidone. Monitor and adjust dose.rStudy
▶ St John’s Wort is predicted to decrease the exposure to
Palonosetron → see TABLE 9 p. 1377 (QT-interval prolongation),
TABLE 13 p. 1378 (serotonin syndrome)
▶ Dopamine receptor agonists (apomorphine) are predicted to
increase the risk of severe hypotension when given with
Pamidronate → see bisphosphonates
▶ Pancreatin is predicted to decrease the effects of acarbose.
Pancuronium → see neuromuscular blocking drugs, non-depolarising
Panitumumab → see monoclonal antibodies
Panobinostat → see TABLE 15 p. 1378 (myelosuppression), TABLE 9
p. 1377 (QT-interval prolongation)
FOOD AND LIFESTYLE Avoid pomegranate, pomegranate juice,
and star fruit as they are predicted to increase panobinostat
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
Theoretical → Also see TABLE 9
. Adjust dose.o ▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to panobinostat. Avoid.oTheoretical
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to panobinostat. Adjust
dose; in hepatic impairment avoid, p. 936.
Study → Also see TABLE 9 p. 1377
▶ Antifungals, azoles (posaconazole) are predicted to increase the
exposure to panobinostat. Adjust dose.oTheoretical
▶ Panobinostat is predicted to increase the exposure to
atomoxetine. Monitor and adjust dose.rTheoretical
▶ Panobinostat is predicted to increase the exposure to beta
(metoprolol). Monitor and adjust dose.
▶ Panobinostat is predicted to increase the exposure to beta
blockers, selective (nebivolol). Monitor and adjust dose.n Theoretical
▶ Calcium channel blockers (verapamil) are predicted to increase
the exposure to panobinostat. Adjust dose.oTheoretical
▶ Ciclosporin is predicted to increase the exposure to
panobinostat. Adjust dose.oTheoretical
▶ Cobicistat is predicted to increase the exposure to
panobinostat. Adjust panobinostat dose; in hepatic
impairment avoid, p. 936.oStudy
▶ Enzalutamide is predicted to decrease the exposure to
panobinostat. Avoid.oTheoretical
▶ HIV-protease inhibitors are predicted to increase the exposure
to panobinostat. Adjust panobinostat dose; in hepatic
impairment avoid, p. 936.oStudy → Also see TABLE 9
▶ Idelalisib is predicted to increase the exposure to
panobinostat. Adjust panobinostat dose; in hepatic
impairment avoid, p. 936.oStudy → Also see TABLE 15
▶ Lapatinib is predicted to increase the exposure to
panobinostat. Adjust dose.oTheoretical → Also see
▶ Macrolides (azithromycin, erythromycin) are predicted to
Theoretical → Also see TABLE 9
. Adjust dose.o ▶ Macrolides (clarithromycin) are predicted to increase the
exposure to panobinostat. Adjust panobinostat dose; in
hepatic impairment avoid, p. 936.oStudy → Also see
▶ Mitotane is predicted to decrease the exposure to
panobinostat. Avoid.oTheoretical → Also see TABLE 15
▶ Panobinostat is predicted to increase the exposure to
pimozide. Avoid.rTheoretical → Also see TABLE 9 p. 1377
BNF 78 Oxybutynin — Panobinostat 1509
▶ Ranolazine is predicted to increase the exposure to
panobinostat. Adjust dose.oTheoretical → Also see
▶ Rifampicin is predicted to decrease the exposure to
panobinostat. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
panobinostat. Avoid.oTheoretical
▶ Vemurafenib is predicted to increase the exposure to
panobinostat. Adjust dose.oTheoretical → Also see
Pantoprazole → see proton pump inhibitors
Paracetamol → see TABLE 1 p. 1375 (hepatotoxicity)
▶ Alcohol (beverage)(in those who drink heavily) causes severe
liver damage when given with paracetamol.rStudy → Also
▶ Paracetamol is predicted to decrease the clearance of alkylating
agents (busulfan).oTheoretical
▶ Paracetamol is predicted to increase the risk of
methaemoglobinaemia when given with topical anaesthetics,
local (prilocaine). Use with caution or avoid.rTheoretical
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
decrease the exposure to paracetamol.
Study → Also see TABLE 1 p. 1375
increases the anticoagulant effect of coumarins.
▶ Paracetamol is predicted to increase the risk of
methaemoglobinaemia when given with dapsone.r
▶ Imatinib increases the risk of hepatotoxicity when given with
▶ Paracetamol potentially increases the risk of high anion gap
metabolic acidosis when given with penicillins (flucloxacillin).
Theoretical → Also see TABLE 1 p. 1375
▶ Paracetamol is predicted to increase the anticoagulant effect
▶ Pitolisant is predicted to decrease the exposure to
decreases the exposure to paracetamol.o
Paraldehyde → see antiepileptics
▶ Bisphosphonates are predicted to decrease the effects of
parathyroid hormone. Avoid.oStudy
Paricalcitol → see vitamin D substances
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to aliskiren.oStudy
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
paritaprevir (with ritonavir and ombitasvir). Avoid.r
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to
▶ Antifungals, azoles (posaconazole) are predicted to increase the
exposure to paritaprevir (with ritonavir and ombitasvir) and
paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to antifungals, azoles (posaconazole).
▶ Bosentan is predicted to decrease the exposure to paritaprevir
(with ritonavir and ombitasvir). Avoid.rStudy
▶ Cobicistat is predicted to increase the exposure to paritaprevir.
▶ Combined hormonal contraceptives (containing
ethinylestradiol) are predicted to increase the risk of
increased ALT concentrations when given with paritaprevir
(with ritonavir and ombitasvir). Avoid.rStudy
▶ Paritaprevir (in fixed-dose combination with dasabuvir)
decreases the anticoagulant effect of coumarins
. Monitor INR and adjust dose.r
▶ Paritaprevir (in fixed-dose combination) decreases the
anticoagulant effect of coumarins (warfarin). Monitor INR and
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to dabigatran.rStudy
▶ Paritaprevir (with ritonavir and ombitasvir) increases the
digoxin. Monitor and adjust digoxin dose, p. 109.
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to edoxaban.rStudy
▶ Efavirenz is predicted to decrease the exposure to paritaprevir
(with ritonavir and ombitasvir). Avoid.rStudy
▶ Enzalutamide is predicted to decrease the exposure to
(with ritonavir and ombitasvir). Avoid.r
▶ Etravirine is predicted to decrease the exposure to
paritaprevir. Avoid.rTheoretical
▶ HIV-protease inhibitors (atazanavir boosted with ritonavir)
markedly increase the exposure to paritaprevir. Avoid or give
▶ HIV-protease inhibitors (darunavir boosted with ritonavir)
slightly decrease the exposure to paritaprevir. Avoid or give
▶ HIV-protease inhibitors (fosamprenavir, tipranavir) (boosted with
ritonavir) are predicted to increase the exposure to
▶ HIV-protease inhibitors (lopinavir boosted with ritonavir)
moderately to markedly increase the exposure to paritaprevir.
▶ HIV-protease inhibitors (saquinavir) are predicted to increase the
paritaprevir (in fixed-dose combination). Avoid.
▶ Paritaprevir is predicted to increase the exposure to idelalisib.
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to loop diuretics (furosemide). Adjust
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to loperamide.oStudy
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to paritaprevir. Avoid.rStudy
▶ Macrolides (erythromycin) are predicted to increase the
exposure to paritaprevir.oTheoretical
▶ Mitotane is predicted to decrease the exposure to paritaprevir
(with ritonavir and ombitasvir). Avoid.rStudy
▶ Nevirapine is predicted to decrease the exposure to
(with ritonavir and ombitasvir). Avoid.r
▶ Rifampicin is predicted to decrease the exposure to
(with ritonavir and ombitasvir). Avoid.r
▶ St John’s Wort is predicted to decrease the exposure to
(with ritonavir and ombitasvir). Avoid.r
▶ Paritaprevir (in fixed-dose combination) is predicted to
increase the risk of rhabdomyolysis when given with statins
(atorvastatin). Avoid.rTheoretical
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
statins (fluvastatin). Avoid.o ▶ Paritaprevir (with ritonavir and ombitasvir) increases the
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