is predicted to decrease the exposure to quetiapine.

Study

▶ Netupitant is predicted to increase the exposure to quetiapine.

Avoid.oStudy

▶ Nevirapine

o

is predicted to decrease the exposure to quetiapine.

Study

▶ Nilotinib is predicted to increase the exposure to quetiapine.

Avoid.oStudy

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

quetiapine. Avoid.oTheoretical

▶ Rifampicin

o

is predicted to decrease the exposure to quetiapine.

Study

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

quetiapine.oStudy

Quinagolide → see dopamine receptor agonists

Quinapril → see ACE inhibitors

Quinine → see antimalarials

Quinolones → see TABLE 9 p. 1377 (QT-interval prolongation)

ciprofloxacin . levofloxacin . moxifloxacin . ofloxacin.

▶ Since systemic absorption can follow topical application,

the possibility of interactions should be borne in mind.

▶ Interactions do not generally apply to topical use of

moxifloxacin unless specified.

▶ Ciprofloxacin is predicted to increase the exposure to

agomelatine.oStudy

▶ Ciprofloxacin is predicted to increase the exposure to

aminophylline. Adjust dose.oTheoretical

▶ Ciprofloxacin is predicted to increase the exposure to

anagrelide.oTheoretical

▶ Antacids decrease the absorption of quinolones. Quinolones

should be taken 2 hours before or 4 hours after

o

antacids.

Study

▶ Ciprofloxacin slightly increases the exposure to antiarrhythmics

(lidocaine).nStudy

▶ Ciprofloxacin affects the concentration of antiepileptics

(fosphenytoin, phenytoin). Monitor concentration and adjust

dose.rStudy

▶ Calcium salts (calcium carbonate) decrease the absorption of

ciprofloxacin

Study

. Separate administration by 2 hours.o ▶ Ciprofloxacin increases the concentration of clozapine.

Monitor side effects and adjust dose.rStudy

▶ Quinolones

r

increase the anticoagulant effect of coumarins.

Anecdotal

▶ Didanosine (buffered) is predicted to greatly decrease the

exposure to oral quinolones. Didanosine should be taken

2 hours after quinolones.oStudy

▶ Ciprofloxacin is predicted to increase the exposure to dopamine

receptor agonists (ropinirole). Adjust dose.oStudy

▶ Ciprofloxacin is predicted to increase the exposure to

duloxetine. Avoid.oTheoretical

▶ Ciprofloxacin is predicted to increase the exposure to

eliglustat

r

. Avoid or adjust dose—consult product literature.

Theoretical

▶ Enteral feeds

Study

decrease the exposure to ciprofloxacin.o ▶ Ciprofloxacin slightly increases the exposure to erlotinib.

Monitor side effects and adjust dose.oStudy

▶ Ciprofloxacin is predicted to increase the exposure to ibrutinib.

Adjust ibrutinib dose, p. 983.rTheoretical

1518 Proton pump inhibitors — Quinolones BNF 78

Interactions | Appendix 1

A1

▶ Iron (oral) decreases the exposure to quinolones. Separate

administration by at least 2 hours.oStudy

▶ Lanthanum moderately decreases the exposure to quinolones.

Quinolones should be taken 2 hours before or 4 hours after

lanthanum.oStudy

▶ Leflunomide is predicted to increase the exposure to

ciprofloxacin.oTheoretical

▶ Ciprofloxacin is predicted to increase the exposure to loxapine.

Avoid.qTheoretical

▶ Ciprofloxacin is predicted to increase the exposure to

melatonin.oTheoretical

▶ Ciprofloxacin potentially increases the risk of toxicity when

given with methotrexate.rAnecdotal

▶ Ciprofloxacin slightly increases the exposure to monoamineoxidase B inhibitors (rasagiline).oStudy

▶ NSAIDs potentially increase the risk of seizures when given

with quinolones.rTheoretical

▶ Ciprofloxacin is predicted to increase the exposure to

olanzapine. Adjust dose.oAnecdotal

▶ Ciprofloxacin very slightly increases the exposure to

pentoxifylline.oStudy

▶ Ciprofloxacin is predicted to increase the exposure to

pirfenidone. Use with caution and adjust dose.oStudy

▶ Ciprofloxacin is predicted to increase the exposure to

pomalidomide

Theoretical

. Adjust pomalidomide dose, p. 961.o ▶ Ciprofloxacin

o

is predicted to increase the exposure to riluzole.

Theoretical

▶ Ciprofloxacin is predicted to increase the exposure to

roflumilast.oTheoretical

▶ Sucralfate decreases the exposure to quinolones. Separate

administration by 2 hours.oStudy

▶ Teriflunomide is predicted to increase the exposure to

ciprofloxacin.oTheoretical

▶ Ciprofloxacin is predicted to increase the exposure to

theophylline. Monitor and adjust dose.oTheoretical

▶ Ciprofloxacin

o

increases the exposure to tizanidine. Avoid.

Study

▶ Ciprofloxacin is predicted to increase the exposure to

tolvaptan

o

. Use with caution and adjust tolvaptan dose, p. 669.

Theoretical

▶ Zinc is predicted to decrease the exposure to quinolones.

Separate administration by 2 hours.oStudy

▶ Ciprofloxacin is predicted to increase the exposure to

zolmitriptan

Theoretical

. Adjust zolmitriptan dose, p. 482.o

Rabeprazole → see proton pump inhibitors

Rabies immunoglobulin → see immunoglobulins

Rabies vaccine

▶ Antimalarials (chloroquine) decrease the efficacy of rabies

vaccine. Avoid.oStudy

▶ Hydroxychloroquine is predicted to decrease efficacy rabies

vaccine.oTheoretical

Raloxifene → see TABLE 5 p. 1375 (thromboembolism)

▶ Combined hormonal contraceptives potentially oppose the

effects of raloxifene. Avoid.rTheoretical

▶ Hormone replacement therapy potentially opposes the effects

of raloxifene. Avoid.rTheoretical

Raltegravir

▶ Antacids

o

slightly decrease the exposure to raltegravir. Avoid.

Study

▶ Antiepileptics (carbamazepine) are predicted to affect the

exposure to raltegravir.oTheoretical

▶ Antiepileptics (fosphenytoin, phenobarbital, phenytoin,

primidone) are predicted to affect the exposure to raltegravir.

Use with caution or avoid.oTheoretical

▶ Calcium salts (calcium carbonate) greatly decrease the exposure

to raltegravir (high-dose). Avoid.rStudy

▶ Encorafenib is predicted to increase the exposure to

raltegravir.oTheoretical

▶ HIV-protease inhibitors (atazanavir) increase the exposure to

raltegravir (high-dose). Avoid.oStudy

▶ HIV-protease inhibitors (darunavir) increase the risk of rash

when given with raltegravir.oStudy

▶ HIV-protease inhibitors (fosamprenavir) (boosted with ritonavir)

decrease the exposure to raltegravir and raltegravir decreases

the exposure to HIV-protease inhibitors (fosamprenavir)

(boosted with ritonavir). Avoid.rStudy

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

predicted to decrease the exposure to raltegravir (high-dose).

Avoid.oStudy

▶ Rifampicin slightly decreases the exposure to raltegravir.

Avoid or adjust dose

Study

—consult product literature.o

Raltitrexed → see TABLE 15 p. 1378 (myelosuppression)

▶ Folates

o

are predicted to alter the effects of raltitrexed. Avoid.

Study

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

raltitrexed. Public Health England advises avoid (refer to

Green Book).rTheoretical

Ramipril → see ACE inhibitors

Ramucirumab → see monoclonal antibodies

Ranibizumab

▶ Ranibizumab is predicted to increase the risk of bleeding

events when given with argatroban.rTheoretical

▶ Ranibizumab is predicted to increase the risk of bleeding

events when given with bivalirudin.oTheoretical

▶ Ranibizumab increases the risk of bleeding events when given

with coumarins.rTheoretical

▶ Ranibizumab is predicted to increase the risk of bleeding

events when given with danaparoid.rTheoretical

▶ Ranibizumab increases the risk of bleeding events when given

with heparin (unfractionated).rTheoretical

▶ Ranibizumab increases the risk of bleeding events when given

with low molecular-weight heparins.rTheoretical

▶ Ranibizumab is predicted to increase the risk of bleeding

events when given with phenindione.rTheoretical

Ranitidine → see H2 receptor antagonists

Ranolazine → see TABLE 9 p. 1377 (QT-interval prolongation)

▶ Ranolazine is predicted to increase the exposure to afatinib.

Separate administration by 12 hours.oStudy

▶ Ranolazine

o

is predicted to increase the exposure to aliskiren.

Theoretical

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to ranolazine.rStudy → Also see TABLE 9 p. 1377

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to ranolazine. Avoid.rStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Study → Also see TABLE 9 p. 1377

ranolazine.r

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

predicted to increase the exposure to

r

ranolazine. Avoid.

Study → Also see TABLE 9 p. 1377

▶ Aprepitant

r

is predicted to increase the exposure to ranolazine.

Study

▶ Ranolazine is predicted to increase the exposure to beta

blockers, non-selective (nadolol).oStudy

▶ Ranolazine is predicted to increase the exposure to bictegravir.

Use with caution or avoid.oTheoretical

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

increase the exposure to ranolazine.rStudy

▶ Ranolazine

o

is predicted to increase the exposure to ceritinib.

Theoretical → Also see TABLE 9 p. 1377

▶ Ciclosporin is predicted to increase the concentration of

ranolazine and ranolazine is predicted to increase the

concentration of ciclosporin.oTheoretical

▶ Cobicistat is predicted to increase the exposure to ranolazine.

Avoid.rStudy

▶ Ranolazine is predicted to increase the exposure to colchicine.

Avoid or adjust colchicine dose, p. 1120.rTheoretical

▶ Crizotinib

r

is predicted to increase the exposure to ranolazine.

Study → Also see TABLE 9 p. 1377

▶ Ranolazine

r

is predicted to increase the exposure to dabigatran.

Theoretical

▶ Ranolazine

Study

increases the concentration of digoxin.o

BNF 78 Quinolones — Ranolazine 1519

Interactions | Appendix 1

A1

Ranolazine (continued)

▶ Ranolazine is predicted to increase the exposure to dopamine

receptor agonists (pramipexole). Adjust dose.oStudy

▶ Ranolazine is predicted to slightly increase the exposure to

edoxaban.rTheoretical

▶ Enzalutamide is predicted to decrease the exposure to

ranolazine. Avoid.rStudy

▶ Ranolazine

o

is predicted to increase the exposure to erlotinib.

Theoretical

▶ Ranolazine is predicted to increase the exposure to

fidaxomicin. Avoid.oStudy

▶ Grapefruit juice is predicted to increase the concentration of

ranolazine. Avoid.rTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to ranolazine. Avoid.rStudy → Also see TABLE 9 p. 1377

▶ Idelalisib is predicted to increase the exposure to ranolazine.

Avoid.rStudy

▶ Imatinib

r

is predicted to increase the exposure to ranolazine.

Study

▶ Ranolazine is predicted to increase the exposure to lomitapide.

Separate administration by 12 hours.oTheoretical

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to ranolazine. Avoid.rStudy → Also see TABLE 9

p. 1377

▶ Macrolides (erythromycin) are predicted to increase the

exposure to ranolazine.rStudy → Also see TABLE 9 p. 1377

▶ Mitotane is predicted to decrease the exposure to ranolazine.

Avoid.rStudy

▶ Netupitant

r

is predicted to increase the exposure to ranolazine.

Study

▶ Nilotinib

r

is predicted to increase the exposure to ranolazine.

Study → Also see TABLE 9 p. 1377

▶ Ranolazine

o

is predicted to increase the exposure to nintedanib.

Study

▶ Ranolazine is predicted to increase the exposure to

panobinostat. Adjust dose.oTheoretical → Also see

TABLE 9 p. 1377

▶ Ranolazine is predicted to increase the exposure to

pibrentasvir.oTheoretical

▶ Rifampicin is predicted to decrease the exposure to ranolazine.

Avoid.rStudy

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

ranolazine. Avoid.rStudy

▶ Ranolazine is predicted to increase the exposure to statins

(atorvastatin).oTheoretical

▶ Ranolazine slightly increases the exposure to statins

(simvastatin). Adjust simvastatin dose, p. 205.oStudy

▶ Ranolazine increases the concentration of tacrolimus. Adjust

dose.rAnecdotal

▶ Ranolazine is predicted to increase the exposure to ticagrelor.

Use with caution or avoid.rStudy

▶ Ranolazine

r

is predicted to increase the exposure to topotecan.

Study

▶ Ranolazine is predicted to increase the concentration of

trametinib.oTheoretical

▶ Ranolazine is predicted to increase the exposure to venetoclax.

Avoid or monitor for toxicity.rTheoretical

Rasagiline → see monoamine-oxidase B inhibitors

Reboxetine

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to reboxetine.oAnecdotal

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

predicted to increase the exposure to

o

reboxetine. Avoid.

Study

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

concentration of

o

reboxetine. Use with caution and adjust dose.

Theoretical

▶ Cobicistat is predicted to increase the exposure to reboxetine.

Avoid.oStudy

▶ Enzalutamide is predicted to decrease the exposure to

reboxetine.oAnecdotal

▶ HIV-protease inhibitors are predicted to increase the exposure

to reboxetine. Avoid.oStudy

▶ Idelalisib is predicted to increase the exposure to reboxetine.

Avoid.oStudy

▶ Reboxetine is predicted to increase the risk of a hypertensive

crisis when given with linezolid. Avoid.rTheoretical

▶ Reboxetine is predicted to increase the risk of hypokalaemia

when given with loop diuretics.oTheoretical

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to reboxetine. Avoid.oStudy

▶ Mitotane

o

is predicted to decrease the exposure to reboxetine.

Anecdotal

▶ Reboxetine is predicted to increase the risk of a hypertensive

crisis when given with moclobemide. Avoid.rTheoretical

▶ Reboxetine is predicted to increase the risk of a hypertensive

crisis when given with monoamine-oxidase A and B inhibitors,

irreversible. Avoid.rTheoretical

▶ Reboxetine is predicted to increase the risk of a hypertensive

crisis when given with monoamine-oxidase B inhibitors

(rasagiline, selegiline). Avoid.rTheoretical

▶ Rifampicin

o

is predicted to decrease the exposure to reboxetine.

Anecdotal

▶ Reboxetine is predicted to increase the risk of hypokalaemia

when given with thiazide diuretics.oAnecdotal

Regorafenib → see TABLE 15 p. 1378 (myelosuppression), TABLE 4

p. 1375 (antiplatelet effects)

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to regorafenib. Avoid.oStudy

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

predicted to increase the exposure to

o

regorafenib. Avoid.

Study

▶ Cobicistat is predicted to increase the exposure to regorafenib.

Avoid.oStudy

▶ Regorafenib is predicted to increase the risk of bleeding events

when given with coumarins.rStudy

▶ Enzalutamide is predicted to decrease the exposure to

regorafenib. Avoid.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

regorafenib. Avoid.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to regorafenib. Avoid.oStudy

▶ Idelalisib is predicted to increase the exposure to regorafenib.

Avoid.oStudy → Also see TABLE 15 p. 1378

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to regorafenib. Avoid.oStudy

▶ Regorafenib is predicted to increase the exposure to

methotrexate.oTheoretical → Also see TABLE 15 p. 1378

▶ Mitotane is predicted to decrease the exposure to regorafenib.

Avoid.oStudy → Also see TABLE 15 p. 1378

▶ Regorafenib is predicted to increase the exposure to NSAIDs

(mefenamic acid). Avoid.oTheoretical → Also see TABLE 4

p. 1375

▶ Regorafenib is predicted to increase the risk of bleeding events

when given with phenindione.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to

regorafenib. Avoid.oStudy

▶ Regorafenib is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, rosuvastatin).oStudy

▶ Regorafenib is predicted to increase the exposure to

sulfasalazine.oStudy → Also see TABLE 15 p. 1378

▶ Regorafenib

o

is predicted to increase the exposure to topotecan.

Study → Also see TABLE 15 p. 1378

Remifentanil → see opioids

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

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to

o

repaglinide. Monitor blood glucose and adjust dose.

Study

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

predicted to increase the exposure to

Study

repaglinide.o ▶ Ciclosporin

o

moderately increases the exposure to repaglinide.

Study

▶ Clopidogrel

r

increases the exposure to repaglinide. Avoid.

Study

1520 Ranolazine — Repaglinide BNF 78

Interactions | Appendix 1

A1

▶ Cobicistat

o

is predicted to increase the exposure to repaglinide.

Study

▶ Enzalutamide is predicted to decrease the exposure to

repaglinide

Study

. Monitor blood glucose and adjust dose.o ▶ Fibrates (gemfibrozil) increase the exposure to repaglinide.

Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to repaglinide.oStudy

▶ Idelalisib

o

is predicted to increase the exposure to repaglinide.

Study

▶ Iron chelators (deferasirox) moderately increase the exposure

to repaglinide. Avoid.oStudy

▶ Leflunomide is predicted to increase the exposure to

repaglinide.oStudy

▶ Letermovir is predicted to increase the concentration of

repaglinide. Avoid.oTheoretical

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to repaglinide.oStudy

▶ Mitotane is predicted to decrease the exposure to repaglinide.

Monitor blood glucose and adjust dose.oStudy

▶ Opicapone is predicted to increase the exposure to repaglinide.

Avoid.oStudy

▶ Pitolisant is predicted to decrease the exposure to repaglinide.

nTheoretical

▶ Rifampicin is predicted to decrease the exposure to

repaglinide

Study

. Monitor blood glucose and adjust dose.o ▶ Teriflunomide is predicted to increase the exposure to

repaglinide.oStudy

▶ Trimethoprim slightly increases the exposure to repaglinide.

Avoid or monitor blood glucose.oStudy

▶ Venetoclax

o

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