is predicted to increase the exposure to repaglinide.

Theoretical

Retigabine → see antiepileptics

Retinoids → see TABLE 5 p. 1375 (thromboembolism)

acitretin . adapalene . alitretinoin . bexarotene .isotretinoin . tazarotene .tretinoin.

▶ Avoid concomitant use of keratolytics in patients taking

acitretin and isotretinoin.

▶ Since systemic absorption can follow topical application of

isotretinoin and tretinoin, the possibility of interactions

should be borne in mind.

▶ Alcohol (beverage) potentially increases the concentration of

acitretin

o

. Avoid and for 2 months after stopping acitretin.

Study

▶ Antiarrhythmics (amiodarone) are predicted to increase the

exposure to

o

alitretinoin. Adjust alitretinoin dose, p. 1262.

Theoretical

▶ Antifungals, azoles (fluconazole, itraconazole, ketoconazole,

miconazole, voriconazole) are predicted to increase the

exposure to

o

alitretinoin. Adjust alitretinoin dose, p. 1262.

Theoretical

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

predicted to increase the risk of tretinoin toxicity when given

with tretinoin.oStudy

▶ Clopidogrel is predicted to increase the exposure to

alitretinoin. Adjust alitretinoin dose, p. 1262.oTheoretical

▶ Cobicistat is predicted to increase the exposure to alitretinoin.

Adjust alitretinoin dose, p. 1262.oTheoretical

▶ Fibrates (gemfibrozil) are predicted to increase the exposure to

alitretinoin. Adjust alitretinoin dose, p. 1262.oTheoretical

▶ Fibrates (gemfibrozil) increase the concentration of

bexarotene. Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to

Theoretical

alitretinoin. Adjust alitretinoin dose, p. 1262.o ▶ Idelalisib is predicted to increase the exposure to alitretinoin.

Adjust alitretinoin dose, p. 1262.oTheoretical

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to

o

alitretinoin. Adjust alitretinoin dose, p. 1262.

Theoretical

▶ Acitretin is predicted to increase the concentration of

methotrexate. Avoid.oAnecdotal

▶ Retinoids (acitretin, alitretinoin, isotretinoin, tretinoin) increase

the risk of benign intracranial hypertension when given with

tetracyclines. Avoid.rAnecdotal

▶ Bexarotene is predicted to increase the risk of toxicity when

given with vitamin A. Adjust dose.oTheoretical

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

increase the risk of vitamin A toxicity when given with vitamin

A. Avoid.rTheoretical

▶ Tretinoin is predicted to increase the risk of vitamin A toxicity

when given with vitamin A. Avoid.rStudy

Ribavirin

▶ Ribavirin is predicted to increase the exposure to didanosine.

Avoid.rStudy

▶ Ribavirin increases the risk of toxicity when given with

stavudine. Avoid.rStudy

▶ Ribavirin increases the risk of anaemia and/or leucopenia

when given with zidovudine. Avoid.rStudy

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

FOOD AND LIFESTYLE Avoid concomitant use of pomegranate

or pomegranate juice as it is predicted to increase ribociclib

exposure.

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

alpha blockers (alfuzosin). Avoid.oTheoretical

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to ribociclib.oStudy → Also see TABLE 9 p. 1377

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

antiarrhythmics (amiodarone). Avoid.oTheoretical → Also

see TABLE 9 p. 1377

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to markedly decrease the

exposure to ribociclib. Avoid.rStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Study → Also see TABLE 9 p. 1377

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

predicted to increase the exposure to ribociclib. Avoid or

adjust ribociclib dose, p. 997.oStudy → Also see TABLE 9

p. 1377

▶ Aprepitant

o

is predicted to increase the exposure to ribociclib.

Study

▶ Bosentan

o

is predicted to decrease the exposure to ribociclib.

Study

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

increase the exposure to ribociclib.oStudy

▶ Ribociclib is predicted to increase the exposure to ciclosporin.

Use with caution and adjust dose.oTheoretical

▶ Cobicistat is predicted to increase the exposure to ribociclib.

Avoid or adjust ribociclib dose, p. 997.oStudy

▶ Crizotinib

o

is predicted to increase the exposure to ribociclib.

Study → Also see TABLE 9 p. 1377

▶ Ribociclib

o

is predicted to increase the exposure to digoxin.

Theoretical

▶ Efavirenz

o

is predicted to decrease the exposure to ribociclib.

Study → Also see TABLE 9 p. 1377

▶ Enzalutamide is predicted to markedly decrease the exposure

to ribociclib. Avoid.rStudy

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

ergotamine. Avoid.oTheoretical

▶ Ribociclib is predicted to increase the exposure to everolimus.

Use with caution and adjust dose.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

ribociclib. Avoid.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

Study

to ribociclib

→ Also see

. Avoid or adjust

TABLE 9 p. 1377

ribociclib dose, p. 997.o ▶ Idelalisib is predicted to increase the exposure to ribociclib.

Avoid or adjust ribociclib dose, p. 997.oStudy

▶ Imatinib

o

is predicted to increase the exposure to ribociclib.

Study

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to

o

ribociclib. Avoid or adjust ribociclib dose, p. 997.

Study → Also see TABLE 9 p. 1377

▶ Macrolides (erythromycin) are predicted to increase the

exposure to ribociclib.oStudy → Also see TABLE 9 p. 1377

BNF 78 Repaglinide — Ribociclib 1521

Interactions | Appendix 1

A1

Ribociclib (continued)

▶ Ribociclib

o

is predicted to increase the exposure to metformin.

Theoretical

▶ Ribociclib moderately increases the exposure to midazolam.

Avoid.oStudy

▶ Mitotane is predicted to markedly decrease the exposure to

ribociclib. Avoid.rStudy

▶ Netupitant

o

is predicted to increase the exposure to ribociclib.

Study

▶ Nevirapine

o

is predicted to decrease the exposure to ribociclib.

Study

▶ Nilotinib

o

is predicted to increase the exposure to ribociclib.

Study → Also see TABLE 9 p. 1377

▶ Ribociclib is predicted to increase the exposure to opioids

(alfentanil, fentanyl)

o

. Use with caution and adjust dose.

Theoretical

▶ Ribociclib is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors

Theoretical → Also see TABLE 9 p. 1377

(sildenafil). Avoid.o ▶ Ribociclib (high-dose) is predicted to increase the exposure to

pimozide. Avoid.oTheoretical → Also see TABLE 9 p. 1377

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

quetiapine. Avoid.oTheoretical

▶ Rifampicin is predicted to markedly decrease the exposure to

ribociclib. Avoid.rStudy

▶ Ribociclib is predicted to increase the exposure to sirolimus.

Use with caution and adjust dose.oTheoretical

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

ribociclib. Avoid.rStudy

▶ Ribociclib is predicted to increase the exposure to statins

(pravastatin, rosuvastatin).oTheoretical

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

statins (simvastatin). Avoid.oTheoretical

▶ Ribociclib is predicted to increase the exposure to tacrolimus.

Use with caution and adjust dose.oTheoretical

Rifabutin

GENERAL INFORMATION Although some manufacturers class

rifabutin as a potent inducer of CYP3A4, clinical data suggests

it is potentially a weak inducer, and therefore the BNF does

not extrapolate the interactions of potent CYP3A4 inducers to

rifabutin. For those who wish to err on the side of caution, see

the interactions of rifampicin but bear in mind other

mechanisms might be involved.

▶ Antifungals, azoles (fluconazole) increase the risk of uveitis

when given with rifabutin. Adjust dose.rStudy

▶ Antifungals, azoles (itraconazole, posaconazole) increase the

concentration of rifabutin and rifabutin decreases the

concentration of antifungals, azoles (itraconazole,

posaconazole). Avoid.rStudy

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

concentration of rifabutin and rifabutin is predicted to

decrease the concentration of antifungals, azoles

(ketoconazole). Avoid.rTheoretical

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

concentration of

o

rifabutin. Use with caution and adjust dose.

Theoretical

▶ Rifabutin is predicted to decrease the exposure to antifungals,

azoles (isavuconazole). Avoid.rTheoretical

▶ Rifabutin decreases the concentration of antifungals, azoles

(voriconazole) and antifungals, azoles (voriconazole) increase

the concentration of rifabutin. Avoid or adjust voriconazole

dose, p. 599.rStudy

▶ Rifabutin slightly decreases the exposure to antimalarials

(atovaquone). Avoid.oStudy

▶ Rifabutin

o

slightly decreases the exposure to bictegravir. Avoid.

Study

▶ Rifabutin is predicted to decrease the exposure to brigatinib.

Avoid.oTheoretical

▶ Rifabutin decreases the concentration of cobicistat and

cobicistat increases the exposure to rifabutin. Avoid or adjust

dose.rStudy

▶ Rifabutin is predicted to decrease the efficacy of combined

hormonal contraceptives. For FSRH guidance, see

Contraceptives, interactions p. 794.rStudy

▶ Rifabutin decreases the exposure to dapsone.oStudy

▶ Rifabutin is predicted to decrease the efficacy of desogestrel.

For FSRH guidance, see

r

Contraceptives, interactions p. 794.

Theoretical

▶ Rifabutin moderately decreases the exposure to doravirine.

Adjust doravirine dose, p. 644.rStudy

▶ Efavirenz slightly decreases the exposure to rifabutin. Adjust

dose.rStudy

▶ Rifabutin is predicted to decrease the efficacy of etonogestrel.

For FSRH guidance, see

r

Contraceptives, interactions p. 794.

Theoretical

▶ Rifabutin decreases the exposure to etravirine.oStudy

▶ HIV-protease inhibitors (atazanavir, darunavir, fosamprenavir,

lopinavir, saquinavir, tipranavir) (boosted with ritonavir)

increase the exposure to

r

rifabutin. Monitor and adjust dose.

Study

▶ HIV-protease inhibitors (ritonavir) markedly increase the

exposure to rifabutin. Avoid or adjust dose.rStudy

▶ Rifabutin is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ Rifabutin is predicted to decrease the exposure to ledipasvir.

Avoid.rTheoretical

▶ Rifabutin is predicted to decrease the concentration of

letermovir.oTheoretical

▶ Rifabutin is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ Lumacaftor is predicted to decrease the exposure to rifabutin.

Adjust dose.oTheoretical

▶ Macrolides (azithromycin) increase the risk of neutropenia

when given with rifabutin.rStudy

▶ Macrolides (clarithromycin) increase the risk of uveitis when

given with rifabutin. Adjust dose.rStudy

▶ Macrolides (erythromycin) are predicted to increase the risk of

uveitis when given with

Theoretical

rifabutin. Adjust dose.r

▶ Rifabutin is predicted to decrease the efficacy of

norethisterone. For FSRH guidance, see Contraceptives,

interactions p. 794.rAnecdotal

▶ Rifabutin slightly decreases the exposure to rilpivirine. Adjust

dose.rStudy

▶ Rifabutin is predicted to decrease the exposure to rolapitant.

Avoid.oTheoretical

▶ Rifabutin is predicted to decrease the exposure to sofosbuvir.

Avoid.rTheoretical

▶ Rifabutin is predicted to decrease the exposure to tenofovir

alafenamide. Avoid.oTheoretical

▶ Rifabutin is predicted to decrease the exposure to tezacaftor.

Avoid.rTheoretical

▶ Rifabutin decreases the efficacy of ulipristal. For FSRH

guidance, see

Anecdotal

Contraceptives, interactions p. 794.r

▶ Rifabutin is predicted to decrease the concentration of

voxilaprevir. Avoid.rTheoretical

Rifampicin

▶ Rifampicin is predicted to markedly decrease the exposure to

abemaciclib. Avoid.rStudy

▶ Rifampicin is predicted to decrease the exposure to

abiraterone. Avoid.rStudy

▶ Rifampicin

o

is predicted to decrease the exposure to afatinib.

Study

▶ Rifampicin is predicted to decrease the exposure to

agomelatine.oTheoretical

▶ Rifampicin is predicted to decrease the exposure to aldosterone

antagonists (eplerenone). Avoid.oTheoretical

▶ Rifampicin decreases the exposure to aliskiren.oStudy

▶ Rifampicin is predicted to decrease the exposure to

alprazolam. Adjust dose.oTheoretical

▶ Rifampicin

o

transiently increases the exposure to ambrisentan.

Study

▶ Rifampicin decreases the exposure to aminophylline. Adjust

dose.oStudy

▶ Rifampicin is predicted to decrease the exposure to

anaesthetics, local (ropivacaine).oTheoretical

▶ Antacids decrease the absorption of rifampicin. Rifampicin

should be taken 1 hour before antacids.oStudy

1522 Ribociclib — Rifampicin BNF 78

Interactions | Appendix 1

A1

▶ Rifampicin is predicted to decrease the exposure to

antiarrhythmics

Study

(disopyramide, dronedarone). Avoid.r

▶ Rifampicin is predicted to decrease the efficacy of

antiarrhythmics (propafenone).oStudy

▶ Rifampicin is predicted to decrease the exposure to

anticholinesterases, centrally acting (donepezil).nStudy

▶ Antiepileptics (phenobarbital, primidone) are predicted to

decrease the exposure to rifampicin and rifampicin is predicted

to decrease the exposure to antiepileptics (phenobarbital,

primidone). Use with caution and adjust dose.oStudy

▶ Rifampicin slightly decreases the exposure to antiepileptics

(brivaracetam). Adjust dose.oStudy

▶ Rifampicin decreases the concentration of antiepileptics

(fosphenytoin, phenytoin)

o

. Use with caution and adjust dose.

Study

▶ Rifampicin markedly increases the clearance of antiepileptics

(lamotrigine). Adjust lamotrigine dose, p. 318.oStudy

▶ Rifampicin is predicted to decrease the exposure to

antiepileptics

Study

(perampanel). Monitor and adjust dose.o ▶ Rifampicin slightly decreases the exposure to antifungals, azoles

(fluconazole). Adjust dose.oStudy

▶ Rifampicin is predicted to decrease the exposure to antifungals,

azoles (isavuconazole). Avoid.rStudy

▶ Rifampicin markedly decreases the exposure to antifungals,

azoles (itraconazole). Avoid and for 14 days after stopping

rifampicin.oStudy

▶ Rifampicin markedly decreases the exposure to antifungals,

azoles (ketoconazole) and antifungals, azoles (ketoconazole)

potentially decrease the exposure to

o

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