is predicted to increase the exposure to adefovir.

Study

▶ Teriflunomide is predicted to decrease the exposure to

agomelatine.oTheoretical

▶ Teriflunomide decreases the exposure to aminophylline. Adjust

dose.oStudy

▶ Teriflunomide is predicted to decrease the exposure to

anaesthetics, local (ropivacaine).oTheoretical

▶ Teriflunomide is predicted to increase the exposure to

o

anthracyclines (daunorubicin, doxorubicin, mitoxantrone).

Theoretical

▶ Teriflunomide is predicted to increase the exposure to

antihistamines, non-sedating (fexofenadine).oStudy

▶ Teriflunomide

o

potentially increases the exposure to baricitinib.

Theoretical

▶ Teriflunomide is predicted to increase the exposure to

bosentan.oStudy

▶ Teriflunomide is predicted to moderately increase the

o

clearance of caffeine citrate. Monitor and adjust dose.

Study

▶ Teriflunomide is predicted to increase the exposure to

cephalosporins (cefaclor).oStudy

▶ Teriflunomide is predicted to decrease the exposure to

clozapine.oTheoretical

▶ Teriflunomide

r

affects the anticoagulant effect of coumarins.

Study

▶ Teriflunomide is predicted to decrease the exposure to

duloxetine.oTheoretical

▶ Teriflunomide is predicted to increase the exposure to

ganciclovir.oStudy

▶ Teriflunomide is predicted to increase the exposure to H2

receptor antagonists (cimetidine, famotidine).oStudy

▶ Teriflunomide is predicted to increase the concentration of

letermovir.oStudy

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

teriflunomide. Public Health England advises avoid (refer to

Green Book).rTheoretical

▶ Teriflunomide is predicted to increase the exposure to loop

diuretics (furosemide).oStudy

▶ Teriflunomide is predicted to decrease the exposure to

melatonin.oTheoretical

▶ Teriflunomide is predicted to increase the exposure to

methotrexate.oStudy

▶ Teriflunomide is predicted to increase the clearance of

mexiletine. Monitor and adjust dose.oStudy

▶ Teriflunomide is predicted to increase the exposure to

montelukast.oTheoretical

▶ Teriflunomide is predicted to increase the exposure to

nateglinide.oTheoretical

▶ Teriflunomide is predicted to increase the exposure to NSAIDs

(indometacin, ketoprofen).oTheoretical

▶ Teriflunomide is predicted to decrease the exposure to

olanzapine. Monitor and adjust dose.oStudy

▶ Teriflunomide is predicted to increase the exposure to

oseltamivir.oStudy

▶ Teriflunomide is predicted to increase the exposure to

penicillins (benzylpenicillin).oStudy

▶ Teriflunomide is predicted to increase the exposure to

pioglitazone.oStudy

▶ Teriflunomide is predicted to decrease the exposure to

pirfenidone.oTheoretical

▶ Teriflunomide is predicted to increase the exposure to

quinolones (ciprofloxacin).oTheoretical

▶ Teriflunomide is predicted to increase the exposure to

repaglinide.oStudy

▶ Teriflunomide is predicted to increase the exposure to

rifampicin.oTheoretical

▶ Teriflunomide is predicted to increase the exposure to

selexipag. Adjust dose.oTheoretical

▶ Teriflunomide is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, pravastatin, simvastatin)

Study

.o ▶ Teriflunomide moderately increases the exposure to statins

(rosuvastatin). Adjust rosuvastatin dose, p. 204.oStudy

▶ Teriflunomide is predicted to increase the exposure to

sulfasalazine.oStudy

▶ Teriflunomide is predicted to increase the exposure to

sulfonylureas (glibenclamide).oStudy

▶ Teriflunomide is predicted to increase the concentration of

taxanes (paclitaxel).rAnecdotal

▶ Teriflunomide is predicted to increase the exposure to

tenofovir alafenamide.oTheoretical

▶ Teriflunomide is predicted to increase the exposure to

tenofovir disoproxil.oTheoretical

▶ Teriflunomide is predicted to decrease the exposure to

theophylline. Adjust dose.oStudy

▶ Teriflunomide moderately decreases the exposure to

tizanidine.nStudy

▶ Teriflunomide is predicted to increase the exposure to

topotecan.oStudy

▶ Teriflunomide is predicted to increase the exposure to

zidovudine.oTheoretical

Tetanus immunoglobulin → see immunoglobulins

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

▶ Tetrabenazine is predicted to decrease the effects of levodopa.

Use with caution or avoid.oTheoretical

▶ Tetrabenazine is predicted to increase the risk of CNS toxicity

when given with monoamine-oxidase A and B inhibitors,

irreversible

r

. Avoid and for 14 days after stopping the MAOI.

Theoretical

Tetracaine → see anaesthetics, local

Tetracycline → see tetracyclines

Tetracyclines → see TABLE 1 p. 1375 (hepatotoxicity)

demeclocycline . doxycycline . lymecycline . minocycline . oxytetracycline .tetracycline .tigecycline.

ROUTE-SPECIFIC INFORMATION Interactions do not generally

apply to topical use of oxytetracycline unless specified.

▶ ACE inhibitors (quinapril) (tablet) decrease the absorption of

oral tetracycline. Avoid.oStudy

▶ Antacids decrease the absorption of tetracyclines. Separate

administration by 2 to 3 hours.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) decrease the exposure to doxycycline.

Monitor and adjust dose.oStudy → Also see TABLE 1

p. 1375

1542 Terbinafine —Tetracyclines BNF 78

Interactions | Appendix 1

A1

▶ Tetracycline decreases the concentration of antimalarials

(atovaquone).oStudy

▶ Calcium salts (calcium carbonate) are predicted to decrease the

absorption of tetracyclines. Separate administration by 2 to

3 hours.oTheoretical

▶ Tetracyclines increase the risk of bleeding events when given

with coumarins.oAnecdotal

▶ Dairy products decrease the exposure to tetracyclines

(demeclocycline, oxytetracycline, tetracycline)

Study

. Avoid.o ▶ Enzalutamide decreases the exposure to doxycycline. Monitor

and adjust dose.oStudy

▶ Iron (oral) decreases the absorption of tetracyclines.

Tetracyclines

o

should be taken 2 to 3 hours after iron (oral).

Study

▶ Kaolin

o

is predicted to decrease the absorption of tetracyclines.

Theoretical

▶ Lanthanum is predicted to decrease the absorption of

tetracyclines

Theoretical

. Separate administration by 2 hours.o ▶ Mitotane decreases the exposure to doxycycline. Monitor and

adjust dose.oStudy

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

the risk of benign intracranial hypertension when given with

tetracyclines. Avoid.rAnecdotal

▶ Rifampicin decreases the exposure to doxycycline. Monitor and

adjust dose.oStudy

▶ Oral zinc is predicted to decrease the absorption of

tetracyclines

o

. Separate administration by 2 to 3 hours.

Theoretical

Tezacaftor

FOOD AND LIFESTYLE Avoid bitter (Seville) oranges as they are

predicted to increase the exposure to tezacaftor.

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to tezacaftor. Adjust tezacaftor with ivacaftor p. 295

dose with moderate inhibitors of CYP3A4.rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to tezacaftor. Avoid.rTheoretical

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to tezacaftor. Adjust

tezacaftor with ivacaftor p. 295 dose with moderate inhibitors

of CYP3A4.rStudy

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

predicted to increase the exposure to tezacaftor. Adjust

tezacaftor with ivacaftor p. 295 dose with potent inhibitors of

CYP3A4.rStudy

▶ Aprepitant is predicted to increase the exposure to tezacaftor.

Adjust tezacaftor with ivacaftor p. 295 dose with moderate

inhibitors of CYP3A4.rStudy

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

increase the exposure to tezacaftor. Adjust tezacaftor with

ivacaftor

r

p. 295 dose with moderate inhibitors of CYP3A4.

Study

▶ Cobicistat is predicted to increase the exposure to tezacaftor.

Adjust tezacaftor with ivacaftor p. 295 dose with potent

inhibitors of CYP3A4.rStudy

▶ Crizotinib is predicted to increase the exposure to tezacaftor.

Adjust tezacaftor with ivacaftor p. 295 dose with moderate

inhibitors of CYP3A4.rStudy

▶ Enzalutamide is predicted to decrease the exposure to

tezacaftor. Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

tezacaftor. Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to tezacaftor. Adjust tezacaftor with ivacaftor p. 295 dose with

potent inhibitors of CYP3A4.rStudy

▶ Idelalisib is predicted to increase the exposure to tezacaftor.

Adjust tezacaftor with ivacaftor p. 295 dose with potent

inhibitors of CYP3A4.rStudy

▶ Imatinib is predicted to increase the exposure to tezacaftor.

Adjust tezacaftor with ivacaftor p. 295 dose with moderate

inhibitors of CYP3A4.rStudy

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to tezacaftor. Adjust tezacaftor with ivacaftor p. 295

dose with potent inhibitors of CYP3A4.rStudy

▶ Macrolides (erythromycin) are predicted to increase the

exposure to tezacaftor. Adjust tezacaftor with ivacaftor p. 295

dose with moderate inhibitors of CYP3A4.rStudy

▶ Mitotane is predicted to decrease the exposure to tezacaftor.

Avoid.rTheoretical

▶ Netupitant is predicted to increase the exposure to tezacaftor.

Adjust tezacaftor with ivacaftor p. 295 dose with moderate

inhibitors of CYP3A4.rStudy

▶ Nilotinib is predicted to increase the exposure to tezacaftor.

Adjust tezacaftor with ivacaftor p. 295 dose with moderate

inhibitors of CYP3A4.rStudy

▶ Rifabutin is predicted to decrease the exposure to tezacaftor.

Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to tezacaftor.

Avoid.rTheoretical

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

tezacaftor. Avoid.rTheoretical

Thalidomide → see TABLE 6 p. 1376 (bradycardia), TABLE 15 p. 1378

(myelosuppression), TABLE 12 p. 1378 (peripheral neuropathy), TABLE 5

p. 1375 (thromboembolism), TABLE 11 p. 1377 (CNS depressant effects)

▶ Combined hormonal contraceptives are predicted to increase

the risk of venous thromboembolism when given with

thalidomide. Avoid.rStudy

▶ Hormone replacement therapy is predicted to increase the risk

of venous thromboembolism when given with

r

thalidomide.

Theoretical

Theophylline → see TABLE 17 p. 1379 (reduced serum potassium)

FOOD AND LIFESTYLE Smoking can increase theophylline

clearance and increased doses of theophylline are therefore

required; dose adjustments are likely to be necessary if

smoking started or stopped during treatment.

▶ Aciclovir is predicted to increase the exposure to theophylline.

Monitor and adjust dose.rTheoretical

▶ Theophylline decreases the efficacy of antiarrhythmics

(adenosine). Separate administration by 24 hours.nStudy

▶ Antiepileptics (carbamazepine) potentially increase the

clearance of theophylline and theophylline decreases the

exposure to

o

antiepileptics (carbamazepine). Adjust dose.

Anecdotal

▶ Antiepileptics (fosphenytoin, phenytoin) are predicted to

decrease the exposure to

Study

theophylline. Adjust dose.o ▶ Antiepileptics (phenobarbital, primidone) are predicted to

increase the clearance of

Theoretical

theophylline. Adjust dose.o ▶ Antiepileptics (stiripentol) are predicted to increase the

exposure to theophylline. Avoid.oTheoretical

▶ Beta blockers, non-selective are predicted to increase the risk

of bronchospasm when given with

Theoretical

theophylline. Avoid.r

▶ Beta blockers, selective are predicted to increase the risk of

bronchospasm when given with

Theoretical

theophylline. Avoid.r

▶ Caffeine citrate

o

decreases the clearance of theophylline.

Study

▶ Combined hormonal contraceptives are predicted to increase

the exposure to

o

theophylline. Monitor and adjust dose.

Theoretical

▶ Theophylline increases the risk of agitation when given with

doxapram.oStudy

▶ Enteral feeds

Study

decrease the exposure to theophylline.o ▶ Esketamine is predicted to increase the risk of seizures when

given with theophylline. Avoid.rTheoretical

▶ H2 receptor antagonists (cimetidine) increase the concentration

of theophylline. Adjust dose.rStudy

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

exposure to theophylline. Adjust dose.oStudy

▶ Interferons slightly increase the exposure to theophylline.

Adjust dose.oStudy

▶ Iron chelators (deferasirox) increase the exposure to

theophylline. Avoid.oStudy

BNF 78 Tetracyclines —Theophylline 1543

Interactions | Appendix 1

A1

Theophylline (continued)

▶ Isoniazid

r

is predicted to affect the clearance of theophylline.

Anecdotal

▶ Leflunomide is predicted to decrease the exposure to

theophylline. Adjust dose.oStudy

▶ Theophylline is predicted to decrease the concentration of

lithium

Anecdotal

. Monitor concentration and adjust dose.o ▶ Macrolides (azithromycin, clarithromycin) are predicted to

increase the exposure to

Anecdotal

theophylline. Adjust dose.o ▶ Macrolides (erythromycin) decrease the clearance of

theophylline and theophylline potentially decreases the

clearance of

Study

macrolides (erythromycin). Adjust dose.r

▶ Methotrexate

o

decreases the clearance of theophylline.

Study

▶ Mexiletine is predicted to increase the exposure to

theophylline. Monitor and adjust dose.oTheoretical

▶ Monoclonal antibodies (blinatumomab) are predicted to

transiently increase the exposure to theophylline. Monitor and

adjust dose.oTheoretical

▶ Monoclonal antibodies (sarilumab) potentially affect the

exposure to

Theoretical

theophylline. Monitor and adjust dose.o ▶ Monoclonal antibodies (tocilizumab) are predicted to decrease

the exposure to

o

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