TRIPASS XR تري باس

 

is predicted to increase the exposure to ruxolitinib.

Theoretical

▶ Nevirapine is predicted to decrease the exposure to ruxolitinib.

Monitor and adjust dose.oTheoretical

▶ Nilotinib

o

is predicted to increase the exposure to ruxolitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Ruxolitinib is predicted to increase the risk of bleeding events

when given with phenindione.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to ruxolitinib.

Monitor and adjust dose.oStudy

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

ruxolitinib. Monitor and adjust dose.oTheoretical

Sacubitril → see TABLE 8 p. 1376 (hypotension)

▶ Sacubitril

r

is predicted to increase the exposure to statins.

Study

Safinamide → see monoamine-oxidase B inhibitors

Salbutamol → see beta2 agonists

Salmeterol → see beta2 agonists

Sapropterin → see TABLE 8 p. 1376 (hypotension)

▶ Methotrexate is predicted to decrease the efficacy of

sapropterin.oTheoretical

▶ Phosphodiesterase type-5 inhibitors are predicted to increase

the risk of hypotension when given with

Theoretical → Also see TABLE 8 p. 1376

sapropterin.o ▶ Trimethoprim is predicted to decrease the efficacy of

sapropterin.oTheoretical

Saquinavir → see HIV-protease inhibitors

Sarilumab → see monoclonal antibodies

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

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to saxagliptin.nStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to moderately decrease

the exposure to saxagliptin.oStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to saxagliptin.n

Study

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

predicted to increase the exposure to

Study

saxagliptin.o ▶ Aprepitant is predicted to increase the exposure to saxagliptin.

nStudy

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

increase the exposure to saxagliptin.nStudy

▶ Cobicistat

o

is predicted to increase the exposure to saxagliptin.

Study

▶ Crizotinib is predicted to increase the exposure to saxagliptin.

nStudy

▶ Enzalutamide is predicted to moderately decrease the

exposure to saxagliptin.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

saxagliptin.nTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to saxagliptin.oStudy

▶ Idelalisib

o

is predicted to increase the exposure to saxagliptin.

Study

▶ Imatinib is predicted to increase the exposure to saxagliptin.

nStudy

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to saxagliptin.oStudy

▶ Macrolides (erythromycin) are predicted to increase the

exposure to saxagliptin.nStudy

▶ Mitotane is predicted to moderately decrease the exposure to

saxagliptin.oStudy

▶ Netupitant is predicted to increase the exposure to saxagliptin.

nStudy

▶ Nilotinib is predicted to increase the exposure to saxagliptin.

nStudy

▶ Rifampicin is predicted to moderately decrease the exposure

to saxagliptin.oStudy

Secukinumab → see monoclonal antibodies

Selegiline → see monoamine-oxidase B inhibitors

Selenium

ROUTE-SPECIFIC INFORMATION Interactions do not generally

apply to topical use unless specified.

▶ Oral selenium is predicted to decrease the absorption of

eltrombopag. Eltrombopag should be taken 2 hours before or

4 hours after selenium.rTheoretical

Selexipag

▶ Antiepileptics (carbamazepine, fosphenytoin, phenytoin) are

predicted to decrease the exposure to the active metabolite of

selexipag. Adjust dose.oStudy

▶ Antiepileptics (valproate) are predicted to increase the exposure

to selexipag.qTheoretical

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

exposure to selexipag.qTheoretical

▶ Clopidogrel is predicted to increase the exposure to selexipag.

Adjust dose.oStudy

▶ Fibrates (gemfibrozil) increase the exposure to selexipag.

Avoid.rStudy

▶ Iron chelators (deferasirox) are predicted to increase the

exposure to selexipag. Adjust dose.oStudy

▶ Leflunomide is predicted to increase the exposure to selexipag.

Adjust dose.oTheoretical

▶ Rifampicin moderately decreases the exposure to the active

metabolite of selexipag. Adjust dose.oStudy

▶ Teriflunomide is predicted to increase the exposure to

selexipag. Adjust dose.oTheoretical

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

Sertraline → see SSRIs

Sevoflurane → see volatile halogenated anaesthetics

Sildenafil → see phosphodiesterase type-5 inhibitors

Siltuximab → see monoclonal antibodies

Silver sulfadiazine

PHARMACOLOGY Silver might inactivate enzymatic debriding

agents—concurrent use might not be appropriate.

Simvastatin → see statins

1528 Ruxolitinib — Simvastatin BNF 78

Interactions | Appendix 1

A1

Sirolimus

▶ Antiarrhythmics (amiodarone) are predicted to increase the

concentration of sirolimus.rAnecdotal

▶ Antiarrhythmics (dronedarone) increase the concentration of

sirolimus. Monitor and adjust dose.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the

concentration of sirolimus. Avoid.rStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

increase the concentration of sirolimus. Monitor and adjust

dose.oStudy

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

predicted to increase the concentration of

r

sirolimus. Avoid.

Study

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

concentration of

Study

sirolimus. Monitor and adjust dose.o ▶ Apalutamide is predicted to decrease the exposure to

sirolimus. Avoid or monitor.oStudy

▶ Aprepitant increases the concentration of sirolimus. Monitor

and adjust dose.oStudy

▶ Bosentan is predicted to decrease the concentration of

sirolimus and sirolimus potentially increases the

concentration of bosentan. Avoid.rTheoretical

▶ Brigatinib potentially decreases the concentration of

sirolimus. Avoid.oTheoretical

▶ Calcium channel blockers (diltiazem, verapamil) increase the

concentration of

Study

sirolimus. Monitor and adjust dose.o ▶ Ceritinib is predicted to increase the exposure to sirolimus.

Avoid.rTheoretical

▶ Sirolimus is predicted to affect the efficacy of chenodeoxycholic

acid. Monitor and adjust dose.oTheoretical

▶ Ciclosporin moderately increases the exposure to sirolimus.

Separate administration by 4 hours.rStudy

▶ Cobicistat is predicted to increase the concentration of

sirolimus. Avoid.rStudy

▶ Crizotinib increases the concentration of sirolimus. Monitor

and adjust dose.oStudy

▶ Doravirine is predicted to decrease the exposure to sirolimus.

Monitor

o

sirolimus concentration and adjust dose, p. 840.

Theoretical

▶ Efavirenz is predicted to decrease the concentration of

sirolimus. Monitor and adjust dose.oTheoretical

▶ Eliglustat is predicted to increase the exposure to sirolimus.

Adjust dose.oStudy

▶ Enzalutamide is predicted to decrease the concentration of

sirolimus. Avoid.rStudy

▶ Grapefruit juice increases the concentration of sirolimus.

Avoid.oStudy

▶ HIV-protease inhibitors are predicted to increase the

concentration of sirolimus. Avoid.rStudy

▶ Idelalisib is predicted to increase the concentration of

sirolimus. Avoid.rStudy

▶ Imatinib increases the concentration of sirolimus. Monitor and

adjust dose.oStudy

▶ Lapatinib

o

is predicted to increase the exposure to sirolimus.

Theoretical

▶ Letermovir moderately increases the exposure to sirolimus.

Monitor and adjust dose.rStudy

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

sirolimus. Public Health England advises avoid (refer to Green

Book).rTheoretical

▶ Lumacaftor is predicted to decrease the exposure to sirolimus.

Avoid.rTheoretical

▶ Macrolides (clarithromycin) are predicted to increase the

concentration of sirolimus. Avoid.rStudy

▶ Macrolides (erythromycin) increase the concentration of

sirolimus. Monitor and adjust dose.oStudy

▶ Sirolimus is predicted to decrease the efficacy of mifamurtide.

Avoid.rTheoretical

▶ Mirabegron is predicted to increase the exposure to sirolimus.

nTheoretical

▶ Mitotane is predicted to decrease the concentration of

sirolimus. Avoid.rStudy

▶ Monoclonal antibodies (sarilumab) potentially affect the

exposure to

Theoretical

sirolimus. Monitor and adjust dose.o ▶ Netupitant increases the concentration of sirolimus. Monitor

and adjust dose.oStudy

▶ Nevirapine is predicted to decrease the concentration of

sirolimus. Monitor and adjust dose.oTheoretical

▶ Nilotinib increases the concentration of sirolimus. Monitor and

adjust dose.oStudy

▶ Palbociclib is predicted to increase the exposure to sirolimus.

Adjust dose.oTheoretical

▶ Pibrentasvir (with glecaprevir) is predicted to increase the

exposure to sirolimus.oStudy

▶ Pitolisant is predicted to decrease the exposure to sirolimus.

Avoid.rTheoretical

▶ Ribociclib is predicted to increase the exposure to sirolimus.

Use with caution and adjust dose.oTheoretical

▶ Rifampicin is predicted to decrease the concentration of

sirolimus. Avoid.rStudy

▶ Rucaparib is predicted to increase the exposure to sirolimus.

Monitor and adjust dose.oStudy

▶ St John’s Wort is predicted to decrease the concentration of

sirolimus. Monitor and adjust dose.rTheoretical

▶ Sirolimus is predicted to decrease the concentration of

tacrolimus

r

and tacrolimus increases the exposure to sirolimus.

Study

▶ Velpatasvir

r

is predicted to increase the exposure to sirolimus.

Theoretical

▶ Venetoclax is predicted to increase the exposure to sirolimus.

Avoid or adjust dose.rStudy

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

Sodium aurothiomalate

▶ ACE inhibitors are predicted to increase the risk of

r

hypersensitivity when given with sodium aurothiomalate.

Anecdotal

▶ Sodium aurothiomalate potentially increases the risk of sideeffects when given with penicillamine (in those who have had

previous adverse reactions to gold). Avoid.rStudy

Sodium bicarbonate

ROUTE-SPECIFIC INFORMATION Interactions do not generally

apply to topical use unless specified.

▶ Oral sodium bicarbonate decreases the absorption of

antifungals, azoles (ketoconazole).oStudy

▶ Sodium bicarbonate

r

decreases the concentration of lithium.

Anecdotal

▶ Sodium bicarbonate is predicted to decrease the efficacy of

methenamine. Avoid.oTheoretical

Sodium citrate

▶ Sodium citrate is predicted to decrease the efficacy of

methenamine. Avoid.oTheoretical

▶ Sodium citrate is predicted to increase the risk of side-effects

when given with sucralfate. Avoid.oTheoretical

Sodium clodronate → see bisphosphonates

Sodium feredetate → see iron (oral)

Sodium nitroprusside → see TABLE 8 p. 1376 (hypotension)

▶ Sodium nitroprusside is predicted to increase the risk of

methaemoglobinaemia when given with topical anaesthetics,

local (prilocaine). Use with caution or avoid.rTheoretical

▶ Sodium nitroprusside is predicted to increase the risk of

methaemoglobinaemia when given with

Theoretical

dapsone.r

Sodium oxybate → see TABLE 8 p. 1376 (hypotension), TABLE 11 p. 1377

(CNS depressant effects)

▶ Antiepileptics (valproate) increase the exposure to sodium

oxybate. Adjust sodium oxybate dose, p. 491.oStudy

Sodium phenylbutyrate

▶ Antiepileptics (valproate) potentially decrease the effects of

sodium phenylbutyrate.oAnecdotal

▶ Corticosteroids potentially decrease the effects of sodium

phenylbutyrate.oAnecdotal

▶ Haloperidol potentially decreases the effects of sodium

phenylbutyrate.oAnecdotal

Sodium picosulfate → see TABLE 18 p. 1379 (hyponatraemia)

BNF 78 Sirolimus — Sodium picosulfate 1529

Interactions | Appendix 1

A1

Sodium stibogluconate

▶ Sodium stibogluconate increases the risk of cardiovascular

side-effects when given with amphotericin. Separate

administration by 14 days.rStudy

Sofosbuvir

▶ Sofosbuvir is predicted to increase the risk of severe

bradycardia or heart block when given with antiarrhythmics

(amiodarone). Refer to specialist literature.rAnecdotal

▶ Antiepileptics (carbamazepine) are predicted to decrease the

exposure to sofosbuvir. Avoid.rStudy

▶ Antiepileptics (fosphenytoin, oxcarbazepine, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to sofosbuvir. Avoid.rTheoretical

▶ H2 receptor antagonists potentially decrease the exposure to

sofosbuvir. Adjust dose, see ledipasvir with sofosbuvir p. 628,

sofosbuvir with velpatasvir p. 629, and sofosbuvir with

velpatasvir and voxilaprevir p. 630.oStudy

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

exposure to sofosbuvir. Avoid.rTheoretical

▶ Modafinil is predicted to decrease the exposure to sofosbuvir.

Avoid.rTheoretical

▶ Proton pump inhibitors potentially decrease the exposure to

sofosbuvir. Adjust dose, see ledipasvir with sofosbuvir p. 628,

sofosbuvir with velpatasvir p. 629, and sofosbuvir with

velpatasvir and voxilaprevir p. 630.oStudy

▶ Rifabutin is predicted to decrease the exposure to sofosbuvir.

Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to sofosbuvir.

Avoid.rStudy

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

sofosbuvir. Avoid.rStudy

Solifenacin → see TABLE 10 p. 1377 (antimuscarinics)

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to solifenacin.oTheoretical

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

predicted to increase the exposure to solifenacin. Adjust

solifenacin p. 779 or tamsulosin with solifenacin p. 786 dose;

avoid in hepatic and renal impairment.rStudy

▶ Cobicistat is predicted to increase the exposure to solifenacin.

Adjust solifenacin p. 779 or tamsulosin with solifenacin p. 786

dose; avoid in hepatic and renal impairment.rStudy

▶ Enzalutamide is predicted to decrease the exposure to

solifenacin.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to solifenacin. Adjust solifenacin p. 779 or tamsulosin with

solifenacin

r

p. 786 dose; avoid in hepatic and renal impairment.

Study

▶ Idelalisib is predicted to increase the exposure to solifenacin.

Adjust solifenacin p. 779 or tamsulosin with solifenacin p. 786

dose; avoid in hepatic and renal impairment.rStudy

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to solifenacin. Adjust solifenacin p. 779 or tamsulosin

with solifenacin p. 786 dose; avoid in hepatic and renal

impairment.rStudy

▶ Mitotane

o

is predicted to decrease the exposure to solifenacin.

Theoretical

▶ Rifampicin

o

is predicted to decrease the exposure to solifenacin.

Theoretical

Somatropin

▶ Corticosteroids are predicted to decrease the effects of

somatropin.oTheoretical

Sorafenib → see TABLE 15 p. 1378 (myelosuppression), TABLE 9 p. 1377

(QT-interval prolongation)

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to sorafenib.oTheoretical

▶ Sorafenib

r

increases the anticoagulant effect of coumarins.

Anecdotal

▶ Enzalutamide is predicted to decrease the exposure to

sorafenib.oTheoretical

▶ Mitotane

o

is predicted to decrease the exposure to sorafenib.

Theoretical → Also see TABLE 15 p. 1378

▶ Neomycin

o

moderately decreases the exposure to sorafenib.

Study

▶ Sorafenib is predicted to increase the risk of bleeding events

when given with phenindione.rTheoretical

▶ Rifampicin

o

is predicted to decrease the exposure to sorafenib.

Theoretical

Sotalol → see beta blockers, non-selective

Spironolactone → see aldosterone antagonists

SSRIs → see TABLE 18 p. 1379 (hyponatraemia), TABLE 13 p. 1378

(serotonin syndrome), TABLE 9 p. 1377 (QT-interval prolongation),

TABLE 4 p. 1375 (antiplatelet effects)

citalopram . dapoxetine . escitalopram. fluoxetine . fluvoxamine . paroxetine . sertraline. ▶ Fluvoxamine very markedly increases the exposure to

agomelatine. Avoid.rStudy

▶ Fluvoxamine moderately increases the exposure to alprazolam.

Adjust dose.oStudy

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

exposure to amfetamines.rTheoretical → Also see TABLE 13

p. 1378