▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
fingolimod. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
fludarabine. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
fluorouracil. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
gemcitabine. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
hydroxycarbamide. Public Health England advises avoid (refer
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
irinotecan. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with iron
chelators (dexrazoxane). Avoid.rTheoretical
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
leflunomide. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
mercaptopurine (high-dose). Public Health England advises
avoid (refer to Green Book).rTheoretical
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
methotrexate (high-dose). Public Health England advises
avoid (refer to Green Book).rTheoretical
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
mitomycin. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
monoclonal antibodies. Public Health England advises avoid
(refer to Green Book).rTheoretical
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
mycophenolate. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
pemetrexed. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with platinum
compounds. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
procarbazine. Public Health England advises avoid (refer to
▶ 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
▶ 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
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
streptozocin. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
tacrolimus. Public Health England advises avoid (refer to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with taxanes
(docetaxel, paclitaxel). Public Health England advises avoid
(refer to Green Book).rTheoretical
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with tegafur.
Public Health England advises avoid (refer to Green Book).
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
temsirolimus. Public Health England advises avoid (refer to
▶ 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
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
tioguanine. Public Health England advises avoid (refer to
▶ Live vaccines potentially increase the risk of generalised
infection (possibly life-threatening) when given with
tofacitinib. Avoid.rTheoretical
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
topotecan. Public Health England advises avoid (refer to Green
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
trabectedin. Public Health England advises avoid (refer to
▶ Venetoclax potentially decreases the efficacy of live vaccines.
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with vinca
alkaloids. Public Health England advises avoid (refer to Green
Lixisenatide → see TABLE 14 p. 1378 (antidiabetic drugs)
SEPARATION OF ADMINISTRATION Some orally administered
drugs should be taken at least 1 hour before, or 4 hours after,
Lofepramine → see tricyclic antidepressants
Lomitapide → see TABLE 1 p. 1375 (hepatotoxicity)
FOOD AND LIFESTYLE Bitter (Seville) orange is predicted to
increase the exposure to lomitapide; separate administration
▶ Alprazolam is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Antiarrhythmics (amiodarone) are predicted to increase the
lomitapide. Separate administration by 12 hours.
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to lomitapide. Avoid.oTheoretical
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to lomitapide. Monitor and adjust dose.oTheoretical →
▶ Antifungals, azoles (clotrimazole) are predicted to increase the
lomitapide. Separate administration by 12 hours.
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to
Theoretical → Also see TABLE 1 p. 1375
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to markedly increase the exposure to lomitapide.
Avoid.rStudy → Also see TABLE 1 p. 1375
▶ Apalutamide is predicted to decrease the exposure to
lomitapide. Avoid or monitor.oStudy
BNF 78 Live vaccines — Lomitapide 1481
▶ Aprepitant is predicted to increase the exposure to lomitapide.
▶ Bicalutamide is predicted to increase the exposure to
to increase the exposure to lomitapide. Separate
administration by 12 hours.oTheoretical
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to lomitapide. Avoid.oTheoretical
▶ Ciclosporin is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Cilostazol is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Cobicistat is predicted to markedly increase the exposure to
▶ Oral combined hormonal contraceptives slightly increase the
lomitapide. Separate administration by 12 hours.
▶ Lomitapide increases the exposure to coumarins (warfarin).
Monitor INR and adjust dose.rStudy
▶ Crizotinib is predicted to increase the exposure to lomitapide.
▶ Enzalutamide is predicted to decrease the exposure to
lomitapide. Monitor and adjust dose.oTheoretical
▶ Everolimus is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Fosaprepitant is predicted to increase the exposure to
. Separate administration by 12 hours.o ▶ Grapefruit juice is predicted to increase the exposure to
increase the exposure to lomitapide. Separate administration
▶ HIV-protease inhibitors are predicted to markedly increase the
exposure to lomitapide. Avoid.rStudy
▶ Idelalisib is predicted to markedly increase the exposure to
▶ Imatinib is predicted to increase the exposure to lomitapide.
▶ Isoniazid is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.qTheoretical →
▶ Ivacaftor is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Lapatinib is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Linagliptin is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Macrolides (azithromycin) are predicted to increase the
exposure to lomitapide. Separate administration by 12 hours.
▶ Macrolides (clarithromycin) are predicted to markedly increase
the exposure to lomitapide. Avoid.rStudy
▶ Macrolides (erythromycin) are predicted to increase the
exposure to lomitapide. Avoid.oTheoretical
▶ Mitotane is predicted to decrease the exposure to lomitapide.
Monitor and adjust dose.oTheoretical
▶ Netupitant is predicted to increase the exposure to lomitapide.
▶ Nilotinib is predicted to increase the exposure to lomitapide.
▶ Pazopanib is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Peppermint oil is predicted to increase the exposure to
. Separate administration by 12 hours.o ▶ Propiverine is predicted to increase the exposure to
Separate administration by 12 hours.oTheoretical
▶ Rifampicin is predicted to decrease the exposure to lomitapide.
Monitor and adjust dose.oTheoretical
▶ SSRIs (fluoxetine) are predicted to increase the exposure to
Adjust lomitapide dose or separate administration by
12 hours, p. 207.nStudy → Also see TABLE 1 p. 1375
▶ Lomitapide increases the exposure to statins (simvastatin).
Monitor and adjust simvastatin dose, p. 205.oStudy →
▶ Tacrolimus is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Ticagrelor is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Tolvaptan is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
Lomustine → see alkylating agents
Loop diuretics → see TABLE 18 p. 1379 (hyponatraemia), TABLE 8 p. 1376
(hypotension), TABLE 19 p. 1379 (ototoxicity), TABLE 17 p. 1379 (reduced
bumetanide . furosemide .torasemide. ▶ Aliskiren
slightly decreases the exposure to furosemide.
Study → Also see TABLE 8 p. 1376
▶ Loop diuretics increase the risk of nephrotoxicity when given
with aminoglycosides. Avoid.oStudy → Also see TABLE 19
▶ Antiepileptics (fosphenytoin, phenytoin) decrease the effects of
▶ Intravenous furosemide potentially increases the risk of
sweating, variable blood pressure, and tachycardia when
given after chloral hydrate.oAnecdotal
▶ Dasabuvir (with ombitasvir, paritaprevir, and ritonavir)
increases the concentration of
▶ Leflunomide is predicted to increase the exposure to
▶ Loop diuretics increase the concentration of lithium. Monitor
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
furosemide. Adjust dose.o ▶ Reboxetine is predicted to increase the risk of hypokalaemia
when given with loop diuretics.oTheoretical
▶ Teriflunomide is predicted to increase the exposure to
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to loperamide.rTheoretical
is predicted to increase the exposure to loperamide.
▶ Loperamide greatly increases the absorption of oral
desmopressin (and possibly sublingual).oStudy
▶ Eliglustat is predicted to increase the exposure to loperamide.
is predicted to increase the exposure to loperamide.
▶ Mirabegron is predicted to increase the exposure to
▶ Opicapone is predicted to increase the exposure to loperamide.
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to loperamide.oStudy
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
▶ Pitolisant is predicted to decrease the exposure to loperamide.
▶ Velpatasvir is predicted to increase the exposure to
Lopinavir → see HIV-protease inhibitors
Loprazolam → see TABLE 11 p. 1377 (CNS depressant effects)
Loratadine → see antihistamines, non-sedating
1482 Lomitapide — Loratadine BNF 78
Lorazepam → see TABLE 11 p. 1377 (CNS depressant effects)
increases the clearance of lorazepam.o
Lormetazepam → see TABLE 11 p. 1377 (CNS depressant effects)
Losartan → see angiotensin-II receptor antagonists
Low molecular-weight heparins → see TABLE 16 p. 1379 (increased
serum potassium), TABLE 3 p. 1375 (anticoagulant effects)
dalteparin . enoxaparin .tinzaparin. ▶ Ranibizumab increases the risk of bleeding events when given
with low molecular-weight heparins.rTheoretical
Loxapine → see TABLE 8 p. 1376 (hypotension), TABLE 11 p. 1377 (CNS
depressant effects), TABLE 10 p. 1377 (antimuscarinics)
▶ Combined hormonal contraceptives are predicted to increase
the exposure to loxapine. Avoid.qTheoretical
▶ Loxapine is predicted to decrease the effects of dopamine
receptor agonists.oTheoretical → Also see TABLE 8
p. 1376 → Also see TABLE 10 p. 1377
is predicted to decrease the effects of levodopa.
Theoretical → Also see TABLE 8 p. 1376
▶ Mexiletine is predicted to increase the exposure to loxapine.
▶ Quinolones (ciprofloxacin) are predicted to increase the
exposure to loxapine. Avoid.qTheoretical
▶ SSRIs (fluvoxamine) are predicted to increase the exposure to
▶ Lumacaftor is predicted to decrease the exposure to
antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone). Avoid.rTheoretical
▶ Lumacaftor is predicted to decrease the exposure to
antifungals, azoles (fluconazole). Adjust dose.nTheoretical
▶ Lumacaftor is predicted to decrease the exposure to
antifungals, azoles (itraconazole, ketoconazole, posaconazole,
voriconazole). Avoid or monitor efficacy.oTheoretical
▶ Lumacaftor is predicted to decrease the exposure to
ciclosporin. Avoid.rTheoretical
▶ Lumacaftor is predicted to decrease the efficacy of combined
hormonal contraceptives. Use additional contraceptive
▶ Lumacaftor is predicted to decrease the exposure to
(methylprednisolone). Adjust dose.r
▶ Lumacaftor is predicted to decrease the exposure to
doravirine. Avoid.rTheoretical
▶ Lumacaftor is predicted to decrease the exposure to
everolimus. Avoid.rTheoretical
▶ Lumacaftor potentially decreases the exposure to glecaprevir.
▶ Lumacaftor is predicted to decrease the efficacy of
. Use additional contraceptive precautions.
▶ Lumacaftor is predicted to decrease the exposure to macrolides
(clarithromycin, erythromycin).oTheoretical
▶ Lumacaftor is predicted to decrease the exposure to
▶ Lumacaftor potentially decreases the exposure to pibrentasvir.
▶ Lumacaftor is predicted to decrease the exposure to rifabutin.
▶ Lumacaftor is predicted to decrease the exposure to sirolimus.
▶ Lumacaftor is predicted to decrease the exposure to
tacrolimus. Avoid.rTheoretical
▶ Lumacaftor is predicted to decrease the exposure to
temsirolimus. Avoid.rTheoretical
▶ Lumacaftor is predicted to decrease the efficacy of ulipristal.
Use additional contraceptive precautions.rTheoretical
Lumefantrine → see antimalarials
Lurasidone → see TABLE 8 p. 1376 (hypotension), TABLE 11 p. 1377 (CNS
▶ Antiarrhythmics (dronedarone) are predicted to increase the
lurasidone. Adjust lurasidone dose, p. 398.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to lurasidone. Avoid.oStudy → Also see TABLE 11 p. 1377
▶ Antifungals, azoles (fluconazole, isavuconazole) are predicted to
increase the exposure to lurasidone. Adjust lurasidone dose,
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to
▶ Antifungals, azoles (posaconazole) moderately increase the
exposure to lurasidone. Avoid.rStudy
▶ Apalutamide is predicted to decrease the exposure to
lurasidone. Avoid or monitor.oStudy
▶ Aprepitant is predicted to increase the exposure to lurasidone.
Adjust lurasidone dose, p. 398.oStudy
▶ Bosentan is predicted to decrease the exposure to lurasidone.
Monitor and adjust dose.oTheoretical
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to lurasidone. Adjust lurasidone dose,
p. 398.oStudy → Also see TABLE 8 p. 1376
▶ Cobicistat is predicted to increase the exposure to lurasidone.
▶ Crizotinib is predicted to increase the exposure to lurasidone.
Adjust lurasidone dose, p. 398.oStudy
▶ Efavirenz is predicted to decrease the exposure to lurasidone.
Monitor and adjust dose.oTheoretical
▶ Enzalutamide is predicted to decrease the exposure to
▶ Grapefruit juice is predicted to increase the exposure to
lurasidone. Avoid.rTheoretical
▶ HIV-protease inhibitors are predicted to increase the exposure
▶ Idelalisib is predicted to increase the exposure to lurasidone.
▶ Imatinib is predicted to increase the exposure to lurasidone.
Adjust lurasidone dose, p. 398.oStudy
is predicted to decrease the effects of levodopa.
Theoretical → Also see TABLE 8 p. 1376
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to lurasidone. Avoid.rStudy
▶ Macrolides (erythromycin) are predicted to increase the
lurasidone. Adjust lurasidone dose, p. 398.
▶ Mitotane is predicted to decrease the exposure to lurasidone.
▶ Netupitant is predicted to increase the exposure to lurasidone.
Adjust lurasidone dose, p. 398.oStudy
▶ Nevirapine is predicted to decrease the exposure to lurasidone.
Monitor and adjust dose.oTheoretical
▶ Nilotinib is predicted to increase the exposure to lurasidone.
Adjust lurasidone dose, p. 398.oStudy
▶ Rifampicin is predicted to decrease the exposure to lurasidone.
▶ St John’s Wort is predicted to decrease the exposure to
lurasidone. Monitor and adjust dose.oTheoretical
Lymecycline → 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
is predicted to increase the exposure to macitentan.
▶ Enzalutamide is predicted to decrease the exposure to
▶ HIV-protease inhibitors are predicted to increase the exposure
is predicted to increase the exposure to macitentan.
▶ Macrolides (clarithromycin) are predicted to increase the
▶ Mitotane is predicted to decrease the exposure to macitentan.
BNF 78 Lorazepam — Macitentan 1483
▶ Rifampicin is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
macitentan. Avoid.rTheoretical
Macrolides → see TABLE 9 p. 1377 (QT-interval prolongation)
azithromycin . clarithromycin . erythromycin.
▶ Interactions do not generally apply to topical use of
azithromycin unless specified.
▶ Since systemic absorption can follow topical application,
the possibility of interactions should be borne in mind.
▶ Clarithromycin is predicted to increase the exposure to
. Avoid or adjust abemaciclib dose, p. 967.r
▶ Erythromycin is predicted to increase the exposure to
▶ Macrolides are predicted to increase the exposure to afatinib.
Separate administration by 12 hours.oStudy
▶ Clarithromycin is predicted to markedly increase the exposure
to aldosterone antagonists (eplerenone). Avoid.rStudy
▶ Erythromycin is predicted to increase the exposure to
aldosterone antagonists (eplerenone). Adjust eplerenone dose,
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