▶ Etravirine moderately decreases the exposure to
phosphodiesterase type-5 inhibitors
. Adjust dose.o ▶ Grapefruit juice is predicted to increase the exposure to
phosphodiesterase type-5 inhibitors
▶ HIV-protease inhibitors are predicted to increase the exposure
to phosphodiesterase type-5 inhibitors (avanafil, vardenafil).
Avoid.rStudy → Also see TABLE 9 p. 1377
▶ HIV-protease inhibitors are predicted to increase the exposure
to sildenafil. Avoid potent inhibitors of CYP3A4 or adjust
sildenafil dose, p. 813.rStudy → Also see TABLE 9 p. 1377
▶ HIV-protease inhibitors are predicted to increase the exposure
to tadalafil. Use with caution or avoid.rStudy
▶ Idelalisib is predicted to increase the exposure to
phosphodiesterase type-5 inhibitors (avanafil, vardenafil). Avoid.
▶ Idelalisib is predicted to increase the exposure to sildenafil.
Avoid potent inhibitors of CYP3A4 or adjust sildenafil dose,
▶ Idelalisib is predicted to increase the exposure to tadalafil. Use
▶ Imatinib is predicted to increase the exposure to avanafil.
Adjust avanafil dose, p. 812.oTheoretical
▶ Imatinib is predicted to increase the exposure to sildenafil.
Monitor or adjust sildenafil dose with moderate inhibitors of
BNF 78 Phenothiazines — Phosphodiesterase type-5 inhibitors 1513
Phosphodiesterase type-5 inhibitors (continued)
is predicted to increase the exposure to tadalafil.
▶ Imatinib is predicted to increase the exposure to vardenafil.
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to sildenafil. Avoid potent inhibitors of CYP3A4 or
adjust sildenafil dose, p. 813.rStudy → Also see TABLE 9
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to tadalafil. Use with caution or avoid.rStudy
▶ Macrolides (erythromycin) are predicted to increase the
exposure to sildenafil. Monitor or adjust sildenafil dose with
moderate inhibitors of CYP3A4, p. 813.oStudy → Also
▶ Macrolides (erythromycin) are predicted to increase the
exposure to tadalafil.rTheoretical
▶ Macrolides (erythromycin) are predicted to increase the
exposure to vardenafil. Adjust dose.rTheoretical → Also
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to phosphodiesterase type-5 inhibitors (avanafil,
vardenafil). Avoid.rStudy → Also see TABLE 9 p. 1377
▶ Mitotane is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors
▶ Mitotane is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors
▶ Netupitant is predicted to increase the exposure to avanafil.
Adjust avanafil dose, p. 812.oTheoretical
▶ Netupitant is predicted to increase the exposure to sildenafil.
Monitor or adjust sildenafil dose with moderate inhibitors of
is predicted to increase the exposure to tadalafil.
▶ Netupitant is predicted to increase the exposure to vardenafil.
▶ Nevirapine is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors.oTheoretical
▶ Nicorandil is predicted to increase the risk of hypotension
phosphodiesterase type-5 inhibitors. Avoid.
Theoretical → Also see TABLE 8 p. 1376
▶ Nilotinib is predicted to increase the exposure to avanafil.
Adjust avanafil dose, p. 812.oTheoretical
▶ Nilotinib is predicted to increase the exposure to sildenafil.
Monitor or adjust sildenafil dose with moderate inhibitors of
CYP3A4, p. 813.oStudy → Also see TABLE 9 p. 1377
is predicted to increase the exposure to tadalafil.
▶ Nilotinib is predicted to increase the exposure to vardenafil.
Adjust dose.rTheoretical → Also see TABLE 9 p. 1377
▶ Nitrates potentially increase the risk of hypotension when
phosphodiesterase type-5 inhibitors
▶ Ribociclib is predicted to increase the exposure to sildenafil.
Avoid.oTheoretical → Also see TABLE 9 p. 1377
▶ Rifampicin is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors
▶ Rifampicin is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors
▶ Riociguat is predicted to increase the risk of hypotension
when given with phosphodiesterase type-5 inhibitors. Avoid.
Theoretical → Also see TABLE 8 p. 1376
▶ Phosphodiesterase type-5 inhibitors are predicted to increase
the risk of hypotension when given with
Theoretical → Also see TABLE 8 p. 1376
sapropterin.o ▶ St John’s Wort is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors.oTheoretical
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
▶ Antiarrhythmics (amiodarone) are predicted to increase the
exposure to pibrentasvir.oTheoretical
▶ Antiarrhythmics (dronedarone) potentially increase the
exposure to pibrentasvir.oTheoretical
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to moderately to markedly
decrease the exposure to pibrentasvir. Avoid.rStudy
▶ Antiepileptics (eslicarbazepine, oxcarbazepine) potentially
decrease the exposure to pibrentasvir. Avoid.rTheoretical
▶ Antifungals, azoles (itraconazole, ketoconazole) are predicted to
increase the exposure to pibrentasvir.oTheoretical
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
antihistamines, non-sedating (fexofenadine).
▶ Bosentan is predicted to decrease the exposure to pibrentasvir.
▶ Calcium channel blockers (verapamil) are predicted to increase
the exposure to pibrentasvir.oTheoretical
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
▶ Combined hormonal contraceptives (containing
ethinylestradiol) are predicted to increase the risk of
increased ALT concentrations when given with pibrentasvir.
▶ Crizotinib potentially decreases the exposure to pibrentasvir.
▶ Pibrentasvir (with glecaprevir) increases the exposure to
▶ Pibrentasvir (with glecaprevir) increases the exposure to
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
▶ Efavirenz is predicted to decrease the exposure to pibrentasvir.
▶ Enzalutamide is predicted to moderately to markedly decrease
the exposure to pibrentasvir. Avoid.rStudy
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
▶ HIV-protease inhibitors (atazanavir, lopinavir) (boosted with
ritonavir) increase the exposure to
▶ HIV-protease inhibitors (ritonavir) potentially increase the
exposure to pibrentasvir.rTheoretical
▶ HIV-protease inhibitors (saquinavir) are predicted to increase the
exposure to pibrentasvir.oTheoretical
is predicted to increase the exposure to pibrentasvir.
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
▶ Lumacaftor potentially decreases the exposure to pibrentasvir.
▶ Macrolides are predicted to increase the exposure to
▶ Mitotane is predicted to moderately to markedly decrease the
exposure to pibrentasvir. Avoid.rStudy
▶ Nevirapine is predicted to decrease the exposure to
▶ Ranolazine is predicted to increase the exposure to
▶ Rifampicin is predicted to moderately to markedly decrease
the exposure to pibrentasvir. Avoid.rStudy
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
▶ St John’s Wort is predicted to decrease the exposure to
▶ Pibrentasvir (with glecaprevir) markedly increases the
exposure to statins (atorvastatin). Avoid.rStudy
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
exposure to statins (fluvastatin).oTheoretical
▶ Pibrentasvir (with glecaprevir) increases the exposure to
statins (pravastatin). Use with caution and adjust pravastatin
1514 Phosphodiesterase type-5 inhibitors — Pibrentasvir BNF 78
▶ Pibrentasvir (with glecaprevir) increases the exposure to
statins (rosuvastatin). Use with caution and adjust rosuvastatin
▶ Pibrentasvir (with glecaprevir) increases the exposure to
statins (simvastatin). Avoid.oStudy
▶ Pibrentasvir (with glecaprevir) slightly increases the exposure
to tacrolimus. Monitor and adjust dose.nStudy
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
exposure to taxanes (paclitaxel).oStudy
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
▶ Vemurafenib is predicted to increase the exposure to
ROUTE-SPECIFIC INFORMATION Since systemic absorption can
follow topical application, the possibility of interactions
▶ Alcohol (beverage) increases the risk of facial flushing and skin
mifamurtide. Avoid.rTheoretical
TABLE 10 p. 1377 (antimuscarinics)
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to pimozide. Avoid.rTheoretical → Also see
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to
Theoretical → Also see TABLE 9 p. 1377
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to
Study → Also see TABLE 9 p. 1377
▶ Antifungals, azoles (miconazole) are predicted to increase the
exposure to pimozide. Avoid.oTheoretical
▶ Aprepitant is predicted to increase the exposure to pimozide.
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to pimozide. Avoid.rTheoretical →
▶ Ceritinib is predicted to increase the exposure to pimozide.
Avoid.rTheoretical → Also see TABLE 9 p. 1377
▶ Cobicistat is predicted to increase the exposure to pimozide.
▶ Crizotinib is predicted to increase the exposure to pimozide.
Avoid.rTheoretical → Also see TABLE 9 p. 1377
▶ Pimozide is predicted to decrease the effects of dopamine
receptor agonists. Avoid.oTheoretical → Also see TABLE 8
p. 1376 → Also see TABLE 9 p. 1377 → Also see TABLE 10 p. 1377
▶ Fosaprepitant is predicted to increase the exposure to
increases the exposure to pimozide. Avoid.
▶ HIV-protease inhibitors are predicted to increase the exposure
to pimozide. Avoid.rStudy → Also see TABLE 9 p. 1377
▶ Idelalisib is predicted to increase the exposure to pimozide.
▶ Imatinib is predicted to increase the exposure to pimozide.
▶ Letermovir is predicted to increase the concentration of
▶ Pimozide decreases the effects of levodopa.rTheoretical →
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to pimozide. Avoid.rStudy → Also see TABLE 9
▶ Macrolides (erythromycin) are predicted to increase the
exposure to pimozide. Avoid.rTheoretical → Also see
▶ Netupitant is predicted to increase the exposure to pimozide.
▶ Nilotinib is predicted to increase the exposure to pimozide.
Avoid.rTheoretical → Also see TABLE 9 p. 1377
▶ Palbociclib is predicted to increase the exposure to pimozide.
▶ Panobinostat is predicted to increase the exposure to
pimozide. Avoid.rTheoretical → Also see TABLE 9 p. 1377
▶ Pitolisant is predicted to decrease the exposure to pimozide.
▶ Ribociclib (high-dose) is predicted to increase the exposure to
pimozide. Avoid.oTheoretical → Also see TABLE 9 p. 1377
is predicted to increase the exposure to pimozide.
▶ Rucaparib is predicted to increase the exposure to pimozide.
Monitor and adjust dose.oStudy
Pindolol → see beta blockers, non-selective
Pioglitazone → see TABLE 14 p. 1378 (antidiabetic drugs)
▶ Pioglitazone potentially decreases the exposure to antifungals,
blood glucose and adjust dose.rStudy
▶ Fibrates (gemfibrozil) increase the exposure to pioglitazone.
Monitor blood glucose and adjust dose.rStudy
▶ Leflunomide is predicted to increase the exposure to
▶ Opicapone is predicted to increase the exposure to
▶ Rifampicin moderately decreases the exposure to pioglitazone.
Monitor and adjust dose.oStudy
▶ St John’s Wort slightly decreases the exposure to pioglitazone.
▶ Teriflunomide is predicted to increase the exposure to
Piperacillin → see penicillins
Piperaquine → see antimalarials
FOOD AND LIFESTYLE Smoking increases pirfenidone
clearance; patients should be encouraged to stop smoking
before and during treatment with pirfenidone.
▶ Antiepileptics (fosphenytoin, phenytoin) are predicted to
decrease the exposure to pirfenidone.oTheoretical
▶ Combined hormonal contraceptives are predicted to increase
pirfenidone. Use with caution and adjust dose.
▶ HIV-protease inhibitors (ritonavir) are predicted to decrease the
exposure to pirfenidone.oTheoretical
▶ Leflunomide is predicted to decrease the exposure to
▶ Mexiletine is predicted to increase the exposure to pirfenidone.
Use with caution and adjust dose.oStudy
▶ Quinolones (ciprofloxacin) are predicted to increase the
pirfenidone. Use with caution and adjust dose.
▶ Rifampicin is predicted to decrease the exposure to
pirfenidone. Avoid.oTheoretical
▶ SSRIs (fluvoxamine) are predicted to moderately increase the
exposure to pirfenidone. Avoid.oStudy
▶ Teriflunomide is predicted to decrease the exposure to
▶ Pitolisant is predicted to decrease the exposure to aliskiren.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to moderately decrease
the exposure to pitolisant.oStudy
▶ Pitolisant is predicted to decrease the exposure to
antihistamines, non-sedating (fexofenadine).nTheoretical
▶ Antihistamines, sedating are predicted to decrease the efficacy
▶ Pitolisant is predicted to decrease the exposure to bosutinib.
▶ Bupropion is predicted to moderately increase the exposure to
pitolisant. Use with caution and adjust dose.oStudy
▶ Pitolisant is predicted to decrease the exposure to ciclosporin.
BNF 78 Pibrentasvir — Pitolisant 1515
▶ Cinacalcet is predicted to moderately increase the exposure to
pitolisant. Use with caution and adjust dose.oStudy
▶ Pitolisant is predicted to decrease the exposure to colchicine.
▶ Pitolisant is predicted to decrease the efficacy of combined
hormonal contraceptives. Avoid.rTheoretical
▶ Pitolisant is predicted to decrease the exposure to coumarins
▶ Pitolisant is predicted to decrease the exposure to crizotinib.
▶ Pitolisant is predicted to decrease the exposure to dabigatran.
▶ Pitolisant is predicted to decrease the exposure to dasatinib.
▶ Pitolisant is predicted to decrease the exposure to digoxin.
▶ Duloxetine is predicted to increase the exposure to pitolisant.
Use with caution and adjust dose.oStudy
▶ Pitolisant is predicted to decrease the exposure to edoxaban.
▶ Pitolisant is predicted to decrease the exposure to efavirenz.
▶ Enzalutamide is predicted to moderately decrease the
▶ Pitolisant is predicted to decrease the exposure to everolimus.
▶ Pitolisant is predicted to decrease the exposure to irinotecan.
▶ Pitolisant is predicted to decrease the exposure to lapatinib.
▶ Pitolisant is predicted to decrease the exposure to loperamide.
▶ Pitolisant is predicted to increase the exposure to metformin.
is predicted to decrease the efficacy of pitolisant.
is predicted to decrease the efficacy of pitolisant.
▶ Mitotane is predicted to moderately decrease the exposure to
▶ Pitolisant is predicted to decrease the exposure to nilotinib.
▶ Pitolisant is predicted to decrease the exposure to opioids
▶ Pitolisant is predicted to decrease the exposure to
▶ Pitolisant is predicted to decrease the exposure to pimozide.
▶ Pitolisant is predicted to decrease the exposure to repaglinide.
▶ Rifampicin is predicted to moderately decrease the exposure
▶ Pitolisant is predicted to decrease the exposure to sirolimus.
▶ SSRIs (fluoxetine, paroxetine) are predicted to moderately
increase the exposure to pitolisant. Use with caution and
▶ St John’s Wort is predicted to decrease the exposure to
pitolisant. Monitor and adjust dose.oTheoretical
▶ Pitolisant is predicted to decrease the exposure to tacrolimus.
▶ Pitolisant is predicted to decrease the exposure to taxanes
(docetaxel). Avoid.rTheoretical
▶ Pitolisant is predicted to decrease the exposure to taxanes
▶ Pitolisant is predicted to decrease the exposure to
temsirolimus. Avoid.rTheoretical
▶ Terbinafine is predicted to moderately increase the exposure
to pitolisant. Use with caution and adjust dose.oStudy
▶ Pitolisant is predicted to decrease the exposure to topotecan.
▶ Tricyclic antidepressants are predicted to decrease the efficacy
▶ Venlafaxine is predicted to increase the exposure to pitolisant.
Use with caution and adjust dose.nTheoretical
Pivmecillinam → see penicillins
Pixantrone → see anthracyclines
Pizotifen → see antihistamines, sedating
Platinum compounds → see TABLE 15 p. 1378 (myelosuppression),
TABLE 2 p. 1375 (nephrotoxicity), TABLE 19 p. 1379 (ototoxicity), TABLE 12
p. 1378 (peripheral neuropathy)
with bleomycin.rStudy → Also see TABLE 15 p. 1378
▶ 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
Polymyxins → see TABLE 2 p. 1375 (nephrotoxicity), TABLE 20 p. 1379
(neuromuscular blocking effects)
ROUTE-SPECIFIC INFORMATION Since systemic absorption can
follow topical application, the possibility of interactions
SEPARATION OF ADMINISTRATION Manufacturers advise take
other drugs at least 3 hours before or after calcium- or
sodium-polystyrene sulfonate; a 6-hour separation should be
▶ Antacids increase the risk of metabolic alkalosis when given
with polystyrene sulfonate.rAnecdotal
Pomalidomide → see TABLE 15 p. 1378 (myelosuppression), TABLE 5
▶ Combined hormonal contraceptives are predicted to increase
the risk of venous thromboembolism when given with
pomalidomide. Avoid.rTheoretical
▶ Hormone replacement therapy is predicted to increase the risk
of venous thromboembolism when given with
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