statins (pravastatin). Adjust pravastatin dose.
▶ Paritaprevir (with ritonavir and ombitasvir) slightly to
moderately increases the exposure to statins (rosuvastatin).
Adjust rosuvastatin dose, p. 204.oStudy
▶ Paritaprevir (in fixed-dose combination) is predicted to
increase the risk of rhabdomyolysis when given with statins
(simvastatin). Avoid.rTheoretical
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to taxanes (paclitaxel).oStudy
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to thyroid hormones (levothyroxine).
Monitor and adjust dose.oTheoretical
1510 Panobinostat — Paritaprevir BNF 78
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to topotecan.oStudy
Pasireotide → see TABLE 6 p. 1376 (bradycardia), TABLE 9 p. 1377 (QTinterval prolongation)
▶ Pasireotide is predicted to decrease the absorption of oral
ciclosporin. Adjust dose.rTheoretical
SEPARATION OF ADMINISTRATION Manufacturer advises take
3 hours before, or after, other drugs.
Pazopanib → see TABLE 15 p. 1378 (myelosuppression), TABLE 9 p. 1377
▶ Antacids are predicted to decrease the absorption of
pazopanib. Pazopanib should be taken 1 hour before or 2 hours
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to pazopanib.oTheoretical → Also see TABLE 9
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to pazopanib. Avoid.rTheoretical
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to
Theoretical → Also see TABLE 9 p. 1377
pazopanib.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to pazopanib. Avoid or
adjust pazopanib dose, p. 993.oStudy → Also see TABLE 9
is predicted to increase the exposure to pazopanib.
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to pazopanib.oTheoretical
▶ Cobicistat is predicted to increase the exposure to pazopanib.
Avoid or adjust pazopanib dose, p. 993.oStudy
▶ Pazopanib is predicted to increase the risk of bleeding events
when given with coumarins.rTheoretical
is predicted to increase the exposure to pazopanib.
Theoretical → Also see TABLE 15 p. 1378 → Also see TABLE 9
▶ Enzalutamide is predicted to decrease the exposure to
▶ Grapefruit juice is predicted to increase the exposure to
▶ H2 receptor antagonists are predicted to decrease the exposure
to pazopanib. H2 receptor antagonists should be taken 10 hours
before or 2 hours after pazopanib.oTheoretical
▶ HIV-protease inhibitors are predicted to increase the exposure
pazopanib dose, p. 993.o ▶ Idelalisib is predicted to increase the exposure to pazopanib.
Avoid or adjust pazopanib dose, p. 993.oStudy → Also see
is predicted to increase the exposure to pazopanib.
Theoretical → Also see TABLE 15 p. 1378
▶ Pazopanib is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Macrolides (clarithromycin) are predicted to increase the
pazopanib. Avoid or adjust pazopanib dose, p. 993.
Study → Also see TABLE 9 p. 1377
▶ Macrolides (erythromycin) are predicted to increase the
exposure to pazopanib.oTheoretical → Also see TABLE 9
▶ Mitotane is predicted to decrease the exposure to pazopanib.
Avoid.rTheoretical → Also see TABLE 15 p. 1378
is predicted to increase the exposure to pazopanib.
is predicted to increase the exposure to pazopanib.
Theoretical → Also see TABLE 15 p. 1378 → Also see TABLE 9
▶ Pazopanib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Proton pump inhibitors are predicted to decrease the exposure
oto pazopanib. Avoid or administer concurrently without food.
▶ Rifampicin is predicted to decrease the exposure to pazopanib.
▶ Pazopanib is predicted to affect the exposure to statins
▶ Pazopanib is predicted to affect the exposure to statins
(pravastatin, rosuvastatin, simvastatin).oTheoretical
Pegaspargase → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 15 p. 1378
▶ Pegaspargase is predicted to increase the risk of
hepatotoxicity when given with imatinib.rTheoretical →
▶ Pegaspargase potentially increases the risk of neurotoxicity
when given with vinca alkaloids (vincristine).Vincristine should
be taken 3 to 24 hours before pegaspargase.rAnecdotal →
Also see TABLE 1 p. 1375 → Also see TABLE 15 p. 1378
Peginterferon alfa → see interferons
Peginterferon beta-1a → see TABLE 15 p. 1378 (myelosuppression)
Pembrolizumab → see monoclonal antibodies
Pemetrexed → see TABLE 15 p. 1378 (myelosuppression), TABLE 2 p. 1375
▶ Antimalarials (pyrimethamine) are predicted to increase the risk
of side-effects when given with
Theoretical → Also see TABLE 15 p. 1378
▶ Aspirin (high-dose) potentially increases the exposure to
pemetrexed. Use with caution or avoid.rTheoretical
▶ 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
▶ NSAIDs are predicted to increase the exposure to pemetrexed.
Use with caution or avoid.rTheoretical → Also see TABLE 2
Penicillamine → see TABLE 2 p. 1375 (nephrotoxicity)
▶ Antacids decrease the absorption of penicillamine. Separate
administration by 2 hours.nStudy
▶ Antimalarials (chloroquine) are predicted to increase the risk of
haematological toxicity when given with
▶ Penicillamine potentially decreases the concentration of
digoxin. Separate administration by 2 hours.rAnecdotal
▶ Hydroxychloroquine is predicted to increase the risk of
haematological toxicity when given with
▶ Iron (oral) is predicted to decrease the absorption of
penicillamine. Separate administration by at least 2 hours.
previous adverse reactions to gold). Avoid.rStudy
▶ Zinc is predicted to decrease the absorption of penicillamine.
Penicillins → see TABLE 1 p. 1375 (hepatotoxicity)
penicillins (amoxicillin, ampicillin).oStudy
▶ Antiepileptics (valproate) increase the risk of side-effects when
given with pivmecillinam. Avoid.rAnecdotal
▶ Penicillins potentially alter the anticoagulant effect of
coumarins. Monitor INR and adjust dose.rAnecdotal
▶ Leflunomide is predicted to increase the exposure to
▶ Penicillins are predicted to increase the risk of toxicity when
given with methotrexate.rAnecdotal → Also see TABLE 1
▶ Piperacillin increases the effects of neuromuscular blocking
drugs, non-depolarising.oStudy
▶ Paracetamol potentially increases the risk of high anion gap
metabolic acidosis when given with
Theoretical → Also see TABLE 1 p. 1375
▶ Penicillins are predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
BNF 78 Paritaprevir — Penicillins 1511
increases the effects of suxamethonium.o ▶ Teriflunomide is predicted to increase the exposure to
Pentamidine → see TABLE 9 p. 1377 (QT-interval prolongation), TABLE 15
p. 1378 (myelosuppression), TABLE 2 p. 1375 (nephrotoxicity)
▶ Didanosine is predicted to increase the risk of pancreatitis
when given with pentamidine. Avoid.rStudy
▶ Foscarnet increases the risk of hypocalcaemia when given with
pentamidine.rAnecdotal → Also see TABLE 2 p. 1375
Pentostatin → see TABLE 15 p. 1378 (myelosuppression), TABLE 5 p. 1375
▶ Alkylating agents (cyclophosphamide) (high-dose) increase the
risk of toxicity when given with
Anecdotal → Also see TABLE 15 p. 1378
▶ Fludarabine increases the risk of pulmonary toxicity when
given with pentostatin. Avoid.rStudy → Also see TABLE 15
▶ Pentoxifylline is predicted to increase the concentration of
aminophylline. Use with caution or avoid.rTheoretical
▶ Quinolones (ciprofloxacin) very slightly increase the exposure
▶ SSRIs (fluvoxamine) are predicted to increase the exposure to
▶ Pentoxifylline increases the concentration of theophylline.
Monitor and adjust dose.rStudy
▶ Peppermint oil is predicted to increase the exposure to
. Separate administration by 12 hours.o
Perampanel → see antiepileptics
Pergolide → see dopamine receptor agonists
Pericyazine → see phenothiazines
Perindopril → see ACE inhibitors
Pertuzumab → see monoclonal antibodies
Phenelzine → see monoamine-oxidase A and B inhibitors, irreversible
Phenindione → see TABLE 3 p. 1375 (anticoagulant effects)
FOOD AND LIFESTYLE The effects of phenindione can be
reduced or abolished by vitamin K, including that found in
health foods, food supplements, enteral feeds, or large
amounts of some green vegetables or green tea. Major
changes in diet (especially involving salads and vegetables)
and in alcohol consumption can affect anticoagulant control.
▶ Antiarrhythmics (propafenone) are predicted to increase the
phenindione. Monitor and adjust dose.
▶ Antifungals, azoles (miconazole) greatly increase the
anticoagulant effect of phenindione.rTheoretical
▶ Axitinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Bosutinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Cabozantinib is predicted to increase the risk of bleeding
events when given with phenindione.rTheoretical
▶ Cephalosporins (ceftriaxone) potentially increase the risk of
bleeding events when given with phenindione.rAnecdotal
▶ Corticosteroids are predicted to increase the effects of
▶ Crizotinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Dasatinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Disulfiram is predicted to increase the anticoagulant effect of
▶ Enteral feeds (vitamin-K containing) potentially decrease the
effects of phenindione.rTheoretical
▶ Erlotinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Fibrates are predicted to increase the anticoagulant effect of
phenindione. Monitor INR and adjust dose.rStudy
▶ Gefitinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ H2 receptor antagonists (cimetidine) increase the exposure to
▶ Imatinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Lapatinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Nandrolone is predicted to increase the anticoagulant effect of
phenindione. Monitor and adjust dose.rTheoretical
▶ Nilotinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Oxymetholone increases the anticoagulant effect of
▶ Paracetamol is predicted to increase the anticoagulant effect
▶ Pazopanib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Penicillins are predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Ponatinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Ranibizumab is predicted to increase the risk of bleeding
events when given with phenindione.rTheoretical
▶ Regorafenib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Ruxolitinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Sorafenib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Statins (rosuvastatin) are predicted to increase the
anticoagulant effect of phenindione. Monitor INR and adjust
▶ Sunitinib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
▶ Vandetanib is predicted to increase the risk of bleeding events
when given with phenindione.rTheoretical
Phenobarbital → see antiepileptics
Phenothiazines → see TABLE 8 p. 1376 (hypotension), TABLE 9 p. 1377
(QT-interval prolongation), TABLE 11 p. 1377 (CNS depressant effects),
TABLE 10 p. 1377 (antimuscarinics)
FOOD AND LIFESTYLE Chlorpromazine and fluphenazine
dose adjustment might be necessary if smoking started or
▶ Phenothiazines are predicted to decrease the effects of
amfetamines and amfetamines are predicted to decrease the
effects of phenothiazines.oStudy
(phenobarbital, primidone) and antiepileptics (phenobarbital,
decrease the concentration of chlorpromazine.
Study → Also see TABLE 11 p. 1377
▶ Chlorpromazine is predicted to increase the risk of
▶ Phenothiazines are 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
▶ Phenothiazines are predicted to decrease the antihypertensive
effects of guanethidine.oTheoretical → Also see TABLE 8
▶ Phenothiazines decrease the effects of levodopa. Avoid or
monitor worsening parkinsonian symptoms.rStudy →
▶ Phenothiazines potentially increase the risk of neurotoxicity
when given with lithium.rAnecdotal → Also see TABLE 9
decreases the effects of metyrapone. Avoid.
1512 Penicillins — Phenothiazines BNF 78
▶ Moclobemide increases the risk of side-effects when given
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the risk of neuroleptic malignant
syndrome when given with phenothiazines.rTheoretical →
Phenoxymethylpenicillin → see penicillins
Phenylephrine → see sympathomimetics, vasoconstrictor
Phenytoin → see antiepileptics
▶ Pholcodine is predicted to increase the risk of CNS excitation
or depression when given with monoamine-oxidase A and B
inhibitors, irreversible. Avoid and for 14 days after stopping
Phosphodiesterase type-5 inhibitors → see TABLE 8 p. 1376
(hypotension), TABLE 9 p. 1377 (QT-interval prolongation)
given with phosphodiesterase type-5 inhibitors. Patient should
be stabilised on first drug then second drug should be added
at the lowest recommended dose.rStudy → Also see
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to sildenafil. Monitor or adjust sildenafil dose with
moderate inhibitors of CYP3A4, p. 813.oStudy → Also
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to tadalafil.rTheoretical
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to vardenafil. Adjust dose.rTheoretical → Also
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
phosphodiesterase type-5 inhibitors (avanafil, tadalafil). Avoid.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
phosphodiesterase type-5 inhibitors (sildenafil, vardenafil).
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to avanafil. Adjust
avanafil dose, p. 812.oTheoretical
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are 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
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to vardenafil. Adjust
dose.rTheoretical → Also see TABLE 9 p. 1377
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to sildenafil. Avoid potent
inhibitors of CYP3A4 or adjust
Study → Also see TABLE 9 p. 1377
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to tadalafil. Use with
▶ Antifungals, azoles (miconazole) are predicted to increase the
sildenafil. Use with caution and adjust dose.
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to phosphodiesterase type-5
inhibitors (avanafil, vardenafil). Avoid.rStudy → Also see
▶ Apalutamide is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors (avanafil, sildenafil,
vardenafil). Avoid or monitor.oStudy → Also see TABLE 9
▶ Aprepitant is predicted to increase the exposure to avanafil.
Adjust avanafil dose, p. 812.oTheoretical
▶ Aprepitant 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.
▶ Aprepitant is predicted to increase the exposure to vardenafil.
▶ Bosentan decreases the exposure to phosphodiesterase type-5
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
avanafil. Adjust avanafil dose, p. 812.
Theoretical → Also see TABLE 8 p. 1376
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to sildenafil. Monitor or adjust sildenafil
dose with moderate inhibitors of CYP3A4,
Study → Also see TABLE 8 p. 1376
p. 813.o ▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to tadalafil.rTheoretical → Also see
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
Theoretical → Also see TABLE 8
▶ Cobicistat is predicted to increase the exposure to
phosphodiesterase type-5 inhibitors (avanafil, vardenafil). Avoid.
▶ Cobicistat is predicted to increase the exposure to sildenafil.
Avoid potent inhibitors of CYP3A4 or adjust sildenafil dose,
▶ Cobicistat is predicted to increase the exposure to tadalafil.
Use with caution or avoid.rStudy
▶ Crizotinib is predicted to increase the exposure to avanafil.
Adjust avanafil dose, p. 812.oTheoretical
▶ Crizotinib 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.
▶ Crizotinib is predicted to increase the exposure to vardenafil.
Adjust dose.rTheoretical → Also see TABLE 9 p. 1377
▶ Efavirenz is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors.oTheoretical → Also
▶ Enzalutamide is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors
▶ Enzalutamide is predicted to decrease the exposure to
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