TRIPASS XR تري باس

 

statins (pravastatin). Adjust pravastatin dose.

Study

▶ 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

Interactions | Appendix 1

A1

▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to

increase the exposure to topotecan.oStudy

Paroxetine → see SSRIs

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

Patiromer

SEPARATION OF ADMINISTRATION Manufacturer advises take

3 hours before, or after, other drugs.

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

(QT-interval prolongation)

▶ Antacids are predicted to decrease the absorption of

pazopanib. Pazopanib should be taken 1 hour before or 2 hours

after antacids.oTheoretical

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to pazopanib.oTheoretical → Also see TABLE 9

p. 1377

▶ 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

p. 1377

▶ Aprepitant

o

is predicted to increase the exposure to pazopanib.

Theoretical

▶ 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

▶ Crizotinib

o

is predicted to increase the exposure to pazopanib.

Theoretical → Also see TABLE 15 p. 1378 → Also see TABLE 9

p. 1377

▶ Enzalutamide is predicted to decrease the exposure to

pazopanib. Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

pazopanib. Avoid.rTheoretical

▶ 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

to

Study

pazopanib

→ Also see

. Avoid or adjust

TABLE 9 p. 1377

pazopanib dose, p. 993.o ▶ Idelalisib is predicted to increase the exposure to pazopanib.

Avoid or adjust pazopanib dose, p. 993.oStudy → Also see

TABLE 15 p. 1378

▶ Imatinib

o

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

exposure to

o

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

p. 1377

▶ Mitotane is predicted to decrease the exposure to pazopanib.

Avoid.rTheoretical → Also see TABLE 15 p. 1378

▶ Netupitant

o

is predicted to increase the exposure to pazopanib.

Theoretical

▶ Nilotinib

o

is predicted to increase the exposure to pazopanib.

Theoretical → Also see TABLE 15 p. 1378 → Also see TABLE 9

p. 1377

▶ 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.

Study

▶ Rifampicin is predicted to decrease the exposure to pazopanib.

Avoid.rTheoretical

▶ Pazopanib is predicted to affect the exposure to statins

(atorvastatin).oAnecdotal

▶ Pazopanib is predicted to affect the exposure to statins

(pravastatin, rosuvastatin, simvastatin).oTheoretical

Pegaspargase → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 15 p. 1378

(myelosuppression)

▶ Pegaspargase is predicted to increase the risk of

hepatotoxicity when given with imatinib.rTheoretical →

Also see TABLE 15 p. 1378

▶ Pegaspargase

Anecdotal → Also see

affects the ef

TABLE 1 p. 1375

ficacy of

→ Also see

methotrexate

TABLE 15

.r

p. 1378

▶ 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

(nephrotoxicity)

▶ Antimalarials (pyrimethamine) are predicted to increase the risk

of side-effects when given with

Theoretical → Also see TABLE 15 p. 1378

pemetrexed.r

▶ 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

Green Book).rTheoretical

▶ NSAIDs are predicted to increase the exposure to pemetrexed.

Use with caution or avoid.rTheoretical → Also see TABLE 2

p. 1375

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

r

penicillamine. Avoid.

Theoretical

▶ 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

r

penicillamine. Avoid.

Theoretical

▶ Iron (oral) is predicted to decrease the absorption of

penicillamine. Separate administration by at least 2 hours.

nStudy

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

previous adverse reactions to gold). Avoid.rStudy

▶ Zinc is predicted to decrease the absorption of penicillamine.

nTheoretical

Penicillins → see TABLE 1 p. 1375 (hepatotoxicity)

amoxicillin . ampicillin . benzylpenicillin . flucloxacillin . phenoxymethylpenicillin . piperacillin . pivmecillinam.temocillin . ticarcillin. ▶ Allopurinol increases the risk of skin rash when given with

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

benzylpenicillin.oTheoretical

▶ Penicillins are predicted to increase the risk of toxicity when

given with methotrexate.rAnecdotal → Also see TABLE 1

p. 1375

▶ 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

flucloxacillin.r

▶ Penicillins are predicted to increase the risk of bleeding events

when given with phenindione.rTheoretical

BNF 78 Paritaprevir — Penicillins 1511

Interactions | Appendix 1

A1

Penicillins (continued)

▶ Piperacillin

Study

increases the effects of suxamethonium.o ▶ Teriflunomide is predicted to increase the exposure to

benzylpenicillin.oStudy

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

Pentazocine → see opioids

Pentostatin → see TABLE 15 p. 1378 (myelosuppression), TABLE 5 p. 1375

(thromboembolism)

▶ Alkylating agents (cyclophosphamide) (high-dose) increase the

risk of toxicity when given with

Anecdotal → Also see TABLE 15 p. 1378

pentostatin

→ Also see

. Avoid.

TABLE 5 p. 1375

r

▶ Fludarabine increases the risk of pulmonary toxicity when

given with pentostatin. Avoid.rStudy → Also see TABLE 15

p. 1378

Pentoxifylline

▶ Pentoxifylline is predicted to increase the concentration of

aminophylline. Use with caution or avoid.rTheoretical

▶ Quinolones (ciprofloxacin) very slightly increase the exposure

to pentoxifylline.oStudy

▶ SSRIs (fluvoxamine) are predicted to increase the exposure to

pentoxifylline.oTheoretical

▶ Pentoxifylline increases the concentration of theophylline.

Monitor and adjust dose.rStudy

Peppermint oil

▶ Peppermint oil is predicted to increase the exposure to

lomitapide

Theoretical

. 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

Pethidine → see opioids

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

anticoagulant effect of

o

phenindione. Monitor and adjust dose.

Theoretical

▶ 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

phenindione.oAnecdotal

▶ 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

phenindione.rTheoretical

▶ 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

phenindione.rAnecdotal

▶ 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

phenindione.rAnecdotal

▶ Paracetamol is predicted to increase the anticoagulant effect

of phenindione.rTheoretical

▶ 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

dose.rTheoretical

▶ 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)

chlorpromazine . fluphenazine . levomepromazine . pericyazine . prochlorperazine . promazine .trifluoperazine.

FOOD AND LIFESTYLE Chlorpromazine and fluphenazine

dose adjustment might be necessary if smoking started or

stopped during treatment.

▶ Phenothiazines are predicted to decrease the effects of

amfetamines and amfetamines are predicted to decrease the

effects of phenothiazines.oStudy

▶ Antacids

Anecdotal

decrease the absorption of phenothiazines.o ▶ Chlorpromazine decreases the concentration of antiepileptics

(phenobarbital, primidone) and antiepileptics (phenobarbital,

primidone)

o

decrease the concentration of chlorpromazine.

Study → Also see TABLE 11 p. 1377

▶ Chlorpromazine is predicted to increase the risk of

hyponatraemia when given with

Theoretical

desmopressin.r

▶ 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

p. 1377

▶ Phenothiazines are predicted to decrease the antihypertensive

effects of guanethidine.oTheoretical → Also see TABLE 8

p. 1376

▶ Phenothiazines decrease the effects of levodopa. Avoid or

monitor worsening parkinsonian symptoms.rStudy →

Also see TABLE 8 p. 1376

▶ Phenothiazines potentially increase the risk of neurotoxicity

when given with lithium.rAnecdotal → Also see TABLE 9

p. 1377

▶ Chlorpromazine

o

decreases the effects of metyrapone. Avoid.

Theoretical

1512 Penicillins — Phenothiazines BNF 78

Interactions | Appendix 1

A1

▶ Moclobemide increases the risk of side-effects when given

with levomepromazine.oStudy

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of neuroleptic malignant

syndrome when given with phenothiazines.rTheoretical →

Also see TABLE 8 p. 1376

Phenoxymethylpenicillin → see penicillins

Phenylephrine → see sympathomimetics, vasoconstrictor

Phenytoin → see antiepileptics

Pholcodine

▶ 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

the MAOI.rTheoretical

Phosphodiesterase type-5 inhibitors → see TABLE 8 p. 1376

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

avanafil . sildenafil .tadalafil .vardenafil. ▶ Alpha blockers cause significant hypotensive effects when

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

TABLE 8 p. 1376

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to

Theoretical

avanafil. Adjust avanafil dose, p. 812.o ▶ Antiarrhythmics (dronedarone) 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

▶ 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

see TABLE 9 p. 1377

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to

r

phosphodiesterase type-5 inhibitors (avanafil, tadalafil). Avoid.

Study

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to

o

phosphodiesterase type-5 inhibitors (sildenafil, vardenafil).

Theoretical

▶ 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

Theoretical

tadalafil.r

▶ 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

sildenafil dose, p. 813.r

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

predicted to increase the exposure to tadalafil. Use with

caution or avoid.rStudy

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

exposure to

r

sildenafil. Use with caution and adjust dose.

Theoretical

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

predicted to increase the exposure to phosphodiesterase type-5

inhibitors (avanafil, vardenafil). Avoid.rStudy → Also see

TABLE 9 p. 1377

▶ Apalutamide is predicted to decrease the exposure to

phosphodiesterase type-5 inhibitors (avanafil, sildenafil,

vardenafil). Avoid or monitor.oStudy → Also see TABLE 9

p. 1377

▶ 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

CYP3A4, p. 813.oStudy

▶ Aprepitant

r

is predicted to increase the exposure to tadalafil.

Theoretical

▶ Aprepitant is predicted to increase the exposure to vardenafil.

Adjust dose.rTheoretical

▶ Bosentan decreases the exposure to phosphodiesterase type-5

inhibitors.oStudy

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

increase the exposure to

o

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

TABLE 8 p. 1376

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

increase the exposure to

Theoretical → Also see TABLE 8

vardenafil

p. 1376

. Adjust dose.r

▶ Cobicistat is predicted to increase the exposure to

r

phosphodiesterase type-5 inhibitors (avanafil, vardenafil). Avoid.

Study

▶ Cobicistat is predicted to increase the exposure to sildenafil.

Avoid potent inhibitors of CYP3A4 or adjust sildenafil dose,

p. 813.rStudy

▶ 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

▶ Crizotinib

r

is predicted to increase the exposure to tadalafil.

Theoretical

▶ 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

see TABLE 9 p. 1377

▶ Enzalutamide is predicted to decrease the exposure to

phosphodiesterase type-5 inhibitors

r

(avanafil, tadalafil). Avoid.

Study

▶ Enzalutamide is predicted to decrease the exposure to

phosphodiesterase type-5 inhibitors

o