theophylline. Monitor and adjust dose.
▶ Obeticholic acid is predicted to increase the exposure to
▶ Pentoxifylline increases the concentration of theophylline.
Monitor and adjust dose.rStudy
▶ Quinolones (ciprofloxacin) are predicted to increase the
theophylline. Monitor and adjust dose.o ▶ Rifampicin is predicted to decrease the exposure to
theophylline. Adjust dose.oStudy
▶ Theophylline is predicted to slightly increase the exposure to
roflumilast. Avoid.oTheoretical
▶ Rucaparib is predicted to increase the exposure to
theophylline. Monitor and adjust dose.oStudy
▶ SSRIs (fluvoxamine) moderately to markedly increase the
exposure to theophylline. Avoid.rStudy
▶ St John’s Wort potentially decreases the exposure to
▶ Sucralfate potentially decreases the absorption of
. Separate administration by at least 2 hours.
▶ Sympathomimetics, vasoconstrictor (ephedrine) increase the risk
of side-effects when given with theophylline. Avoid in
▶ Teriflunomide is predicted to decrease the exposure to
theophylline. Adjust dose.oStudy
▶ Valaciclovir is predicted to increase the exposure to
Thiazide diuretics → see TABLE 18 p. 1379 (hyponatraemia), TABLE 8
p. 1376 (hypotension), TABLE 17 p. 1379 (reduced serum potassium)
hypersensitivity reactions when given with
▶ Aspirin (high-dose) increases the risk of acute renal failure
when given with thiazide diuretics.rTheoretical
▶ Thiazide diuretics increase the risk of hypercalcaemia when
given with calcium salts.rAnecdotal
▶ Thiazide diuretics increase the concentration of lithium. Avoid
or adjust dose and monitor concentration.rStudy
▶ NSAIDs increase the risk of acute renal failure when given with
thiazide diuretics.rTheoretical → Also see TABLE 18 p. 1379
▶ Reboxetine is predicted to increase the risk of hypokalaemia
when given with thiazide diuretics.oAnecdotal
▶ Thiazide diuretics are predicted to increase the risk of
hypercalcaemia when given with toremifene.rTheoretical
▶ Thiazide diuretics increase the risk of hypercalcaemia when
given with vitamin D substances.oTheoretical
Thiopental → see TABLE 8 p. 1376 (hypotension), TABLE 11 p. 1377 (CNS
▶ Sulfonamides are predicted to increase the effects of
▶ Tricyclic antidepressants increase the risk of cardiac
arrhythmias and hypotension when given with
Study → Also see TABLE 8 p. 1376
Thiotepa → see alkylating agents
levothyroxine . liothyronine. ▶ Antacids are predicted to decrease the absorption of
. Separate administration by at least 4 hours.
▶ Antiarrhythmics (amiodarone) are predicted to increase the risk
of thyroid dysfunction when given with thyroid hormones.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenytoin) are
predicted to increase the risk of hypothyroidism when given
▶ Antiepileptics (phenobarbital, primidone) are predicted to
decrease the effects of thyroid hormones.oTheoretical
▶ Apalutamide potentially decreases the exposure to
▶ Oral calcium salts are predicted to decrease the absorption of
. Separate administration by at least 4 hours.
▶ Thyroid hormones are predicted to affect the concentration of
digoxin. Monitor and adjust dose.oTheoretical
▶ HIV-protease inhibitors (ritonavir) decrease the concentration of
levothyroxine. MHRA advises monitor TSH for at least one
month after starting or stopping ritonavir.oAnecdotal
▶ Oral hormone replacement therapy is predicted to decrease the
effects of thyroid hormones.oTheoretical
▶ Iron (oral) decreases the absorption of levothyroxine. Separate
administration by at least 4 hours.oStudy
▶ Lanthanum decreases the absorption of thyroid hormones.
Separate administration by 2 hours.oStudy
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to levothyroxine. Monitor and adjust
▶ Sucralfate decreases the absorption of levothyroxine. Separate
administration by at least 4 hours.oStudy
Tiagabine → see antiepileptics
Tibolone → see TABLE 5 p. 1375 (thromboembolism)
Ticagrelor → see TABLE 4 p. 1375 (antiplatelet effects)
▶ Antiarrhythmics (amiodarone) are predicted to increase the
exposure to ticagrelor. Use with caution or avoid.rStudy
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to markedly decrease the
exposure to ticagrelor. Avoid.rStudy
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to markedly increase the exposure to ticagrelor.
▶ Apalutamide is predicted to decrease the exposure to
ticagrelor. Monitor and adjust dose.oStudy
is predicted to decrease the exposure to ticagrelor.
▶ Ciclosporin is predicted to increase the exposure to ticagrelor.
Use with caution or avoid.rStudy
▶ Cobicistat is predicted to markedly increase the exposure to
increases the concentration of digoxin.o ▶ Efavirenz
is predicted to decrease the exposure to ticagrelor.
▶ Enzalutamide is predicted to markedly decrease the exposure
▶ Ticagrelor is predicted to increase the exposure to ergotamine.
▶ Grapefruit juice moderately increases the exposure to
1544 Theophylline —Ticagrelor BNF 78
▶ HIV-protease inhibitors are predicted to markedly increase the
exposure to ticagrelor. Avoid.rStudy
▶ Idelalisib is predicted to markedly increase the exposure to
▶ Ticagrelor is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Macrolides (azithromycin) are predicted to increase the
exposure to ticagrelor. Use with caution or avoid.rStudy
▶ Macrolides (clarithromycin) are predicted to markedly increase
the exposure to ticagrelor. Avoid.rStudy
▶ Mitotane is predicted to markedly decrease the exposure to
is predicted to decrease the exposure to ticagrelor.
▶ Ranolazine is predicted to increase the exposure to ticagrelor.
Use with caution or avoid.rStudy
▶ Rifampicin is predicted to markedly decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
▶ Ticagrelor slightly increases the exposure to statins
(simvastatin). Adjust simvastatin dose, p. 205.oStudy
▶ Vemurafenib is predicted to increase the exposure to
ticagrelor. Use with caution or avoid.rStudy
Tigecycline → see tetracyclines
Tildrakizumab → see monoclonal antibodies
Timolol → see beta blockers, non-selective
▶ Alcohol (beverage) potentially causes a disulfiram-like
reaction when given with tinidazole. Avoid for 72 hours
stopping treatment.oTheoretical
▶ Tinidazole is predicted to increase the anticoagulant effect of
coumarins. Monitor INR and adjust dose.rTheoretical
Tinzaparin → see low molecular-weight heparins
Tioguanine → see TABLE 15 p. 1378 (myelosuppression)
▶ 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
Tiotropium → see TABLE 10 p. 1377 (antimuscarinics)
Tipranavir → see HIV-protease inhibitors
Tirofiban → see TABLE 4 p. 1375 (antiplatelet effects)
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
▶ Enzalutamide is predicted to decrease the exposure to
is predicted to decrease the exposure to tivozanib.
is predicted to decrease the exposure to tivozanib.
▶ St John’s Wort is predicted to decrease the exposure to
▶ Tivozanib is predicted to decrease the exposure to statins
Tizanidine → see TABLE 6 p. 1376 (bradycardia), TABLE 8 p. 1376
(hypotension), TABLE 9 p. 1377 (QT-interval prolongation), TABLE 11
p. 1377 (CNS depressant effects)
▶ Antiepileptics (fosphenytoin, phenytoin) moderately decrease
the exposure to tizanidine.nStudy
▶ Combined hormonal contraceptives increase the exposure to
▶ HIV-protease inhibitors (ritonavir) moderately decrease the
▶ Iron chelators (deferasirox) are predicted to increase the
exposure to tizanidine. Avoid.oTheoretical
▶ Leflunomide moderately decreases the exposure to tizanidine.
increases the exposure to tizanidine. Avoid.
▶ Obeticholic acid is predicted to increase the exposure to
▶ Quinolones (ciprofloxacin) increase the exposure to tizanidine.
▶ Rifampicin moderately decreases the exposure to tizanidine.
▶ Rucaparib is predicted to increase the exposure to tizanidine.
Monitor and adjust dose.oStudy
▶ SSRIs (fluvoxamine) very markedly increase the exposure to
▶ Teriflunomide moderately decreases the exposure to
Tobramycin → see aminoglycosides
Tocilizumab → see monoclonal antibodies
▶ Antiarrhythmics (dronedarone) given with a potent CYP2C19
inhibitor are predicted to increase the exposure to tofacitinib.
Adjust tofacitinib dose, p. 1105.oStudy
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
given with a potent CYP2C19 inhibitor are predicted to
increase the exposure to tofacitinib. Adjust tofacitinib dose,
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to tofacitinib. Adjust
tofacitinib dose, p. 1105.oStudy
▶ Aprepitant given with a potent CYP2C19 inhibitor is predicted
to increase the exposure to tofacitinib. Adjust tofacitinib dose,
is predicted to decrease the exposure to tofacitinib.
▶ Calcium channel blockers (diltiazem, verapamil) given with a
potent CYP2C19 inhibitor are predicted to increase the
tofacitinib. Adjust tofacitinib dose, p. 1105.
increases the exposure to tofacitinib. Avoid.r
▶ Cobicistat is predicted to increase the exposure to tofacitinib.
Adjust tofacitinib dose, p. 1105.oStudy
▶ Crizotinib given with a potent CYP2C19 inhibitor is predicted
to increase the exposure to tofacitinib. Adjust tofacitinib dose,
is predicted to decrease the exposure to tofacitinib.
▶ Enzalutamide is predicted to decrease the exposure to
▶ HIV-protease inhibitors are predicted to increase the exposure
to tofacitinib. Adjust tofacitinib dose, p. 1105.oStudy
▶ Idelalisib is predicted to increase the exposure to tofacitinib.
Adjust tofacitinib dose, p. 1105.oStudy
▶ Imatinib given with a potent CYP2C19 inhibitor is predicted to
increase the exposure to tofacitinib. Adjust tofacitinib dose,
▶ Live vaccines potentially increase the risk of generalised
infection (possibly life-threatening) when given with
tofacitinib. Avoid.rTheoretical
▶ Macrolides (clarithromycin) are predicted to increase the
tofacitinib. Adjust tofacitinib dose, p. 1105.
▶ Macrolides (erythromycin) given with a potent CYP2C19
inhibitor are predicted to increase the exposure to tofacitinib.
Adjust tofacitinib dose, p. 1105.oStudy
▶ Mitotane is predicted to decrease the exposure to tofacitinib.
▶ Netupitant given with a potent CYP2C19 inhibitor is predicted
to increase the exposure to tofacitinib. Adjust tofacitinib dose,
is predicted to decrease the exposure to tofacitinib.
▶ Nilotinib given with a potent CYP2C19 inhibitor is predicted to
increase the exposure to tofacitinib. Adjust tofacitinib dose,
▶ Rifampicin is predicted to decrease the exposure to tofacitinib.
BNF 78 Ticagrelor —Tofacitinib 1545
▶ SSRIs (fluoxetine, fluvoxamine) given with a moderate CYP3A4
inhibitor are predicted to increase the exposure to tofacitinib.
Adjust tofacitinib dose, p. 1105.oStudy
▶ St John’s Wort is predicted to decrease the exposure to
increases the exposure to tofacitinib. Avoid.r
Tolbutamide → see sulfonylureas
▶ Tolcapone increases the exposure to levodopa. Monitor and
▶ Tolcapone is predicted to increase the risk of cardiovascular
side-effects when given with sympathomimetics, inotropic.
▶ Tolcapone is predicted to increase the effects of
sympathomimetics, vasoconstrictor (adrenaline/epinephrine,
noradrenaline/norepinephrine).oTheoretical
Tolterodine → see TABLE 9 p. 1377 (QT-interval prolongation), TABLE 10
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to tolterodine.nTheoretical → Also see TABLE 9
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to tolterodine.n 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
▶ Aprepitant is predicted to increase the exposure to tolterodine.
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to tolterodine.nTheoretical
▶ Cobicistat is predicted to increase the exposure to tolterodine.
▶ Crizotinib is predicted to increase the exposure to tolterodine.
nTheoretical → Also see TABLE 9 p. 1377
▶ Eliglustat is predicted to increase the exposure to tolterodine.
▶ HIV-protease inhibitors are predicted to increase the exposure
to tolterodine. Avoid.rStudy → Also see TABLE 9 p. 1377
▶ Idelalisib is predicted to increase the exposure to tolterodine.
▶ Imatinib is predicted to increase the exposure to tolterodine.
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to tolterodine. Avoid.rStudy → Also see TABLE 9
▶ Macrolides (erythromycin) are predicted to increase the
exposure to tolterodine.nTheoretical → Also see TABLE 9
▶ Netupitant is predicted to increase the exposure to tolterodine.
▶ Nilotinib is predicted to increase the exposure to tolterodine.
nTheoretical → Also see TABLE 9 p. 1377
Tolvaptan → see TABLE 16 p. 1379 (increased serum potassium)
GENERAL INFORMATION Avoid concurrent use of drugs that
increase serum-sodium concentrations.
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to tolvaptan. Manufacturer advises caution or adjust
dose with moderate inhibitors of CYP3A4, p. 669.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to tolvaptan. Use with caution or avoid depending on
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to tolvaptan.
Manufacturer advises caution or adjust tolvaptan dose with
moderate inhibitors of CYP3A4, p. 669.oStudy
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to tolvaptan. Manufacturer
advises caution or adjust tolvaptan dose with potent inhibitors
▶ Apalutamide is predicted to decrease the exposure to
tolvaptan. Avoid or monitor.oStudy
▶ Aprepitant is predicted to increase the exposure to tolvaptan.
Manufacturer advises caution or adjust tolvaptan dose with
moderate inhibitors of CYP3A4, p. 669.oStudy
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to tolvaptan. Manufacturer advises
caution or adjust tolvaptan dose with moderate inhibitors of
▶ Cobicistat is predicted to increase the exposure to tolvaptan.
Manufacturer advises caution or adjust tolvaptan dose with
potent inhibitors of CYP3A4, p. 669.rStudy
▶ Crizotinib is predicted to increase the exposure to tolvaptan.
Manufacturer advises caution or adjust tolvaptan dose with
moderate inhibitors of CYP3A4, p. 669.oStudy
▶ Tolvaptan increases the concentration of digoxin.nStudy
▶ Enzalutamide is predicted to decrease the exposure to
. Use with caution or avoid depending on indication.
increases the exposure to tolvaptan. Avoid.
▶ HIV-protease inhibitors are predicted to increase the exposure
to tolvaptan. Manufacturer advises caution or adjust tolvaptan
dose with potent inhibitors of CYP3A4, p. 669.rStudy
▶ Idelalisib is predicted to increase the exposure to tolvaptan.
Manufacturer advises caution or adjust tolvaptan dose with
potent inhibitors of CYP3A4, p. 669.rStudy
▶ Imatinib is predicted to increase the exposure to tolvaptan.
Manufacturer advises caution or adjust tolvaptan dose with
moderate inhibitors of CYP3A4, p. 669.oStudy
▶ Tolvaptan is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to tolvaptan. Manufacturer advises caution or adjust
dose with potent inhibitors of CYP3A4, p. 669.r
▶ Macrolides (erythromycin) are predicted to increase the
exposure to tolvaptan. Manufacturer advises caution or adjust
dose with moderate inhibitors of CYP3A4, p. 669.
▶ Mitotane is predicted to decrease the exposure to tolvaptan.
Use with caution or avoid depending on indication.
▶ Netupitant is predicted to increase the exposure to tolvaptan.
Manufacturer advises caution or adjust tolvaptan dose with
moderate inhibitors of CYP3A4, p. 669.oStudy
▶ Nilotinib is predicted to increase the exposure to tolvaptan.
Manufacturer advises caution or adjust tolvaptan dose with
moderate inhibitors of CYP3A4, p. 669.oStudy
▶ Quinolones (ciprofloxacin) are predicted to increase the
exposure to tolvaptan. Use with caution and adjust tolvaptan
▶ Rifampicin is predicted to decrease the exposure to tolvaptan.
Use with caution or avoid depending on indication.
▶ St John’s Wort is predicted to decrease the exposure to
Topiramate → see antiepileptics
Topotecan → see TABLE 15 p. 1378 (myelosuppression)
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
increase the exposure to topotecan.rStudy
▶ Antiepileptics (fosphenytoin, phenytoin) increase the clearance
▶ Antifungals, azoles (isavuconazole) are predicted to increase the
exposure to topotecan.oTheoretical
▶ Antifungals, azoles (itraconazole, ketoconazole) are predicted to
increase the exposure to topotecan.rStudy
▶ Calcium channel blockers (verapamil) are predicted to increase
the exposure to topotecan.rStudy
is predicted to increase the exposure to topotecan.
Theoretical → Also see TABLE 15 p. 1378
is predicted to increase the exposure to topotecan.
1546 Tofacitinib —Topotecan BNF 78
▶ Eliglustat is predicted to increase the exposure to topotecan.
▶ HIV-protease inhibitors (lopinavir, ritonavir, saquinavir) are
predicted to increase the exposure to topotecan.rStudy
is predicted to increase the exposure to topotecan.
▶ Leflunomide is predicted to increase the exposure to
topotecan.oStudy → Also see TABLE 15 p. 1378
▶ 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
▶ Macrolides are predicted to increase the exposure to
▶ Mirabegron is predicted to increase the exposure to topotecan.
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to topotecan.oStudy
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
▶ Pitolisant is predicted to decrease the exposure to topotecan.
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