▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to olaparib. Avoid potent
inhibitors of CYP3A4 or adjust
olaparib dose, p. 1005.o ▶ Aprepitant is predicted to increase the exposure to olaparib.
Avoid moderate inhibitors of CYP3A4 or adjust olaparib dose,
▶ Bosentan is predicted to decrease the exposure to olaparib.
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to olaparib. Avoid moderate inhibitors
of CYP3A4 or adjust olaparib dose, p. 1005.oTheoretical
▶ Cobicistat is predicted to increase the exposure to olaparib.
Avoid potent inhibitors of CYP3A4 or adjust olaparib dose,
▶ Crizotinib is predicted to increase the exposure to olaparib.
Avoid moderate inhibitors of CYP3A4 or adjust olaparib dose,
p. 1005.oTheoretical → Also see TABLE 15 p. 1378
▶ Efavirenz is predicted to decrease the exposure to olaparib.
▶ Enzalutamide is predicted to decrease the exposure to
▶ Grapefruit juice is predicted to increase the exposure to
▶ HIV-protease inhibitors are predicted to increase the exposure
to olaparib. Avoid potent inhibitors of CYP3A4 or adjust
▶ Idelalisib is predicted to increase the exposure to olaparib.
Avoid potent inhibitors of CYP3A4 or adjust olaparib dose,
p. 1005.oStudy → Also see TABLE 15 p. 1378
▶ Imatinib is predicted to increase the exposure to olaparib.
Avoid moderate inhibitors of CYP3A4 or adjust olaparib dose,
p. 1005.oTheoretical → Also see TABLE 15 p. 1378
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to olaparib. Avoid potent inhibitors of CYP3A4 or
adjust olaparib dose, p. 1005.oStudy
▶ Macrolides (erythromycin) are predicted to increase the
exposure to olaparib. Avoid moderate inhibitors of CYP3A4 or
adjust olaparib dose, p. 1005.oTheoretical
▶ Mitotane is predicted to decrease the exposure to olaparib.
Avoid.oTheoretical → Also see TABLE 15 p. 1378
▶ Netupitant is predicted to increase the exposure to olaparib.
Avoid moderate inhibitors of CYP3A4 or adjust olaparib dose,
▶ Nevirapine is predicted to decrease the exposure to olaparib.
▶ Nilotinib is predicted to increase the exposure to olaparib.
Avoid moderate inhibitors of CYP3A4 or adjust olaparib dose,
p. 1005.oTheoretical → Also see TABLE 15 p. 1378
▶ Rifampicin is predicted to decrease the exposure to olaparib.
▶ St John’s Wort is predicted to decrease the exposure to
Olaratumab → see monoclonal antibodies
Olmesartan → see angiotensin-II receptor antagonists
Olodaterol → see beta2 agonists
Olsalazine → see TABLE 15 p. 1378 (myelosuppression)
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin) are predicted to decrease the exposure to
ombitasvir. Avoid.rTheoretical
▶ Efavirenz is predicted to decrease the exposure to ombitasvir.
▶ Enzalutamide is predicted to decrease the exposure to
ombitasvir. Avoid.rTheoretical
▶ Etravirine is predicted to decrease the exposure to ombitasvir.
▶ Ombitasvir (in fixed-dose combination with dasabuvir)
decreases the concentration of HIV-protease inhibitors
(darunavir). Avoid or adjust dose.oStudy
▶ Mitotane is predicted to decrease the exposure to ombitasvir.
▶ Nevirapine is predicted to decrease the exposure to ombitasvir.
▶ Rifampicin is predicted to decrease the exposure to ombitasvir.
▶ St John’s Wort is predicted to decrease the exposure to
ombitasvir. Avoid.rTheoretical
Omega-3-acid ethyl esters → see TABLE 3 p. 1375 (anticoagulant
Omeprazole → see proton pump inhibitors
Ondansetron → see TABLE 13 p. 1378 (serotonin syndrome), TABLE 9
p. 1377 (QT-interval prolongation)
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
▶ Dopamine receptor agonists (apomorphine) increase the risk of
severe hypotension when given with
Study → Also see TABLE 9 p. 1377
▶ Enzalutamide is predicted to decrease the exposure to
is predicted to decrease the exposure to ondansetron.
▶ Rifampicin is predicted to decrease the exposure to
increases the exposure to levodopa. Adjust dose.
▶ Opicapone is predicted to increase the exposure to loperamide.
▶ Opicapone is predicted to increase the risk of elevated blood
▶ Opicapone is predicted to increase the risk of elevated blood
pressure when given with monoamine-oxidase A and B
inhibitors, irreversible. Avoid.rTheoretical
▶ Opicapone is predicted to increase the exposure to
▶ Opicapone is predicted to increase the exposure to
▶ Opicapone is predicted to increase the exposure to repaglinide.
▶ Opicapone is predicted to increase the risk of cardiovascular
▶ Opicapone is predicted to increase the risk of cardiovascular
side-effects when given with sympathomimetics, vasoconstrictor
(adrenaline/epinephrine, noradrenaline/norepinephrine)
Opioids → see TABLE 6 p. 1376 (bradycardia), TABLE 13 p. 1378 (serotonin
syndrome), TABLE 9 p. 1377 (QT-interval prolongation), TABLE 11 p. 1377
(hydromorphone, morphine) (from extended-release
preparations). Avoid.rStudy → Also see TABLE 11 p. 1377
▶ Antiarrhythmics (amiodarone) are predicted to increase the
concentration of fentanyl.oTheoretical → Also see
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to opioids (alfentanil, buprenorphine, fentanyl,
oxycodone). Monitor and adjust dose.oStudy
▶ Antiarrhythmics (dronedarone) are predicted to increase the
.o ▶ Antiepileptics (carbamazepine) decrease the concentration of
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
o ▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) decrease the exposure to methadone.
Monitor and adjust dose.rStudy → Also see TABLE 11 p. 1377
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to oxycodone. Monitor and adjust dose.oStudy → Also
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to opioids (alfentanil, fentanyl).oStudy → Also see
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to
Theoretical → Also see TABLE 9 p. 1377
1506 Olaparib — Opioids BNF 78
▶ Antifungals, azoles (miconazole) are predicted to increase the
alfentanil. Use with caution and adjust dose.
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to opioids (alfentanil,
buprenorphine, fentanyl, oxycodone)
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to opioids (alfentanil,
buprenorphine, fentanyl, oxycodone, sufentanil). Monitor and
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to opioids (methadone,
sufentanil).oTheoretical → Also see TABLE 9 p. 1377
▶ Apalutamide is predicted to decrease the exposure to
alfentanil. Avoid or monitor.oStudy
▶ Aprepitant is predicted to increase the exposure to opioids
(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and
▶ Aprepitant is predicted to increase the exposure to opioids
(methadone, sufentanil).oTheoretical
▶ Bictegravir is predicted to increase the exposure to
▶ Bosentan decreases the exposure to methadone. Monitor and
▶ Brigatinib potentially decreases the concentration of opioids
(alfentanil, fentanyl). Avoid.oTheoretical
is predicted to decrease the efficacy of codeine.
is predicted to decrease the efficacy of tramadol.
Study → Also see TABLE 13 p. 1378
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to opioids (alfentanil, buprenorphine,
o ▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
opioids (methadone, sufentanil).
Theoretical → Also see TABLE 6 p. 1376
▶ Ceritinib is predicted to increase the exposure to opioids
(alfentanil, fentanyl). Avoid.rTheoretical
is predicted to decrease the efficacy of codeine.
is predicted to decrease the efficacy of tramadol.
▶ Cobicistat is predicted to increase the exposure to opioids
(alfentanil, buprenorphine, fentanyl, oxycodone, sufentanil).
Monitor and adjust dose.rStudy
▶ Crizotinib is predicted to increase the exposure to opioids
(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and
adjust dose.oStudy → Also see TABLE 6 p. 1376
▶ Crizotinib is predicted to increase the exposure to opioids
(methadone, sufentanil).oTheoretical → Also see TABLE 6
p. 1376 → Also see TABLE 9 p. 1377
▶ Efavirenz decreases the exposure to methadone. Monitor and
adjust dose.rStudy → Also see TABLE 9 p. 1377
▶ Enzalutamide is predicted to decrease the exposure to
buprenorphine. Monitor and adjust dose.oTheoretical
▶ Enzalutamide decreases the exposure to methadone. Monitor
▶ Enzalutamide is predicted to decrease the exposure to opioids
▶ Enzalutamide is predicted to decrease the exposure to
oxycodone. Monitor and adjust dose.oStudy
▶ H2 receptor antagonists (cimetidine) increase the concentration
of alfentanil. Use with caution and adjust dose.rStudy
▶ H2 receptor antagonists (cimetidine) increase the exposure to
▶ HIV-protease inhibitors (boosted with ritonavir) are predicted
to decrease the exposure to methadone.oStudy → Also
▶ HIV-protease inhibitors (ritonavir) are predicted to decrease the
concentration of morphine.oTheoretical
▶ HIV-protease inhibitors (ritonavir) increase the risk of CNS
toxicity when given with pethidine. Avoid.rStudy
▶ HIV-protease inhibitors are predicted to increase the exposure
to opioids (alfentanil, buprenorphine, fentanyl, oxycodone,
sufentanil). Monitor and adjust dose.rStudy
is predicted to increase the exposure to methadone.
▶ Idelalisib is predicted to increase the exposure to opioids
(alfentanil, buprenorphine, fentanyl, oxycodone, sufentanil).
Monitor and adjust dose.rStudy
▶ Imatinib is predicted to increase the exposure to opioids
(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and
▶ Imatinib is predicted to increase the exposure to opioids
(methadone, sufentanil).oTheoretical
▶ Letermovir is predicted to increase the exposure to opioids
(alfentanil, fentanyl). Monitor and adjust dose.oStudy
▶ Macrolides (clarithromycin) are predicted to increase the
concentration of methadone.rTheoretical → Also see
▶ Macrolides (erythromycin) are predicted to increase the
exposure to opioids (alfentanil, buprenorphine, fentanyl,
oxycodone). Monitor and adjust dose.oStudy
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to opioids (alfentanil, buprenorphine, fentanyl,
oxycodone, sufentanil). Monitor and adjust dose.rStudy
▶ Macrolides (erythromycin) are predicted to increase the
potentially decrease the absorption of oral mexiletine.
▶ Mitotane is predicted to decrease the exposure to
buprenorphine. Monitor and adjust dose.oTheoretical
▶ Mitotane decreases the exposure to methadone. Monitor and
▶ Mitotane is predicted to decrease the exposure to opioids
▶ Mitotane is predicted to decrease the exposure to oxycodone.
Monitor and adjust dose.oStudy
▶ Opioids are predicted to increase the risk of CNS excitation or
depression when given with monoamine-oxidase A and B
inhibitors, irreversible. Avoid.rStudy → Also see TABLE 13
▶ Monoamine-oxidase B inhibitors (rasagiline) are predicted to
increase the risk of side-effects when given with pethidine.
Avoid and for 14 days after stopping
Theoretical → Also see TABLE 13 p. 1378
▶ Monoamine-oxidase B inhibitors (safinamide) are predicted to
increase the risk of side-effects when given with pethidine.
Avoid and for 1 week after stopping
Theoretical → Also see TABLE 13 p. 1378
▶ Monoamine-oxidase B inhibitors (selegiline) increase the risk of
Anecdotal → Also see TABLE 13 p. 1378
▶ Nalmefene is predicted to decrease the efficacy of opioids.
▶ Netupitant is predicted to increase the exposure to opioids
(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and
▶ Netupitant is predicted to increase the exposure to opioids
(methadone, sufentanil).oTheoretical
▶ Nevirapine decreases the exposure to methadone. Monitor and
▶ Nilotinib is predicted to increase the exposure to opioids
(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and
▶ Nilotinib is predicted to increase the exposure to opioids
(methadone, sufentanil).oTheoretical → Also see TABLE 9
▶ Opioids (buprenorphine) are predicted to increase the risk of
opiate withdrawal when given with
Theoretical → Also see TABLE 11 p. 1377
▶ Opioids (pentazocine) are predicted to increase the risk of
opiate withdrawal when given with opioids (alfentanil, codeine,
diamorphine, dihydrocodeine, dipipanone, fentanyl,
hydromorphone, meptazinol, methadone, morphine, oxycodone,
papaveretum).rTheoretical → Also see TABLE 13 p. 1378 →
▶ Opioids (buprenorphine) are predicted to increase the risk of
opiate withdrawal when given with opioids (codeine,
diamorphine, dihydrocodeine, dipipanone, fentanyl,
hydromorphone, meptazinol, methadone, morphine, oxycodone,
papaveretum, pentazocine, pethidine, remifentanil, sufentanil,
tapentadol, tramadol).rTheoretical → Also see TABLE 11
▶ Opioids (pentazocine) are predicted to increase the risk of
opiate withdrawal when given with opioids (pethidine,
remifentanil, tapentadol, tramadol).rTheoretical → Also see
TABLE 13 p. 1378 → Also see TABLE 11 p. 1377
▶ Opioids (pentazocine) are predicted to increase the risk of
opiate withdrawal when given with
Anecdotal → Also see TABLE 11 p. 1377
▶ Palbociclib is predicted to increase the exposure to opioids
(alfentanil, fentanyl). Adjust dose.oTheoretical
▶ Pitolisant is predicted to decrease the exposure to morphine.
▶ Ribociclib is predicted to increase the exposure to opioids
. Use with caution and adjust dose.
▶ Rifampicin is predicted to decrease the exposure to
buprenorphine. Monitor and adjust dose.oTheoretical
▶ Rifampicin decreases the exposure to methadone. Monitor and
▶ Rifampicin is predicted to decrease the exposure to opioids
▶ Rifampicin decreases the exposure to opioids (codeine,
▶ Rifampicin is predicted to decrease the exposure to oxycodone.
Monitor and adjust dose.oStudy
▶ Rucaparib is predicted to increase the exposure to opioids
(alfentanil, fentanyl). Monitor and adjust dose.oStudy
▶ SSRIs (fluoxetine, paroxetine) are predicted to decrease the
efficacy of codeine.oTheoretical
▶ SSRIs (fluoxetine, paroxetine) are predicted to decrease the
efficacy of tramadol.rStudy → Also see TABLE 13 p. 1378
▶ St John’s Wort decreases the exposure to methadone. Monitor
and adjust dose.rStudy → Also see TABLE 13 p. 1378
▶ St John’s Wort moderately decreases the exposure to
is predicted to decrease the efficacy of codeine.
is predicted to decrease the efficacy of tramadol.
SEPARATION OF ADMINISTRATION Orlistat might affect the
absorption of concurrently administered drugs—consider
separating administration. Particular care should be taken
with antiepileptics, antiretrovirals, and drugs that have a
Orphenadrine → see TABLE 10 p. 1377 (antimuscarinics)
▶ Leflunomide is predicted to increase the exposure to
▶ Teriflunomide is predicted to increase the exposure to
Osimertinib → see TABLE 9 p. 1377 (QT-interval prolongation)
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to moderately decrease
the exposure to osimertinib. Avoid.oStudy
is predicted to decrease the exposure to osimertinib.
is predicted to decrease the exposure to osimertinib.
Theoretical → Also see TABLE 9 p. 1377
▶ Enzalutamide is predicted to moderately decrease the
exposure to osimertinib. Avoid.oStudy
▶ Mitotane is predicted to moderately decrease the exposure to
▶ Nevirapine is predicted to decrease the exposure to
▶ Rifampicin is predicted to moderately decrease the exposure
▶ St John’s Wort is predicted to decrease the exposure to
osimertinib. Avoid.oTheoretical
▶ Osimertinib slightly increases the exposure to statins
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to moderately decrease
the exposure to ospemifene.oStudy
▶ Antifungals, azoles (fluconazole) increase the exposure to
ospemifene. Use with caution or avoid.oStudy
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to ospemifene. Avoid in
poor CYP2C9 metabolisers.oStudy
is predicted to decrease the exposure to ospemifene.
▶ Cobicistat is predicted to increase the exposure to ospemifene.
Avoid in poor CYP2C9 metabolisers.oStudy
▶ Combined hormonal contraceptives potentially oppose the
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