Theoretical

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

predicted to increase the exposure to olaparib. Avoid potent

inhibitors of CYP3A4 or adjust

Study

olaparib dose, p. 1005.o ▶ Aprepitant is predicted to increase the exposure to olaparib.

Avoid moderate inhibitors of CYP3A4 or adjust olaparib dose,

p. 1005.oTheoretical

▶ Bosentan is predicted to decrease the exposure to olaparib.

Avoid.oTheoretical

▶ 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

BNF 78 NSAIDs — Olaparib 1505

Interactions | Appendix 1

A1

Olaparib (continued)

▶ Cobicistat is predicted to increase the exposure to olaparib.

Avoid potent inhibitors of CYP3A4 or adjust olaparib dose,

p. 1005.oStudy

▶ 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.

Avoid.oTheoretical

▶ Enzalutamide is predicted to decrease the exposure to

olaparib. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

olaparib. Avoid.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to olaparib. Avoid potent inhibitors of CYP3A4 or adjust

olaparib dose, p. 1005.oStudy

▶ 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,

p. 1005.oTheoretical

▶ Nevirapine is predicted to decrease the exposure to olaparib.

Avoid.oTheoretical

▶ 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.

Avoid.oTheoretical

▶ St John’s Wort is predicted to decrease the exposure to

olaparib. Avoid.oTheoretical

Olaratumab → see monoclonal antibodies

Olmesartan → see angiotensin-II receptor antagonists

Olodaterol → see beta2 agonists

Olsalazine → see TABLE 15 p. 1378 (myelosuppression)

Ombitasvir

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin) are predicted to decrease the exposure to

ombitasvir. Avoid.rTheoretical

▶ Efavirenz is predicted to decrease the exposure to ombitasvir.

Avoid.rTheoretical

▶ Enzalutamide is predicted to decrease the exposure to

ombitasvir. Avoid.rTheoretical

▶ Etravirine is predicted to decrease the exposure to ombitasvir.

Avoid.rTheoretical

▶ 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.

Avoid.rTheoretical

▶ Nevirapine is predicted to decrease the exposure to ombitasvir.

Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to ombitasvir.

Avoid.rTheoretical

▶ 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

effects)

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

to ondansetron.oStudy

▶ Dopamine receptor agonists (apomorphine) increase the risk of

severe hypotension when given with

r

ondansetron. Avoid.

Study → Also see TABLE 9 p. 1377

▶ Enzalutamide is predicted to decrease the exposure to

ondansetron.oStudy

▶ Mitotane

o

is predicted to decrease the exposure to ondansetron.

Study

▶ Rifampicin is predicted to decrease the exposure to

ondansetron.oStudy

Opicapone

▶ Opicapone

o

increases the exposure to levodopa. Adjust dose.

Study

▶ Opicapone is predicted to increase the exposure to loperamide.

Avoid.oStudy

▶ Opicapone is predicted to increase the risk of elevated blood

pressure when given with

Theoretical

moclobemide. Avoid.r

▶ 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

montelukast. Avoid.oStudy

▶ Opicapone is predicted to increase the exposure to

pioglitazone. Avoid.oStudy

▶ Opicapone is predicted to increase the exposure to repaglinide.

Avoid.oStudy

▶ Opicapone is predicted to increase the risk of cardiovascular

side-effects when given with

r

sympathomimetics, inotropic.

Theoretical

▶ Opicapone is predicted to increase the risk of cardiovascular

side-effects when given with sympathomimetics, vasoconstrictor

(adrenaline/epinephrine, noradrenaline/norepinephrine)

r .

Theoretical

Opioids → see TABLE 6 p. 1376 (bradycardia), TABLE 13 p. 1378 (serotonin

syndrome), TABLE 9 p. 1377 (QT-interval prolongation), TABLE 11 p. 1377

(CNS depressant effects)

alfentanil . buprenorphine . codeine . diamorphine . dihydrocodeine . diphenoxylate . dipipanone . fentanyl . hydromorphone . meptazinol . methadone . morphine . oxycodone . papaveretum . pentazocine . pethidine .remifentanil . sufentanil .tapentadol . tramadol. ▶ Alcohol (beverage) causes rapid release of opioids

(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

TABLE 6 p. 1376

▶ 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

exposure to

Theoretical →

opioids

Also see

(methadone, sufentanil)

TABLE 9 p. 1377

.o ▶ Antiepileptics (carbamazepine) decrease the concentration of

tramadol. Adjust dose.rStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to

Theoretical

buprenorphine

→ Also see

. Monitor and adjust dose.

TABLE 11 p. 1377

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

see TABLE 11 p. 1377

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to opioids (alfentanil, fentanyl).oStudy → Also see

TABLE 11 p. 1377

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

predicted to increase the exposure to

r

methadone. Adjust dose.

Theoretical → Also see TABLE 9 p. 1377

1506 Olaparib — Opioids BNF 78

Interactions | Appendix 1

A1

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

exposure to

o

alfentanil. Use with caution and adjust dose.

Theoretical

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to opioids (alfentanil,

buprenorphine, fentanyl, oxycodone)

o

. Monitor and adjust dose.

Study

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

predicted to increase the exposure to opioids (alfentanil,

buprenorphine, fentanyl, oxycodone, sufentanil). Monitor and

adjust dose.rStudy

▶ 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

adjust dose.oStudy

▶ Aprepitant is predicted to increase the exposure to opioids

(methadone, sufentanil).oTheoretical

▶ Bictegravir is predicted to increase the exposure to

methadone.oTheoretical

▶ Bosentan decreases the exposure to methadone. Monitor and

adjust dose.rStudy

▶ Brigatinib potentially decreases the concentration of opioids

(alfentanil, fentanyl). Avoid.oTheoretical

▶ Bupropion

o

is predicted to decrease the efficacy of codeine.

Theoretical

▶ Bupropion

r

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,

fentanyl, oxycodone)

Study → Also see TABLE 6

. Monitor and adjust dose.

p. 1376

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

increase the exposure to

o

opioids (methadone, sufentanil).

Theoretical → Also see TABLE 6 p. 1376

▶ Ceritinib is predicted to increase the exposure to opioids

(alfentanil, fentanyl). Avoid.rTheoretical

▶ Cinacalcet

o

is predicted to decrease the efficacy of codeine.

Theoretical

▶ Cinacalcet

r

is predicted to decrease the efficacy of tramadol.

Study

▶ 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

and adjust dose.rStudy

▶ Enzalutamide is predicted to decrease the exposure to opioids

(alfentanil, fentanyl).oStudy

▶ 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

fentanyl.oStudy

▶ HIV-protease inhibitors (boosted with ritonavir) are predicted

to decrease the exposure to methadone.oStudy → Also

see TABLE 9 p. 1377

▶ 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

▶ Idelalisib

r

is predicted to increase the exposure to methadone.

Theoretical

▶ 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

adjust dose.oStudy

▶ 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

TABLE 9 p. 1377

▶ 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

exposure to

Theoretical →

opioids

Also see

(methadone, sufentanil)

TABLE 9 p. 1377

.o ▶ Opioids

o

potentially decrease the absorption of oral mexiletine.

Study

▶ Mitotane is predicted to decrease the exposure to

buprenorphine. Monitor and adjust dose.oTheoretical

▶ Mitotane decreases the exposure to methadone. Monitor and

adjust dose.rStudy

▶ Mitotane is predicted to decrease the exposure to opioids

(alfentanil, fentanyl).oStudy

▶ 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

p. 1378

▶ 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

rasagiline.r

▶ 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

safinamide.r

▶ Monoamine-oxidase B inhibitors (selegiline) increase the risk of

side-effects when given with

Anecdotal → Also see TABLE 13 p. 1378

pethidine. Avoid.r

▶ Nalmefene is predicted to decrease the efficacy of opioids.

Avoid.rTheoretical

▶ Netupitant is predicted to increase the exposure to opioids

(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and

adjust dose.oStudy

▶ Netupitant is predicted to increase the exposure to opioids

(methadone, sufentanil).oTheoretical

▶ Nevirapine decreases the exposure to methadone. Monitor and

adjust dose.rStudy

▶ Nilotinib is predicted to increase the exposure to opioids

(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and

adjust dose.oStudy

▶ Nilotinib is predicted to increase the exposure to opioids

(methadone, sufentanil).oTheoretical → Also see TABLE 9

p. 1377

▶ Opioids (buprenorphine) are predicted to increase the risk of

opiate withdrawal when given with

Theoretical → Also see TABLE 11 p. 1377

opioids (alfentanil).r

▶ 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,

BNF 78 Opioids — Opioids 1507

Interactions | Appendix 1

A1

Opioids (continued)

papaveretum).rTheoretical → Also see TABLE 13 p. 1378 →

Also see TABLE 11 p. 1377

▶ 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

p. 1377

▶ 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

opioids (sufentanil).r

▶ Palbociclib is predicted to increase the exposure to opioids

(alfentanil, fentanyl). Adjust dose.oTheoretical

▶ Pitolisant is predicted to decrease the exposure to morphine.

nTheoretical

▶ Ribociclib is predicted to increase the exposure to opioids

(alfentanil, fentanyl)

o

. Use with caution and adjust dose.

Theoretical

▶ Rifampicin is predicted to decrease the exposure to

buprenorphine. Monitor and adjust dose.oTheoretical

▶ Rifampicin decreases the exposure to methadone. Monitor and

adjust dose.rStudy

▶ Rifampicin is predicted to decrease the exposure to opioids

(alfentanil, fentanyl).oStudy

▶ Rifampicin decreases the exposure to opioids (codeine,

morphine).oStudy

▶ 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

oxycodone. Adjust dose.oStudy

▶ Terbinafine

o

is predicted to decrease the efficacy of codeine.

Theoretical

▶ Terbinafine

r

is predicted to decrease the efficacy of tramadol.

Study

Orlistat

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

narrow therapeutic index.

Orphenadrine → see TABLE 10 p. 1377 (antimuscarinics)

Oseltamivir

▶ Leflunomide is predicted to increase the exposure to

oseltamivir.oTheoretical

▶ Teriflunomide is predicted to increase the exposure to

oseltamivir.oStudy

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

▶ Bosentan

o

is predicted to decrease the exposure to osimertinib.

Theoretical

▶ Efavirenz

o

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

osimertinib. Avoid.oStudy

▶ Nevirapine is predicted to decrease the exposure to

osimertinib.rTheoretical

▶ Rifampicin is predicted to moderately decrease the exposure

to osimertinib. Avoid.oStudy

▶ St John’s Wort is predicted to decrease the exposure to

osimertinib. Avoid.oTheoretical

▶ Osimertinib slightly increases the exposure to statins

(rosuvastatin).oStudy

Ospemifene

▶ 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

▶ Bosentan

o

is predicted to decrease the exposure to ospemifene.

Study

▶ Cobicistat is predicted to increase the exposure to ospemifene.

Avoid in poor CYP2C9 metabolisers.oStudy

▶ Combined hormonal contraceptives potentially oppose the

effects of ospemifene. Avoid.rTheoretical

▶ Efavirenz

o

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