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topotecan.rTheoretical

▶ St John’s Wort decreases the efficacy of ulipristal. For FSRH

guidance, see

Anecdotal

Contraceptives, interactions p. 794.r

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

velpatasvir. Avoid.oTheoretical

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

venetoclax. Avoid.rStudy

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

vismodegib. Avoid.oTheoretical

▶ St John’s Wort is predicted to decrease the concentration of

voxilaprevir. Avoid.rTheoretical

Statins → see TABLE 1 p. 1375 (hepatotoxicity)

atorvastatin . fluvastatin . pravastatin .rosuvastatin . simvastatin. ▶ Atorvastatin slightly to moderately increases the exposure to

aliskiren.oStudy

▶ Antacids moderately decrease the absorption of rosuvastatin.

Separate administration by 2 hours.oStudy

▶ Antiarrhythmics (amiodarone) are predicted to increase the risk

of rhabdomyolysis when given with atorvastatin. Monitor and

adjust dose.oTheoretical

▶ Antiarrhythmics (amiodarone) are predicted to increase the

exposure to fluvastatin.rTheoretical

▶ Antiarrhythmics (amiodarone) increase the risk of

rhabdomyolysis when given with simvastatin. Adjust

simvastatin dose, p. 205.rStudy

BNF 78 St John’s Wort — Statins 1533

Interactions | Appendix 1

A1

Statins (continued)

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to

Study

atorvastatin. Monitor and adjust dose.r

▶ Antiarrhythmics (dronedarone) slightly increase the exposure to

rosuvastatin. Adjust dose.rStudy

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to simvastatin. Use with caution and adjust

simvastatin dose, p. 205.rStudy

▶ Antiepileptics (carbamazepine) moderately decrease the

exposure to

Study → Also see

simvastatin

TABLE 1 p. 1375

. Monitor and adjust dose.r

▶ Antiepileptics (carbamazepine, eslicarbazepine) are predicted to

decrease the exposure to atorvastatin. Monitor and adjust

dose.oTheoretical → Also see TABLE 1 p. 1375

▶ Antiepileptics (eslicarbazepine) moderately decrease the

exposure to

Study

simvastatin. Monitor and adjust dose.o ▶ Antiepileptics (fosphenytoin, phenytoin) potentially decrease

the exposure to

Anecdotal

statins (atorvastatin, simvastatin).o ▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to atorvastatin.

Monitor and adjust dose.rStudy → Also see TABLE 1 p. 1375

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to simvastatin. Use with

caution and adjust simvastatin dose, p. 205.rStudy → Also

see TABLE 1 p. 1375

▶ Antifungals, azoles (fluconazole, miconazole) are predicted to

increase the exposure to fluvastatin.rTheoretical → Also

see TABLE 1 p. 1375

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

predicted to increase the exposure to atorvastatin. Avoid or

adjust dose and monitor rhabdomyolysis.rStudy → Also

see TABLE 1 p. 1375

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

predicted to increase the exposure to

r

simvastatin. Avoid.

Study → Also see TABLE 1 p. 1375

▶ Antifungals, azoles (miconazole) potentially increase the

exposure to atorvastatin.rAnecdotal

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

exposure to simvastatin. Avoid.rTheoretical

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

exposure to

Theoretical

statins (fluvastatin, rosuvastatin).o ▶ Apalutamide slightly decreases the exposure to rosuvastatin.

nStudy

▶ Apalutamide is predicted to decrease the exposure to

simvastatin. Avoid or monitor.oStudy

▶ Aprepitant is predicted to increase the exposure to

atorvastatin. Monitor and adjust dose.rStudy

▶ Aprepitant is predicted to increase the exposure to

simvastatin. Use with caution and adjust simvastatin dose,

p. 205.rStudy

▶ Bosentan slightly decreases the exposure to atorvastatin.n

Study

▶ Bosentan

o

moderately decreases the exposure to simvastatin.

Study

▶ Calcium channel blockers (amlodipine) slightly increase the

exposure to simvastatin. Adjust simvastatin dose, p. 205.n

Study

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

increase the exposure to atorvastatin. Monitor and adjust

dose.rStudy

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

increase the exposure to simvastatin. Use with caution and

adjust simvastatin dose, p. 205.rStudy

▶ Cephalosporins (ceftobiprole) are predicted to increase the

concentration of statins.oTheoretical

▶ Ciclosporin very markedly increases the exposure to

atorvastatin

Study

. Avoid or adjust atorvastatin dose, p. 202.r

▶ Ciclosporin

r

moderately increases the exposure to fluvastatin.

Study

▶ Ciclosporin markedly to very markedly increases the exposure

to pravastatin. Adjust dose.rStudy

▶ Ciclosporin markedly increases the exposure to statins

(rosuvastatin, simvastatin). Avoid.rStudy

▶ Clopidogrel increases the exposure to rosuvastatin. Adjust

rosuvastatin dose, p. 204.oStudy

▶ Cobicistat is predicted to increase the exposure to atorvastatin.

Avoid or adjust dose and monitor rhabdomyolysis.

Study

r

▶ Cobicistat is predicted to increase the exposure to simvastatin.

Avoid.rStudy

▶ Colchicine increases the risk of rhabdomyolysis when given

with statins.rAnecdotal

▶ Statins (fluvastatin, rosuvastatin) increase the anticoagulant

effect of coumarins. Monitor INR and adjust dose.rStudy

▶ Crizotinib is predicted to increase the exposure to atorvastatin.

Monitor and adjust dose.rStudy

▶ Crizotinib is predicted to increase the exposure to simvastatin.

Use with caution and adjust

Study

simvastatin dose, p. 205.r

▶ Danazol is predicted to increase the risk of rhabdomyolysis

when given with atorvastatin.rTheoretical

▶ Danazol increases the risk of rhabdomyolysis when given with

simvastatin. Avoid.rAnecdotal

▶ Statins are predicted to increase the risk of rhabdomyolysis

when given with daptomycin.rTheoretical

▶ Dasabuvir increases the exposure to rosuvastatin. Adjust

rosuvastatin dose, p. 204.oStudy

▶ Dasatinib

o

is predicted to increase the exposure to simvastatin.

Theoretical

▶ Efavirenz slightly decreases the exposure to atorvastatin.n

Study

▶ Efavirenz

o

moderately decreases the exposure to simvastatin.

Study

▶ Elbasvir increases the exposure to atorvastatin. Adjust

atorvastatin dose, p. 202.oStudy

▶ Elbasvir is predicted to increase the exposure to fluvastatin.

Adjust fluvastatin dose, p. 203.qTheoretical

▶ Elbasvir increases the exposure to rosuvastatin. Adjust

rosuvastatin dose, p. 204.oStudy

▶ Elbasvir is predicted to increase the exposure to simvastatin.

Adjust simvastatin dose, p. 205.qTheoretical

▶ Eltrombopag is predicted to increase the exposure to statins.

Monitor and adjust dose.oStudy

▶ Enzalutamide is predicted to decrease the exposure to

simvastatin.rStudy

▶ Ezetimibe potentially increases the risk of rhabdomyolysis

when given with statins.rAnecdotal

▶ Fibrates (bezafibrate, ciprofibrate) increase the risk of

rhabdomyolysis when given with

Study

pravastatin. Avoid.r

▶ Fibrates (bezafibrate, ciprofibrate) increase the risk of

rhabdomyolysis when given with rosuvastatin. Adjust

rosuvastatin dose, p. 204.rStudy

▶ Fibrates (bezafibrate, ciprofibrate) increase the risk of

rhabdomyolysis when given with simvastatin. Adjust

simvastatin dose, p. 205.rStudy

▶ Fibrates (ciprofibrate) increase the risk of rhabdomyolysis

when given with

Study

atorvastatin. Avoid or adjust dose.r

▶ Fibrates (ciprofibrate) increase the risk of rhabdomyolysis

when given with fluvastatin.rStudy

▶ Fibrates (fenofibrate) are predicted to increase the risk of

rhabdomyolysis when given with fluvastatin. Adjust

fenofibrate dose, p. 199.rTheoretical

▶ Fibrates (fenofibrate) are predicted to increase the risk of

rhabdomyolysis when given with

Theoretical

pravastatin. Avoid.r

▶ Fibrates (fenofibrate) increase the risk of rhabdomyolysis when

given with rosuvastatin. Adjust fenofibrate and rosuvastatin

doses, p. 199, p. 204.rAnecdotal

▶ Fibrates (gemfibrozil) increase the risk of rhabdomyolysis when

given with statins. Avoid.rAnecdotal

▶ Fibrates (bezafibrate) increase the risk of rhabdomyolysis when

given with statins (atorvastatin, fluvastatin).rStudy

1534 Statins — Statins BNF 78

Interactions | Appendix 1

A1

▶ Fibrates (fenofibrate) increase the risk of rhabdomyolysis when

given with statins (atorvastatin, simvastatin). Adjust

fenofibrate dose, p. 199.rAnecdotal

▶ Fusidic acid increases the risk of rhabdomyolysis when given

with statins. Avoid.rAnecdotal

▶ Glecaprevir (with pibrentasvir) markedly increases the

exposure to atorvastatin. Avoid.rStudy

▶ Glecaprevir (with pibrentasvir) is predicted to increase the

exposure to fluvastatin.oTheoretical

▶ Glecaprevir (with pibrentasvir) increases the exposure to

pravastatin. Use with caution and adjust pravastatin dose,

p. 203.oStudy

▶ Glecaprevir (with pibrentasvir) increases the exposure to

rosuvastatin. Use with caution and adjust rosuvastatin dose,

p. 204.oStudy

▶ Glecaprevir (with pibrentasvir) increases the exposure to

simvastatin. Avoid.oStudy

▶ Grapefruit juice increases the exposure to atorvastatin.n

Study

▶ Grapefruit juice

r

increases the exposure to simvastatin. Avoid.

Study

▶ Grazoprevir increases the exposure to atorvastatin. Adjust

atorvastatin dose, p. 202.oStudy

▶ Grazoprevir is predicted to increase the exposure to

fluvastatin. Adjust fluvastatin dose, p. 203.qTheoretical

▶ Grazoprevir increases the exposure to rosuvastatin. Adjust

rosuvastatin dose, p. 204.oStudy

▶ Grazoprevir is predicted to increase the exposure to

simvastatin. Adjust simvastatin dose, p. 205.qTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to atorvastatin. Avoid or adjust dose and monitor

rhabdomyolysis.rStudy

▶ HIV-protease inhibitors slightly to moderately increase the

exposure to rosuvastatin. Avoid or adjust dose.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to simvastatin. Avoid.rStudy

▶ Idelalisib is predicted to increase the exposure to atorvastatin.

Avoid or adjust dose and monitor rhabdomyolysis.

Study

r

▶ Idelalisib is predicted to increase the exposure to simvastatin.

Avoid.rStudy

▶ Imatinib is predicted to increase the exposure to atorvastatin.

Monitor and adjust dose.rStudy

▶ Imatinib is predicted to increase the exposure to simvastatin.

Use with caution and adjust

Study

simvastatin dose, p. 205.r

▶ Ledipasvir is predicted to increase the exposure to

rosuvastatin. Avoid.rTheoretical

▶ Ledipasvir is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, pravastatin, simvastatin). Monitor

and adjust dose.oTheoretical

▶ Leflunomide is predicted to increase the exposure to

rosuvastatin. Adjust dose.oStudy → Also see TABLE 1

p. 1375

▶ Leflunomide is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, pravastatin, simvastatin)

Study → Also see TABLE 1 p. 1375

.o ▶ Letermovir moderately increases the exposure to atorvastatin.

Avoid or adjust atorvastatin dose, p. 202.rStudy

▶ Letermovir is predicted to increase the exposure to fluvastatin.

Monitor and adjust dose.oTheoretical

▶ Letermovir is predicted to increase the exposure to

pravastatin. Avoid or adjust dose.oTheoretical

▶ Letermovir is predicted to increase the exposure to statins

(rosuvastatin, simvastatin). Avoid.rStudy

▶ Lomitapide increases the exposure to atorvastatin. Adjust

lomitapide dose or separate administration by 12 hours, p. 207.

nStudy → Also see TABLE 1 p. 1375

▶ Lomitapide increases the exposure to simvastatin. Monitor and

adjust simvastatin dose, p. 205.oStudy → Also see TABLE 1

p. 1375

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to atorvastatin. Avoid or adjust dose and monitor

rhabdomyolysis.rStudy

▶ Macrolides (clarithromycin) moderately increase the exposure

to pravastatin.rStudy

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to simvastatin. Avoid.rStudy

▶ Macrolides (erythromycin) are predicted to increase the

exposure to

Study

atorvastatin. Monitor and adjust dose.r

▶ Macrolides (erythromycin) are predicted to increase the

exposure to pravastatin.rStudy

▶ Macrolides (erythromycin) are predicted to increase the

exposure to simvastatin. Use with caution and adjust

simvastatin dose, p. 205.rStudy

▶ Mitotane

r

is predicted to decrease the exposure to simvastatin.

Study

▶ Monoclonal antibodies (sarilumab) are predicted to decrease the

exposure to statins (atorvastatin, simvastatin).oStudy

▶ Monoclonal antibodies (tocilizumab) are predicted to decrease

the exposure to statins (atorvastatin, simvastatin). Monitor and

adjust dose.oStudy

▶ Netupitant is predicted to increase the exposure to

atorvastatin. Monitor and adjust dose.rStudy

▶ Netupitant is predicted to increase the exposure to

simvastatin. Use with caution and adjust simvastatin dose,

p. 205.rStudy

▶ Nevirapine slightly decreases the exposure to atorvastatin.

nStudy

▶ Nevirapine

o

moderately decreases the exposure to simvastatin.

Study

▶ Nicotinic acid is predicted to increase the risk of

rhabdomyolysis when given with statins.rTheoretical

▶ Nilotinib is predicted to increase the exposure to atorvastatin.

Monitor and adjust dose.rStudy

▶ Nilotinib is predicted to increase the exposure to simvastatin.

Use with caution and adjust

Study

simvastatin dose, p. 205.r

▶ Osimertinib

o

slightly increases the exposure to rosuvastatin.

Study

▶ Paritaprevir (in fixed-dose combination) is predicted to

increase the risk of rhabdomyolysis when given with

atorvastatin. Avoid.rTheoretical

▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to

increase the exposure to

Theoretical

fluvastatin. Avoid.o ▶ Paritaprevir (with ritonavir and ombitasvir) increases the

exposure to

o

pravastatin. Adjust pravastatin dose, p. 203.

Study

▶ Paritaprevir (with ritonavir and ombitasvir) slightly to

moderately increases the exposure to rosuvastatin. Adjust

rosuvastatin dose, p. 204.oStudy

▶ Paritaprevir (in fixed-dose combination) is predicted to

increase the risk of rhabdomyolysis when given with

simvastatin. Avoid.rTheoretical

▶ Pazopanib

o

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