Aldosterone antagonists (continued)
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to markedly increase the exposure to eplerenone.
▶ Apalutamide is predicted to decrease the exposure to
eplerenone. Avoid or monitor.oStudy
▶ Aprepitant is predicted to increase the exposure to eplerenone.
Adjust eplerenone dose, p. 193.rStudy
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to eplerenone. Adjust eplerenone dose,
p. 193.rStudy → Also see TABLE 8 p. 1376
▶ Cobicistat is predicted to markedly increase the exposure to
▶ Crizotinib is predicted to increase the exposure to eplerenone.
Adjust eplerenone dose, p. 193.rStudy
▶ Eplerenone very slightly increases the exposure to digoxin.
▶ Spironolactone increases the concentration of digoxin.
Monitor and adjust dose.oStudy
▶ Enzalutamide is predicted to decrease the exposure to
eplerenone. Avoid.oTheoretical
▶ HIV-protease inhibitors are predicted to markedly increase the
exposure to eplerenone. Avoid.rStudy
▶ Idelalisib is predicted to markedly increase the exposure to
▶ Imatinib is predicted to increase the exposure to eplerenone.
Adjust eplerenone dose, p. 193.rStudy
▶ Eplerenone potentially increases the concentration of lithium.
▶ Spironolactone potentially increases the concentration of
▶ Macrolides (clarithromycin) are predicted to markedly increase
the exposure to eplerenone. Avoid.rStudy
▶ Macrolides (erythromycin) are predicted to increase the
exposure to eplerenone. Adjust eplerenone dose, p. 193.r
▶ Mitotane is predicted to decrease the exposure to eplerenone.
▶ Spironolactone is predicted to decrease the effects of mitotane.
▶ Netupitant is predicted to increase the exposure to eplerenone.
Adjust eplerenone dose, p. 193.rStudy
▶ Nilotinib is predicted to increase the exposure to eplerenone.
Adjust eplerenone dose, p. 193.rStudy
▶ Rifampicin is predicted to decrease the exposure to
eplerenone. Avoid.oTheoretical
▶ St John’s Wort is predicted to slightly decrease the exposure to
Alectinib → see TABLE 6 p. 1376 (bradycardia), TABLE 1 p. 1375
Alemtuzumab → see monoclonal antibodies
Alendronic acid → see bisphosphonates
Alfacalcidol → see vitamin D substances
Alfuzosin → see alpha blockers
Alimemazine → see antihistamines, sedating
Aliskiren → see TABLE 8 p. 1376 (hypotension), TABLE 16 p. 1379
FOOD AND LIFESTYLE Avoid apple juice and orange juice as
they greatly decrease aliskiren concentrations and plasma
▶ ACE inhibitors increase the risk of renal impairment when
given with aliskiren. Use with caution or avoid aliskiren in
selected patients, p. 179.rStudy → Also see TABLE 8 p. 1376 →
▶ Angiotensin-II receptor antagonists increase the risk of renal
impairment when given with aliskiren. Use with caution or
avoid aliskiren in selected patients, p. 179.rStudy → Also
see TABLE 8 p. 1376 → Also see TABLE 16 p. 1379
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
increase the exposure to aliskiren.rStudy
▶ Antiepileptics (carbamazepine) decrease the exposure to
▶ Antifungals, azoles (itraconazole) markedly increase the
exposure to aliskiren. Avoid.rStudy
▶ Antifungals, azoles (ketoconazole) moderately increase the
▶ Calcium channel blockers (verapamil) moderately increase the
exposure to aliskiren.oStudy → Also see TABLE 8 p. 1376
is predicted to increase the exposure to aliskiren.
▶ Ciclosporin markedly increases the exposure to aliskiren.
Avoid.rStudy → Also see TABLE 16 p. 1379
▶ Eliglustat is predicted to increase the exposure to aliskiren.
▶ Grapefruit juice moderately decreases the exposure to
▶ HIV-protease inhibitors (ritonavir, saquinavir) are predicted to
increase the exposure to aliskiren.oTheoretical
is predicted to increase the exposure to aliskiren.
▶ Aliskiren slightly decreases the exposure to loop diuretics
(furosemide).oStudy → Also see TABLE 8 p. 1376
▶ Macrolides (azithromycin) are predicted to increase the
exposure to aliskiren.oTheoretical
▶ Macrolides (clarithromycin, erythromycin) are predicted to
increase the exposure to aliskiren.oStudy
▶ Mirabegron is predicted to increase the exposure to aliskiren.
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
increase the exposure to aliskiren.oStudy
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
▶ Pitolisant is predicted to decrease the exposure to aliskiren.
is predicted to increase the exposure to aliskiren.
▶ Rifampicin decreases the exposure to aliskiren.oStudy
is predicted to increase the exposure to aliskiren.
▶ Vemurafenib is predicted to increase the exposure to aliskiren.
Use with caution and adjust dose.oTheoretical
Alkylating agents → see TABLE 15 p. 1378 (myelosuppression), TABLE 2
p. 1375 (nephrotoxicity), TABLE 5 p. 1375 (thromboembolism)
▶ Antifungals, azoles (isavuconazole) are predicted to increase the
exposure to cyclophosphamide.oStudy
▶ Antifungals, azoles (itraconazole) increase the risk of busulfan
busulfan. Monitor and adjust dose.
▶ Antifungals, azoles (miconazole) are predicted to increase the
busulfan. Use with caution and adjust dose.
is predicted to increase the exposure to ifosfamide.
calcium salts decrease the absorption of estramustine.
▶ Fosaprepitant is predicted to increase the exposure to
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
alkylating agents. Public Health England advises avoid (refer
▶ Metronidazole increases the risk of toxicity when given with
▶ Netupitant very slightly increases the exposure to
is predicted to increase the exposure to ifosfamide.
is predicted to decrease the clearance of busulfan.
1382 Aldosterone antagonists — Alkylating agents BNF 78
▶ Cyclophosphamide (high-dose) increases the risk of toxicity
when given with pentostatin. Avoid.rAnecdotal → Also see
TABLE 15 p. 1378 → Also see TABLE 5 p. 1375
▶ Rolapitant is predicted to increase the exposure to
bendamustine. Avoid or monitor.oStudy
▶ Cyclophosphamide increases the risk of prolonged
neuromuscular blockade when given with
▶ ACE inhibitors are predicted to increase the risk of
hypersensitivity and haematological reactions when given
▶ Allopurinol potentially increases the risk of haematological
toxicity when given with azathioprine. Adjust azathioprine
▶ Allopurinol is predicted to decrease the effects of capecitabine.
▶ Allopurinol moderately increases the exposure to didanosine.
▶ Allopurinol potentially increases the risk of haematological
toxicity when given with mercaptopurine. Adjust
mercaptopurine dose, p. 912.rStudy
▶ Allopurinol increases the risk of skin rash when given with
penicillins (amoxicillin, ampicillin).oStudy
▶ Allopurinol is predicted to increase the risk of hyperuricaemia
when given with pyrazinamide.oTheoretical
▶ Thiazide diuretics are predicted to increase the risk of
hypersensitivity reactions when given with
Almotriptan → see TABLE 13 p. 1378 (serotonin syndrome)
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole)
increase the exposure to almotriptan.nStudy
▶ Cobicistat increases the exposure to almotriptan.nStudy
▶ Almotriptan is predicted to increase the risk of
vasoconstriction when given with ergotamine. Ergotamine
should be taken at least 24 hours before or 6 hours after
▶ HIV-protease inhibitors increase the exposure to almotriptan.
▶ Idelalisib increases the exposure to almotriptan.nStudy
▶ Macrolides (clarithromycin) increase the exposure to
Alogliptin → see TABLE 14 p. 1378 (antidiabetic drugs)
Alpha blockers → see TABLE 7 p. 1376 (first-dose hypotension), TABLE 8
exposure to tamsulosin.oTheoretical
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to
tamsulosin.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to
doxazosin.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to moderately increase the exposure to alpha
(alfuzosin, tamsulosin). Use with caution or avoid.
is predicted to increase the exposure to tamsulosin.
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to tamsulosin.oTheoretical → Also
▶ Cobicistat is predicted to moderately increase the exposure to
alpha blockers (alfuzosin, tamsulosin). Use with caution or
is predicted to increase the exposure to doxazosin.
is predicted to increase the exposure to tamsulosin.
▶ HIV-protease inhibitors are predicted to moderately increase
the exposure to alpha blockers (alfuzosin, tamsulosin). Use with
▶ HIV-protease inhibitors are predicted to increase the exposure
▶ Idelalisib is predicted to moderately increase the exposure to
alpha blockers (alfuzosin, tamsulosin). Use with caution or
is predicted to increase the exposure to doxazosin.
is predicted to increase the exposure to tamsulosin.
▶ Macrolides (clarithromycin) are predicted to increase the
▶ Macrolides (erythromycin) are predicted to increase the
exposure to tamsulosin.oTheoretical
▶ Macrolides (clarithromycin) are predicted to moderately
increase the exposure to alpha blockers (alfuzosin, tamsulosin).
Use with caution or avoid.oStudy
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the effects of
Theoretical → Also see TABLE 8 p. 1376
is predicted to increase the exposure to tamsulosin.
is predicted to increase the exposure to tamsulosin.
▶ 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
▶ Ribociclib (high-dose) is predicted to increase the exposure to
Alpha tocopherol → see vitamin E substances
Alpha tocopheryl acetate → see vitamin E substances
Alprazolam → see TABLE 11 p. 1377 (CNS depressant effects)
▶ Antiarrhythmics (dronedarone) are predicted to increase the
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to alprazolam. Adjust dose.oTheoretical → Also see
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole)
moderately increase the exposure to
▶ Antifungals, azoles (miconazole) are predicted to increase the
alprazolam. Use with caution and adjust dose.
is predicted to increase the exposure to alprazolam.
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to alprazolam.rStudy
▶ Cobicistat moderately increases the exposure to alprazolam.
is predicted to increase the exposure to alprazolam.
▶ Enzalutamide is predicted to decrease the exposure to
alprazolam. Adjust dose.oTheoretical
▶ Fosaprepitant is predicted to increase the exposure to
▶ HIV-protease inhibitors moderately increase the exposure to
▶ Idelalisib moderately increases the exposure to alprazolam.
is predicted to increase the exposure to alprazolam.
▶ Alprazolam is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Macrolides (clarithromycin) moderately increase the exposure
▶ Macrolides (erythromycin) are predicted to increase the
▶ Mitotane is predicted to decrease the exposure to alprazolam.
▶ Monoclonal antibodies (tocilizumab) are predicted to decrease
alprazolam. Monitor and adjust dose.
BNF 78 Alkylating agents — Alprazolam 1383
is predicted to increase the exposure to alprazolam.
is predicted to increase the exposure to alprazolam.
▶ Rifampicin is predicted to decrease the exposure to
alprazolam. Adjust dose.oTheoretical
▶ SSRIs (fluvoxamine) moderately increase the exposure to
alprazolam. Adjust dose.oStudy
▶ St John’s Wort moderately decreases the exposure to
Alprostadil → see TABLE 8 p. 1376 (hypotension)
Alteplase → see TABLE 3 p. 1375 (anticoagulant effects)
Aluminium hydroxide → see antacids
Amantadine → see dopamine receptor agonists
▶ Ciclosporin moderately increases the exposure to ambrisentan.
Adjust ambrisentan dose, p. 184.oStudy
transiently increases the exposure to ambrisentan.
Amfetamines → see TABLE 13 p. 1378 (serotonin syndrome)
dexamfetamine . lisdexamfetamine. ▶ Amfetamines are predicted to decrease the effects of
apraclonidine. Avoid.rTheoretical
▶ Amfetamines are predicted to increase the risk of side-effects
when given with atomoxetine.rTheoretical
decreases the effects of guanethidine.r
▶ HIV-protease inhibitors (ritonavir, tipranavir) are predicted to
increase the exposure to amfetamines.rTheoretical
▶ Moclobemide is predicted to increase the risk of a hypertensive
Theoretical → Also see TABLE 13
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the risk of a hypertensive crisis when
given with amfetamines. Avoid and for 14 days after stopping
the MAOI.rAnecdotal → Also see TABLE 13 p. 1378
▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are
predicted to increase the risk of severe hypertension when
given with amfetamines. Avoid.rTheoretical → Also see
▶ Monoamine-oxidase B inhibitors (safinamide) are predicted to
increase the risk of severe hypertension when given with
amfetamines.rTheoretical → Also see TABLE 13 p. 1378
▶ Nabilone is predicted to increase the risk of cardiovascular
side-effects when given with amfetamines.rTheoretical
▶ Phenothiazines are predicted to decrease the effects of
amfetamines and amfetamines are predicted to decrease the
effects of phenothiazines.oStudy
▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the
exposure to amfetamines.rTheoretical → Also see TABLE 13
Amifampridine → see TABLE 9 p. 1377 (QT-interval prolongation)
Amikacin → see aminoglycosides
Amiloride → see potassium-sparing diuretics
Aminoglycosides → see TABLE 2 p. 1375 (nephrotoxicity), TABLE 19
p. 1379 (ototoxicity), TABLE 20 p. 1379 (neuromuscular blocking effects)
amikacin . gentamicin . streptomycin .tobramycin.
▶ Since systemic absorption can follow topical application,
the possibility of interactions with topical gentamicin
▶ Since systemic absorption can follow topical application,
the possibility of interactions with topical tobramycin
▶ Aminoglycosides are predicted to decrease the effects of
agalsidase. Avoid.oTheoretical
▶ Antifungals, azoles (miconazole) potentially decrease the
exposure to tobramycin.oAnecdotal
▶ Ataluren is predicted to increase the risk of nephrotoxicity
▶ Aminoglycosides increase the risk of hypocalcaemia when
given with bisphosphonates.oAnecdotal → Also see
▶ Aminoglycosides potentially increase the concentration of
digoxin. Monitor and adjust dose.nStudy
▶ Loop diuretics increase the risk of nephrotoxicity when given
with aminoglycosides. Avoid.oStudy → Also see TABLE 19
▶ Aminoglycosides are predicted to decrease the effects of
▶ Aminoglycosides are predicted to decrease the effects of
Aminophylline → see TABLE 17 p. 1379 (reduced serum potassium)
FOOD AND LIFESTYLE Smoking can increase aminophylline
clearance and increased doses of aminophylline are therefore
required; dose adjustments are likely to be necessary if
smoking started or stopped during treatment.
▶ Aciclovir increases the exposure to aminophylline. Monitor and
▶ Aminophylline is predicted to decrease the efficacy of
antiarrhythmics (adenosine). Separate administration by
▶ Antiepileptics (fosphenytoin) are predicted to decrease the
exposure to aminophylline. Adjust dose.oStudy
▶ Antiepileptics (phenobarbital) are predicted to decrease the
exposure to aminophylline. Adjust dose.oTheoretical
▶ Antiepileptics (phenytoin) decrease the exposure to
aminophylline. Adjust dose.oStudy
▶ Antiepileptics (primidone) are predicted to increase the
clearance of aminophylline. Adjust dose.oTheoretical
▶ Antiepileptics (stiripentol) are predicted to increase the
exposure to aminophylline. Avoid.oTheoretical
▶ Beta blockers, non-selective are predicted to increase the risk
of bronchospasm when given with
▶ Beta blockers, selective are predicted to increase the risk of
▶ Combined hormonal contraceptives are predicted to increase
aminophylline. Adjust dose.o ▶ Aminophylline increases the risk of agitation when given with
▶ Esketamine is predicted to increase the risk of seizures when
given with aminophylline. Avoid.rTheoretical
▶ H2 receptor antagonists (cimetidine) increase the concentration
of aminophylline. Adjust dose.rStudy
▶ HIV-protease inhibitors (ritonavir) decrease the exposure to
aminophylline. Adjust dose.oStudy
▶ Interferons are predicted to slightly increase the exposure to
aminophylline. Adjust dose.oTheoretical
▶ Iron chelators (deferasirox) are predicted to increase the
exposure to aminophylline. Avoid.oTheoretical
is predicted to affect the clearance of aminophylline.
▶ Leflunomide decreases the exposure to aminophylline. Adjust
▶ Aminophylline is predicted to decrease the concentration of
▶ Macrolides (azithromycin) are predicted to increase the
exposure to aminophylline.oTheoretical
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to aminophylline. Adjust dose.oTheoretical
▶ Aminophylline is predicted to decrease the exposure to
macrolides (erythromycin). Adjust dose.rStudy
▶ Methotrexate is predicted to decrease the clearance of
▶ Mexiletine is predicted to increase the exposure to
aminophylline. Adjust dose.oTheoretical
▶ Monoclonal antibodies (blinatumomab) are predicted to
transiently increase the exposure to aminophylline. Monitor
▶ Monoclonal antibodies (sarilumab) potentially affect the
aminophylline. Monitor and adjust dose.o
1384 Alprazolam — Aminophylline BNF 78
▶ Monoclonal antibodies (tocilizumab) are predicted to decrease
aminophylline. Monitor and adjust dose.
▶ Pentoxifylline is predicted to increase the concentration of
aminophylline. Use with caution or avoid.rTheoretical
▶ Quinolones (ciprofloxacin) are predicted to increase the
exposure to aminophylline. Adjust dose.oTheoretical
▶ Rifampicin decreases the exposure to aminophylline. Adjust
▶ Aminophylline is predicted to slightly increase the exposure to
roflumilast. Avoid.oTheoretical
▶ Rucaparib is predicted to increase the exposure to
aminophylline. Monitor and adjust dose.oStudy
▶ SSRIs (fluvoxamine) moderately to markedly increase the
exposure to aminophylline. Avoid.rStudy
▶ St John’s Wort is predicted to decrease the concentration of
▶ Sympathomimetics, vasoconstrictor (ephedrine) increase the risk
of side-effects when given with aminophylline. Avoid in
▶ Teriflunomide decreases the exposure to aminophylline. Adjust
▶ Valaciclovir is predicted to increase the exposure to
▶ Aminosalicylic acid is predicted to increase the risk of
methaemoglobinaemia when given with topical anaesthetics,
local (prilocaine). Use with caution or avoid.rTheoretical
▶ Aminosalicylic acid is predicted to increase the risk of
methaemoglobinaemia when given with
Amiodarone → see antiarrhythmics
Amisulpride → see TABLE 9 p. 1377 (QT-interval prolongation), TABLE 11
p. 1377 (CNS depressant effects)
▶ Amisulpride is predicted to decrease the effects of dopamine
No comments:
Post a Comment
اكتب تعليق حول الموضوع