▶ Apalutamide slightly decreases the exposure to statins
▶ Apalutamide is predicted to decrease the exposure to statins
(simvastatin). Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to
temsirolimus. Avoid or monitor.oStudy
▶ Apalutamide potentially decreases the exposure to thyroid
hormones (levothyroxine).nTheoretical
▶ Apalutamide is predicted to decrease the exposure to
ticagrelor. Monitor and adjust dose.oStudy
▶ Apalutamide is predicted to decrease the exposure to
tolvaptan. Avoid or monitor.oStudy
Apixaban → see TABLE 3 p. 1375 (anticoagulant effects)
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to apixaban.oTheoretical
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to moderately decrease
BNF 78 Antimalarials — Apixaban 1409
apixaban. Use with caution or avoid.r
▶ Antifungals, azoles (itraconazole) are predicted to increase the
exposure to apixaban. Avoid.rTheoretical
▶ Antifungals, azoles (ketoconazole) slightly to moderately
increase the exposure to apixaban. Avoid.rStudy
▶ Antifungals, azoles (voriconazole) are predicted to increase the
exposure to apixaban. Avoid.oTheoretical
▶ Calcium channel blockers (verapamil) are predicted to increase
the exposure to apixaban.oTheoretical
▶ Cobicistat is predicted to increase the exposure to apixaban.
▶ Enzalutamide is predicted to moderately decrease the
exposure to apixaban. Use with caution or avoid.rStudy
▶ HIV-protease inhibitors (ritonavir) are predicted to increase the
exposure to apixaban. Avoid.rTheoretical
▶ Macrolides (erythromycin) are predicted to increase the
exposure to apixaban.oTheoretical
▶ Mitotane is predicted to moderately decrease the exposure to
apixaban. Use with caution or avoid.rStudy
▶ Rifampicin is predicted to moderately decrease the exposure
to apixaban. Use with caution or avoid.rStudy
▶ St John’s Wort is predicted to decrease the exposure to
apixaban. Use with caution or avoid.oTheoretical
Apomorphine → see dopamine receptor agonists
Apraclonidine → see TABLE 6 p. 1376 (bradycardia), TABLE 8 p. 1376
(hypotension), TABLE 11 p. 1377 (CNS depressant effects)
▶ Amfetamines are predicted to decrease the effects of
apraclonidine. Avoid.rTheoretical
▶ Methylphenidate is predicted to decrease the effects of
apraclonidine. Avoid.rTheoretical
▶ Sympathomimetics, inotropic are predicted to decrease the
effects of apraclonidine. Avoid.rTheoretical
▶ Sympathomimetics, vasoconstrictor are predicted to decrease
the effects of apraclonidine. Avoid.rTheoretical
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) moderately decrease the exposure to
▶ Enzalutamide moderately decreases the exposure to
▶ Mitotane moderately decreases the exposure to apremilast.
▶ Rifampicin moderately decreases the exposure to apremilast.
▶ St John’s Wort is predicted to decrease the exposure to
apremilast. Avoid.rTheoretical
▶ Aprepitant is predicted to increase the exposure to
▶ Aprepitant is predicted to increase the exposure to aldosterone
(eplerenone). Adjust eplerenone dose, p. 193.r
▶ Aprepitant is predicted to increase the exposure to alkylating
agents (ifosfamide).rTheoretical
▶ Aprepitant is predicted to increase the exposure to alpha
blockers (tamsulosin).oTheoretical
is predicted to increase the exposure to alprazolam.
▶ Aprepitant increases the exposure to antiarrhythmics
▶ Aprepitant is predicted to increase the exposure to
(propafenone). Monitor and adjust dose.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to markedly decrease the
exposure to aprepitant. Avoid.oStudy
▶ Antifungals, azoles (fluconazole) are predicted to increase the
exposure to aprepitant.oTheoretical
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to markedly increase the exposure to
▶ Antifungals, azoles (posaconazole) are predicted to increase the
▶ Aprepitant is predicted to increase the exposure to antifungals,
azoles (isavuconazole).oTheoretical
▶ Aprepitant is predicted to increase the exposure to
antihistamines, non-sedating (mizolastine).rTheoretical
▶ Aprepitant is predicted to increase the exposure to
antihistamines, non-sedating (rupatadine). Avoid.oStudy
▶ Aprepitant is predicted to increase the concentration of
antimalarials (piperaquine).rTheoretical
is predicted to increase the exposure to axitinib.
▶ Aprepitant is predicted to increase the exposure to
bedaquiline. Avoid prolonged use.nTheoretical
▶ Aprepitant is predicted to increase the exposure to beta2
is predicted to decrease the exposure to aprepitant.
▶ Aprepitant is predicted to increase the exposure to bosutinib.
Avoid or adjust dose.rTheoretical
▶ Aprepitant is predicted to increase the exposure to buspirone.
Use with caution and adjust dose.oStudy
▶ Aprepitant is predicted to increase the exposure to
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to aprepitant and aprepitant is predicted
to increase the exposure to calcium channel blockers (diltiazem,
▶ Aprepitant is predicted to increase the exposure to calcium
channel blockers (amlodipine, felodipine, lacidipine,
lercanidipine, nicardipine, nifedipine, nimodipine). Monitor and
▶ Aprepitant is predicted to increase the exposure to cariprazine.
is predicted to increase the exposure to ceritinib.
▶ Aprepitant is predicted to increase the concentration of
▶ Cobicistat is predicted to markedly increase the exposure to
▶ Aprepitant is predicted to increase the exposure to
▶ Aprepitant is predicted to increase the exposure to colchicine.
Adjust colchicine dose with moderate inhibitors of CYP3A4,
▶ Aprepitant is predicted to decrease the efficacy of combined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactions p. 794.rStudy
▶ Aprepitant is predicted to increase the exposure to oral
corticosteroids (budesonide).oStudy
▶ Aprepitant moderately increases the exposure to corticosteroids
(dexamethasone). Monitor and adjust dose.oStudy
▶ Aprepitant is predicted to increase the exposure to
corticosteroids (fluticasone).oStudy
▶ Aprepitant is predicted to increase the exposure to
(methylprednisolone). Monitor and adjust dose.
decreases the anticoagulant effect of coumarins.
▶ Aprepitant is predicted to slightly increase the exposure to
is predicted to increase the exposure to dasatinib.
▶ Aprepitant is predicted to decrease the efficacy of desogestrel.
Contraceptives, interactions p. 794.
▶ Aprepitant increases the risk of QT-prolongation when given
with domperidone. Avoid.rStudy
▶ Aprepitant is predicted to increase the exposure to dopamine
receptor agonists (bromocriptine).rTheoretical
▶ Aprepitant is predicted to increase the concentration of
dopamine receptor agonists (cabergoline).oAnecdotal
▶ Aprepitant is predicted to moderately increase the exposure to
is predicted to decrease the exposure to aprepitant.
1410 Apixaban — Aprepitant BNF 78
is predicted to increase the exposure to eletriptan.
▶ Aprepitant is predicted to increase the exposure to eliglustat.
Avoid or adjust dose—consult product literature.rStudy
▶ Aprepitant is predicted to moderately increase the exposure to
▶ Enzalutamide is predicted to markedly decrease the exposure
▶ Aprepitant is predicted to increase the risk of ergotism when
given with ergometrine.rTheoretical
▶ Aprepitant is predicted to increase the risk of ergotism when
given with ergotamine.rTheoretical
is predicted to increase the exposure to erlotinib.
▶ Aprepitant is predicted to decrease the efficacy of etonogestrel.
Contraceptives, interactions p. 794.
▶ Aprepitant is predicted to increase the concentration of
everolimus. Avoid or adjust dose.oStudy
▶ Aprepitant is predicted to increase the exposure to
fesoterodine. Adjust fesoterodine dose with moderate
inhibitors of CYP3A4 in hepatic and renal impairment, p. 777.
is predicted to increase the exposure to gefitinib.
▶ Aprepitant is predicted to increase the concentration of
guanfacine. Adjust guanfacine dose, p. 352.oTheoretical
▶ HIV-protease inhibitors are predicted to markedly increase the
▶ Aprepitant is predicted to decrease the effects of hormone
replacement therapy.oAnecdotal
▶ Aprepitant is predicted to increase the exposure to ibrutinib.
Adjust ibrutinib dose with moderate inhibitors of CYP3A4,
▶ Idelalisib is predicted to markedly increase the exposure to
is predicted to increase the exposure to imatinib.
▶ Aprepitant is predicted to increase the exposure to
intravenous irinotecan.rTheoretical
▶ Aprepitant is predicted to increase the exposure to ivabradine.
Adjust ivabradine dose, p. 211.rTheoretical
▶ Aprepitant is predicted to increase the exposure to ivacaftor.
Adjust ivacaftor p. 293 or tezacaftor with ivacaftor p. 295 dose
with moderate inhibitors of CYP3A4.rStudy
is predicted to increase the exposure to lapatinib.
▶ Aprepitant is predicted to decrease the efficacy of
levonorgestrel. For FSRH guidance, see Contraceptives,
interactions p. 794.rTheoretical
▶ Aprepitant is predicted to increase the exposure to lomitapide.
▶ Aprepitant is predicted to increase the exposure to lurasidone.
Adjust lurasidone dose, p. 398.oStudy
▶ Macrolides (clarithromycin) are predicted to markedly increase
the exposure to aprepitant.oStudy
▶ Macrolides (erythromycin) are predicted to increase the
is predicted to increase the exposure to maraviroc.
▶ Aprepitant is predicted to increase the exposure to midazolam.
Monitor side effects and adjust dose.rStudy
▶ Aprepitant is predicted to increase the exposure to
▶ Mitotane is predicted to markedly decrease the exposure to
▶ Aprepitant is predicted to increase the exposure to naloxegol.
naloxegol dose and monitor side effects, p. 65.o ▶ Nevirapine
is predicted to decrease the exposure to aprepitant.
is predicted to increase the exposure to nilotinib.
▶ Aprepitant is predicted to decrease the efficacy of
norethisterone. For FSRH guidance, see Contraceptives,
interactions p. 794.rAnecdotal
▶ Aprepitant is predicted to increase the exposure to olaparib.
Avoid moderate inhibitors of CYP3A4 or adjust olaparib dose,
▶ 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
▶ Aprepitant is predicted to increase the exposure to oxybutynin.
is predicted to increase the exposure to pazopanib.
▶ Aprepitant is predicted to increase the exposure to
phosphodiesterase type-5 inhibitors (avanafil). Adjust avanafil
▶ Aprepitant is predicted to increase the exposure to
phosphodiesterase type-5 inhibitors (sildenafil). Monitor or
adjust sildenafil dose with moderate inhibitors of CYP3A4,
▶ Aprepitant is predicted to increase the exposure to
phosphodiesterase type-5 inhibitors (tadalafil).rTheoretical
▶ Aprepitant is predicted to increase the exposure to
phosphodiesterase type-5 inhibitors
▶ Aprepitant is predicted to increase the exposure to pimozide.
▶ Aprepitant is predicted to increase the exposure to quetiapine.
is predicted to increase the exposure to ranolazine.
is predicted to increase the exposure to ribociclib.
▶ Rifampicin is predicted to markedly decrease the exposure to
is predicted to increase the exposure to ruxolitinib.
▶ Aprepitant is predicted to increase the exposure to saxagliptin.
▶ Aprepitant increases the concentration of sirolimus. Monitor
▶ Aprepitant is predicted to increase the exposure to SSRIs
(dapoxetine). Adjust dapoxetine dose with moderate inhibitors
of CYP3A4, p. 821.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
aprepitant. Avoid.oTheoretical
▶ Aprepitant is predicted to increase the exposure to statins
(atorvastatin). Monitor and adjust dose.rStudy
▶ Aprepitant is predicted to increase the exposure to statins
(simvastatin). Use with caution and adjust simvastatin dose,
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