cilostazol. Use with caution and adjust dose.
▶ Cobicistat is predicted to moderately increase the exposure to
cilostazol. Adjust cilostazol dose, p. 232.oStudy
is predicted to alter the effects of cilostazol.
▶ HIV-protease inhibitors are predicted to moderately increase
cilostazol. Adjust cilostazol dose, p. 232.
▶ Idelalisib is predicted to moderately increase the exposure to
cilostazol. Adjust cilostazol dose, p. 232.oStudy
▶ Cilostazol is predicted to increase the exposure to lomitapide.
Separate administration by 12 hours.oTheoretical
▶ Macrolides (clarithromycin) are predicted to moderately
increase the exposure to cilostazol. Adjust cilostazol dose,
▶ Macrolides (erythromycin) slightly increase the exposure to
cilostazol. Adjust cilostazol dose, p. 232.oStudy
▶ Proton pump inhibitors (esomeprazole) are predicted to increase
the exposure to cilostazol.oTheoretical
1428 Ciclosporin — Cilostazol BNF 78
▶ Proton pump inhibitors (omeprazole) are predicted to increase
cilostazol. Adjust cilostazol dose, p. 232.
is predicted to alter the effects of cilostazol.
▶ SSRIs (fluoxetine, fluvoxamine) are predicted to increase the
cilostazol dose, p. 232.o ▶ St John
o’s Wort is predicted to alter the effects of cilostazol.
Cimetidine → see H2 receptor antagonists
FOOD AND LIFESTYLE Dose adjustment might be necessary if
smoking started or stopped during treatment.
▶ Cinacalcet is predicted to increase the exposure to
anticholinesterases, centrally acting (galantamine). Monitor and
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to cinacalcet. Monitor and adjust dose.oStudy
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to moderately increase the exposure to cinacalcet.
▶ Cinacalcet is predicted to moderately increase the exposure to
aripiprazole. Adjust aripiprazole dose, p. 395.oStudy
▶ Cinacalcet is predicted to markedly increase the exposure to
atomoxetine. Adjust dose.rStudy
▶ Cinacalcet is predicted to increase the exposure to beta
blockers, selective (metoprolol, nebivolol).oStudy
▶ Cobicistat is predicted to moderately increase the exposure to
cinacalcet. Adjust dose.oStudy
▶ Cinacalcet is predicted to slightly increase the exposure to
▶ Cinacalcet is predicted to increase the exposure to eliglustat.
Avoid or adjust dose—consult product literature.rStudy
▶ Enzalutamide is predicted to decrease the exposure to
cinacalcet. Monitor and adjust dose.oStudy
▶ Cinacalcet increases the risk of hypocalcaemia when given
with etelcalcetide. Avoid.rTheoretical
▶ HIV-protease inhibitors are predicted to moderately increase
the exposure to cinacalcet. Adjust dose.oStudy
▶ Idelalisib is predicted to moderately increase the exposure to
cinacalcet. Adjust dose.oStudy
▶ Macrolides (clarithromycin) are predicted to moderately
cinacalcet. Adjust dose.o ▶ Cinacalcet
is predicted to increase the exposure to mexiletine.
▶ Mitotane is predicted to decrease the exposure to cinacalcet.
Monitor and adjust dose.oStudy
▶ Cinacalcet is predicted to decrease the efficacy of opioids
▶ Cinacalcet is predicted to decrease the efficacy of opioids
▶ Cinacalcet is predicted to moderately increase the exposure to
pitolisant. Use with caution and adjust dose.oStudy
▶ Rifampicin is predicted to decrease the exposure to cinacalcet.
Monitor and adjust dose.oStudy
▶ Cinacalcet is predicted to increase the exposure to risperidone.
▶ SSRIs (fluvoxamine) are predicted to increase the exposure to
cinacalcet. Adjust dose.oTheoretical
▶ Cinacalcet is predicted to increase the exposure to SSRIs
▶ Cinacalcet is predicted to decrease the efficacy of tamoxifen.
▶ Cinacalcet is predicted to increase the exposure to tricyclic
. Monitor for toxicity and adjust dose.r
▶ Cinacalcet is predicted to increase the exposure to vortioxetine.
Monitor and adjust dose.oStudy
Cinnarizine → see antihistamines, sedating
Ciprofloxacin → see quinolones
Cisatracurium → see neuromuscular blocking drugs, non-depolarising
Cisplatin → see platinum compounds
Cladribine → see TABLE 15 p. 1378 (myelosuppression)
SEPARATION OF ADMINISTRATION Oral cladribine might affect
the absorption of concurrently administered drugs—consider
separating administration by at least 3 hours.
▶ Antiepileptics (carbamazepine) are predicted to increase the risk
of haematological toxicity when given with oral
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
cladribine. Public Health England advises avoid (refer to Green
Clarithromycin → see macrolides
Clavulanic acid → see TABLE 1 p. 1375 (hepatotoxicity)
Clemastine → see antihistamines, sedating
Clevidipine → see calcium channel blockers
ROUTE-SPECIFIC INFORMATION Since systemic absorption can
follow topical application, the possibility of interactions
▶ Clindamycin increases the effects of neuromuscular blocking
drugs, non-depolarising.rAnecdotal
increases the effects of suxamethonium.r
Clobazam → see TABLE 11 p. 1377 (CNS depressant effects)
▶ Antiepileptics (stiripentol) increase the concentration of
▶ Clobazam potentially affects the concentration of antiepileptics
(fosphenytoin, phenytoin).rAnecdotal
▶ Antifungals, azoles (fluconazole, voriconazole) potentially
clobazam. Adjust dose.o ▶ Moclobemide potentially increases the exposure to clobazam.
▶ Proton pump inhibitors (esomeprazole, omeprazole) potentially
clobazam. Adjust dose.o ▶ SSRIs (fluoxetine, fluvoxamine) potentially increase the
exposure to clobazam. Adjust dose.oTheoretical
Clofarabine → see TABLE 15 p. 1378 (myelosuppression)
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
clofarabine. Public Health England advises avoid (refer to
▶ Clofazimine potentially increases the risk of QT-prolongation
when given with bedaquiline.rStudy
Clomethiazole → see TABLE 11 p. 1377 (CNS depressant effects)
▶ Alcohol (beverage) causes serious, potentially fatal, CNS
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) decrease the exposure to clomethiazole.
Monitor and adjust dose.oStudy → Also see TABLE 11
▶ Enzalutamide decreases the exposure to clomethiazole.
Monitor and adjust dose.oStudy
▶ Mitotane decreases the exposure to clomethiazole. Monitor
▶ Rifampicin decreases the exposure to clomethiazole. Monitor
Clomipramine → see tricyclic antidepressants
Clonazepam → see TABLE 11 p. 1377 (CNS depressant effects)
▶ Clonazepam potentially affects the concentration of
antiepileptics (fosphenytoin, phenytoin).rAnecdotal
Clonidine → see TABLE 6 p. 1376 (bradycardia), TABLE 8 p. 1376
(hypotension), TABLE 11 p. 1377 (CNS depressant effects)
▶ Tricyclic antidepressants decrease the antihypertensive effects
of clonidine. Monitor and adjust dose.oAnecdotal →
Clopidogrel → see TABLE 4 p. 1375 (antiplatelet effects)
▶ Antifungals, azoles (fluconazole) are predicted to decrease the
efficacy of clopidogrel. Avoid.rTheoretical
BNF 78 Cilostazol — Clopidogrel 1429
▶ Antifungals, azoles (voriconazole) are predicted to decrease the
efficacy of clopidogrel. Avoid.oStudy
▶ Clopidogrel is predicted to increase the exposure to
▶ Clopidogrel is predicted to increase the exposure to
▶ Clopidogrel is predicted to very markedly increase the
exposure to dasabuvir. Avoid.rStudy
▶ Clopidogrel moderately increases the exposure to
. Avoid or adjust enzalutamide dose, p. 947.r
▶ Grapefruit juice markedly decreases the exposure to
▶ Moclobemide is predicted to decrease the efficacy of
▶ Clopidogrel is predicted to moderately increase the exposure
▶ Clopidogrel increases the exposure to pioglitazone. Monitor
blood glucose and adjust dose.rStudy
▶ Proton pump inhibitors (esomeprazole, omeprazole) are
increases the exposure to repaglinide. Avoid.
▶ Clopidogrel is predicted to increase the exposure to retinoids
▶ SSRIs (fluoxetine, fluvoxamine) are predicted to decrease the
efficacy of clopidogrel. Avoid.rTheoretical → Also see
▶ Clopidogrel increases the exposure to statins (rosuvastatin).
Adjust rosuvastatin dose, p. 204.oStudy
▶ Clopidogrel is predicted to increase the concentration of
taxanes (paclitaxel).rAnecdotal
Clotrimazole → see antifungals, azoles
Clozapine → see TABLE 8 p. 1376 (hypotension), TABLE 15 p. 1378
(myelosuppression), TABLE 11 p. 1377 (CNS depressant effects), TABLE 10
▶ Dose adjustment might be necessary if smoking started or
▶ Avoid concomitant use of clozapine with drugs that have a
substantial potential for causing agranulocytosis.
▶ Antiepileptics (carbamazepine) are predicted to increase the risk
of myelosuppression when given with
▶ Antiepileptics (fosphenytoin, phenobarbital, phenytoin,
primidone) are predicted to decrease the exposure to
clozapine.oAnecdotal → Also see TABLE 11 p. 1377
▶ Combined hormonal contraceptives increase the concentration
of clozapine. Monitor side effects and adjust dose.rStudy
▶ Clozapine is predicted to decrease the effects of dopamine
receptor agonists.oTheoretical → Also see TABLE 8
p. 1376 → Also see TABLE 10 p. 1377
▶ Enzalutamide is predicted to decrease the exposure to
▶ HIV-protease inhibitors (ritonavir) are predicted to affect the
exposure to clozapine. Avoid.rTheoretical
▶ Iron chelators (deferasirox) are predicted to increase the
exposure to clozapine. Avoid.oTheoretical
is predicted to decrease the exposure to clozapine.
Theoretical → Also see TABLE 15 p. 1378
is predicted to decrease the effects of levodopa.
Theoretical → Also see TABLE 8 p. 1376
▶ Macrolides (erythromycin) potentially increase the risk of
toxicity when given with clozapine.rAnecdotal
▶ Mexiletine increases the concentration of clozapine. Monitor
side effects and adjust dose.rStudy
▶ Quinolones (ciprofloxacin) increase the concentration of
clozapine. Monitor side effects and adjust dose.rStudy
decreases the exposure to clozapine.r
▶ SSRIs (fluvoxamine) increase the concentration of clozapine.
Monitor side effects and adjust dose.rStudy
▶ Teriflunomide is predicted to decrease the exposure to
▶ Cobicistat is predicted to increase the exposure to abemaciclib.
Avoid or adjust abemaciclib dose, p. 967.rStudy
▶ Cobicistat is predicted to markedly increase the exposure to
aldosterone antagonists (eplerenone). Avoid.rStudy
▶ Cobicistat increases the exposure to almotriptan.nStudy
▶ Cobicistat is predicted to moderately increase the exposure to
alpha blockers (alfuzosin, tamsulosin). Use with caution or
▶ Cobicistat is predicted to increase the exposure to alpha
▶ Cobicistat moderately increases the exposure to alprazolam.
▶ Cobicistat potentially increases the concentration of
antiarrhythmics (amiodarone, disopyramide, flecainide,
▶ Cobicistat very markedly increases the exposure to
antiarrhythmics (dronedarone). Avoid.rStudy
▶ Cobicistat is predicted to increase the exposure to
antiarrhythmics (propafenone). Monitor and adjust dose.r
▶ Cobicistat is predicted to increase the exposure to
anticholinesterases, centrally acting (galantamine). Monitor and
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to cobicistat. Avoid.rTheoretical
▶ Antiepileptics (oxcarbazepine) are predicted to decrease the
concentration of cobicistat.rTheoretical
▶ Cobicistat is predicted to very slightly increase the exposure to
antiepileptics (perampanel).nStudy
▶ Cobicistat is predicted to increase the exposure to antifungals,
azoles (fluconazole, posaconazole).oTheoretical
▶ Cobicistat is predicted to increase the exposure to antifungals,
(isavuconazole). Avoid or monitor side effects.r
▶ Cobicistat is predicted to increase the exposure to antifungals,
azoles (voriconazole). Avoid.oTheoretical
▶ Cobicistat is predicted to increase the exposure to
antihistamines, non-sedating (mizolastine). Avoid.rStudy
▶ Cobicistat is predicted to increase the exposure to
antihistamines, non-sedating (rupatadine). Avoid.oStudy
▶ Cobicistat is predicted to increase the concentration of
antimalarials (piperaquine).rTheoretical
▶ Cobicistat is predicted to increase the exposure to
▶ Cobicistat is predicted to increase the exposure to apixaban.
▶ Cobicistat is predicted to markedly increase the exposure to
▶ Cobicistat is predicted to slightly increase the exposure to
aripiprazole. Adjust aripiprazole dose, p. 395.oStudy
▶ Cobicistat is predicted to increase the exposure to axitinib.
▶ Cobicistat is predicted to increase the exposure to bedaquiline.
▶ Cobicistat is predicted to increase the exposure to beta2
agonists (salmeterol). Avoid.rStudy
slightly increases the exposure to bortezomib.
▶ Bosentan is predicted to decrease the exposure to cobicistat.
▶ Cobicistat is predicted to markedly increase the exposure to
bosutinib. Avoid or adjust dose.rStudy
▶ Cobicistat is predicted to increase the exposure to brigatinib.
Adjust brigatinib dose, p. 971.rStudy
▶ Cobicistat is predicted to increase the exposure to buspirone.
Adjust buspirone dose, p. 342.rStudy
1430 Clopidogrel — Cobicistat BNF 78
slightly increases the exposure to cabozantinib.
▶ Cobicistat is predicted to increase the exposure to calcium
channel blockers (amlodipine, felodipine, lacidipine, nicardipine,
. Monitor and adjust dose.o ▶ Cobicistat is predicted to increase the exposure to calcium
channel blockers (diltiazem, verapamil).rStudy
▶ Cobicistat is predicted to markedly increase the exposure to
calcium channel blockers (lercanidipine). Avoid.rStudy
▶ Cobicistat is predicted to increase the exposure to cannabis
extract. Use with caution and adjust dose.oTheoretical
▶ Cobicistat is predicted to moderately increase the exposure to
▶ Cobicistat is predicted to increase the exposure to ceritinib.
Avoid or adjust ceritinib dose, p. 973.rStudy
increases the concentration of ciclosporin.r
▶ Cobicistat is predicted to moderately increase the exposure to
cilostazol. Adjust cilostazol dose, p. 232.oStudy
▶ Cobicistat is predicted to moderately increase the exposure to
cinacalcet. Adjust dose.oStudy
▶ Cobicistat is predicted to markedly increase the exposure to
cobimetinib. Avoid or monitor for toxicity.rStudy
▶ Cobicistat is predicted to increase the exposure to colchicine.
Avoid potent inhibitors of CYP3A4 or adjust colchicine dose,
▶ Cobicistat is predicted to decrease the efficacy of combined
hormonal contraceptives. Avoid.rStudy
▶ Cobicistat is predicted to increase the exposure to
corticosteroids (beclometasone) (risk with beclometasone is
corticosteroids (betamethasone, budesonide, ciclesonide,
deflazacort, dexamethasone, fludrocortisone, fluticasone,
hydrocortisone, methylprednisolone, mometasone,
. Avoid or monitor side effects.
▶ Cobicistat is predicted to moderately increase the exposure to
▶ Cobicistat is predicted to increase the exposure to dabigatran.
▶ Cobicistat is predicted to increase the exposure to dabrafenib.
Use with caution or avoid.oStudy
▶ Cobicistat is predicted to markedly to very markedly increase
the exposure to darifenacin. Avoid.rStudy
▶ Cobicistat is predicted to markedly increase the exposure to
. Avoid or adjust dose—consult product literature.
very slightly increases the exposure to delamanid.
▶ Cobicistat increases the risk of QT-prolongation when given
with domperidone. Avoid.rStudy
▶ Cobicistat increases the exposure to dopamine receptor agonists
▶ Cobicistat is predicted to increase the concentration of
dopamine receptor agonists (cabergoline).oAnecdotal
▶ Cobicistat is predicted to increase the exposure to doravirine.
▶ Cobicistat is predicted to increase the exposure to dutasteride.
Monitor side effects and adjust dose.oTheoretical
▶ Cobicistat is predicted to increase the exposure to edoxaban.
▶ Efavirenz is predicted to decrease the exposure to cobicistat.
▶ Cobicistat is predicted to markedly increase the exposure to
▶ Cobicistat is predicted to increase the exposure to eliglustat.
Avoid or adjust dose—consult product literature.rStudy
▶ Cobicistat is predicted to increase the exposure to encorafenib.
▶ Enzalutamide is predicted to decrease the exposure to
cobicistat. Avoid.rTheoretical
▶ Cobicistat is predicted to increase the risk of ergotism when
given with ergometrine. Avoid.rTheoretical
▶ Cobicistat is predicted to increase the risk of ergotism when
given with ergotamine. Avoid.rTheoretical
▶ Cobicistat is predicted to slightly increase the exposure to
erlotinib. Use with caution and adjust dose.oStudy
▶ Cobicistat is predicted to increase the exposure to esketamine.
▶ Cobicistat is predicted to increase the concentration of
▶ Cobicistat is predicted to moderately increase the exposure to
fesoterodine. Adjust fesoterodine dose with potent inhibitors
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