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decreases the exposure to praziquantel.

Study

▶ Rifampicin is predicted to decrease the exposure to

corticosteroids (budesonide, deflazacort, dexamethasone,

fludrocortisone, hydrocortisone, methylprednisolone,

prednisolone, triamcinolone)

o

. Monitor and adjust dose.

Study

▶ Rifampicin

q

is predicted to decrease the exposure to fluticasone.

Theoretical

▶ Dexamethasone is predicted to decrease the concentration of

rilpivirine

Theoretical

. Avoid multiple-dose dexamethasone.r

▶ Corticosteroids potentially decrease the effects of sodium

phenylbutyrate.oAnecdotal

▶ Corticosteroids are predicted to decrease the effects of

somatropin.oTheoretical

▶ Corticosteroids are predicted to decrease the effects of

suxamethonium.rAnecdotal

Coumarins → see TABLE 3 p. 1375 (anticoagulant effects)

acenocoumarol .warfarin.

FOOD AND LIFESTYLE The effects of coumarins can be reduced

or abolished by vitamin K, including that found in health

foods, food supplements, enteral feeds, or large amounts of

some green vegetables or green tea. Major changes in diet

(especially involving salads and vegetables) and in alcohol

consumption can affect anticoagulant control. Pomegranate

juice is predicted to increase the INR in response to

acenocoumarol and warfarin.

▶ Alcohol (beverage)(in those who drink heavily) potentially

decreases the anticoagulant effect of coumarins.rStudy

▶ Antiarrhythmics (amiodarone) increase the anticoagulant effect

of coumarins.rStudy

▶ Antiarrhythmics (propafenone) increase the anticoagulant

effect of

Study

coumarins. Monitor INR and adjust dose.o ▶ Antiepileptics (carbamazepine) decrease the effects of

coumarins. Monitor and adjust dose.rStudy

▶ Antiepileptics (fosphenytoin, phenytoin) are predicted to alter

the anticoagulant effect of coumarins.oAnecdotal

▶ Antiepileptics (phenobarbital, primidone) decrease the

anticoagulant effect of coumarins. Monitor INR and adjust

dose.oStudy

▶ Antifungals, azoles (fluconazole) increase the anticoagulant

effect of coumarins. Monitor INR and adjust dose.rStudy

▶ Antifungals, azoles (itraconazole) potentially increase the

anticoagulant effect of coumarins.rAnecdotal

▶ Antifungals, azoles (ketoconazole) potentially increase the

anticoagulant effect of

r

warfarin. Monitor INR and adjust dose.

Anecdotal

▶ Antifungals, azoles (miconazole) greatly increase the

anticoagulant effect of coumarins. MHRA advises avoid unless

INR can be monitored closely; monitor for signs of bleeding.

rStudy

▶ Antifungals, azoles (voriconazole) increase the anticoagulant

effect of

Study

coumarins. Monitor INR and adjust dose.o ▶ Apalutamide is predicted to decrease the exposure to

coumarins. Avoid or monitor.nStudy

▶ Aprepitant

o

decreases the anticoagulant effect of coumarins.

Study

▶ Axitinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Azathioprine

o

decreases the anticoagulant effect of coumarins.

Study

▶ Bosentan

o

decreases the anticoagulant effect of coumarins.

Study

▶ Bosutinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Cabozantinib is predicted to increase the risk of bleeding

events when given with coumarins.rTheoretical

▶ Capecitabine increases the effects of coumarins. Monitor INR

and adjust dose.oAnecdotal

▶ Cephalosporins (ceftriaxone) potentially increase the risk of

bleeding events when given with coumarins.rAnecdotal

▶ Ceritinib is predicted to increase the exposure to warfarin.

Avoid.rTheoretical

▶ Chloramphenicol potentially increases the anticoagulant effect

of coumarins.oAnecdotal

▶ Corticosteroids are predicted to increase the effects of

coumarins.oStudy

▶ Cranberry juice potentially increases the anticoagulant effect

of warfarin. Avoid.rAnecdotal

▶ Crizotinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Dabrafenib is predicted to decrease the anticoagulant effect of

coumarins.rTheoretical

▶ Danazol potentially increases the anticoagulant effect of

coumarins.rAnecdotal

▶ Dasatinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Disulfiram increases the anticoagulant effect of coumarins.

Monitor and adjust dose.rStudy

▶ Efavirenz is predicted to affect the concentration of coumarins.

Adjust dose.oTheoretical

▶ Elvitegravir is predicted to decrease the anticoagulant effect of

coumarins.oTheoretical

▶ Enteral feeds (vitamin-K containing) potentially decrease the

anticoagulant effect of coumarins.rAnecdotal

▶ Enzalutamide potentially decreases the exposure to coumarins.

Avoid or adjust dose and monitor INR.rStudy

▶ Erlotinib

r

increases the anticoagulant effect of coumarins.

Anecdotal

▶ Etravirine

o

increases the anticoagulant effect of coumarins.

Theoretical

▶ Fibrates are predicted to increase the anticoagulant effect of

coumarins. Monitor INR and adjust dose.rStudy

▶ Fluorouracil

r

increases the anticoagulant effect of coumarins.

Anecdotal

▶ Fosaprepitant is predicted to decrease the anticoagulant effect

of coumarins.oTheoretical

▶ Gefitinib is predicted to increase the anticoagulant effect of

coumarins.rAnecdotal

▶ Glucagon

Study

increases the anticoagulant effect of warfarin.r

▶ Glucosamine potentially decreases the anticoagulant effect of

acenocoumarol.oAnecdotal

▶ Glucosamine potentially increases the anticoagulant effect of

warfarin. Avoid.oAnecdotal

▶ Griseofulvin potentially decreases the anticoagulant effect of

coumarins.oAnecdotal

▶ H2 receptor antagonists (cimetidine) increase the anticoagulant

effect of coumarins.rStudy

▶ HIV-protease inhibitors are predicted to affect the

anticoagulant effect of coumarins.oStudy

▶ Imatinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Ivacaftor is predicted to increase the anticoagulant effect of

warfarin.rTheoretical

▶ Ivermectin potentially increases the anticoagulant effect of

coumarins.rAnecdotal

▶ Lapatinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Leflunomide

r

increases the anticoagulant effect of coumarins.

Anecdotal

▶ Letermovir is predicted to decrease the concentration of

warfarin. Monitor and adjust dose.oTheoretical

▶ Lomitapide increases the exposure to warfarin. Monitor INR

and adjust dose.rStudy

▶ Macrolides (clarithromycin, erythromycin) increase the

anticoagulant effect of coumarins. Monitor INR and adjust

dose.rAnecdotal

▶ Mercaptopurine decreases the anticoagulant effect of

coumarins.oAnecdotal

▶ Metronidazole increases the anticoagulant effect of coumarins.

Monitor INR and adjust dose.rStudy

▶ Mexiletine

q

potentially affects the exposure to warfarin. Avoid.

Theoretical

1436 Corticosteroids — Coumarins BNF 78

Interactions | Appendix 1

A1

▶ Monoclonal antibodies (blinatumomab) are predicted to

transiently increase the exposure to warfarin. Monitor and

adjust dose.oTheoretical

▶ Monoclonal antibodies (sarilumab) potentially affect the

exposure to

Theoretical

warfarin. Monitor and adjust dose.r

▶ Monoclonal antibodies (tocilizumab) are predicted to decrease

the exposure to

Theoretical

warfarin. Monitor and adjust dose.o ▶ Nandrolone is predicted to increase the anticoagulant effect of

coumarins. Monitor and adjust dose.rTheoretical

▶ Nevirapine potentially alters the anticoagulant effect of

coumarins.rAnecdotal

▶ Nilotinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Obeticholic acid

r

decreases the anticoagulant effect of warfarin.

Study

▶ Oxymetholone

r

increases the anticoagulant effect of coumarins.

Anecdotal

▶ Paracetamol

o

increases the anticoagulant effect of coumarins.

Study

▶ Paritaprevir (in fixed-dose combination with dasabuvir)

decreases the anticoagulant effect of acenocoumarol. Monitor

INR and adjust dose.rAnecdotal

▶ Paritaprevir (in fixed-dose combination) decreases the

r

anticoagulant effect of warfarin. Monitor INR and adjust dose.

Anecdotal

▶ Pazopanib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Penicillins potentially alter the anticoagulant effect of

coumarins. Monitor INR and adjust dose.rAnecdotal

▶ Pitolisant is predicted to decrease the exposure to warfarin.

nTheoretical

▶ Ponatinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Quinolones

r

increase the anticoagulant effect of coumarins.

Anecdotal

▶ Ranibizumab increases the risk of bleeding events when given

with coumarins.rTheoretical

▶ Regorafenib is predicted to increase the risk of bleeding events

when given with coumarins.rStudy

▶ Rifampicin

r

decreases the anticoagulant effect of coumarins.

Study

▶ Rucaparib slightly increases the exposure to warfarin. Monitor

and adjust dose.rStudy

▶ Ruxolitinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Sorafenib

r

increases the anticoagulant effect of coumarins.

Anecdotal

▶ St John’s Wort decreases the anticoagulant effect of coumarins.

Avoid.rAnecdotal

▶ Statins (fluvastatin, rosuvastatin) increase the anticoagulant

effect of coumarins. Monitor INR and adjust dose.rStudy

▶ Sucralfate potentially decreases the effects of warfarin.

Separate administration by 2 hours.oAnecdotal

▶ Sulfonamides (sulfadiazine) are predicted to increase the

anticoagulant effect of coumarins.rTheoretical

▶ Sulfonamides (sulfamethoxazole) increase the anticoagulant

effect of coumarins.rStudy

▶ Sunitinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Tamoxifen

r

increases the anticoagulant effect of coumarins.

Study

▶ Tegafur

o

increases the anticoagulant effect of coumarins.

Theoretical

▶ Teriflunomide

r

affects the anticoagulant effect of coumarins.

Study

▶ Tetracyclines increase the risk of bleeding events when given

with coumarins.oAnecdotal

▶ Tinidazole is predicted to increase the anticoagulant effect of

coumarins. Monitor INR and adjust dose.rTheoretical

▶ Toremifene is predicted to increase the anticoagulant effect of

coumarins.rTheoretical

▶ Trimethoprim is predicted to increase the anticoagulant effect

of coumarins.rStudy

▶ Vandetanib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Venetoclax

o

slightly increases the exposure to warfarin.

Study

Cranberry juice

▶ Cranberry juice potentially increases the anticoagulant effect

of coumarins (warfarin). Avoid.rAnecdotal

Crisantaspase → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 15 p. 1378

(myelosuppression)

▶ Crisantaspase is predicted to increase the risk of

hepatotoxicity when given with imatinib.rTheoretical →

Also see TABLE 15 p. 1378

▶ Crisantaspase

Anecdotal → Also see

affects the ef

TABLE 1 p. 1375

ficacy of

→ Also see

methotrexate

TABLE 15

.r

p. 1378

▶ Crisantaspase potentially increases the risk of neurotoxicity

when given with vinca alkaloids (vincristine).Vincristine should

be taken 3 to 24 hours before

Anecdotal → Also see TABLE 1 p. 1375

crisantaspase

→ Also see TABLE 15

, p. 933.r

p. 1378

Crizotinib → see TABLE 6 p. 1376 (bradycardia), TABLE 15 p. 1378

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

GENERAL INFORMATION Caution with concurrent use of drugs

that cause gastrointestinal perforation—discontinue

treatment if gastrointestinal perforation occurs.

▶ Crizotinib

o

is predicted to increase the exposure to abemaciclib.

Study

▶ Crizotinib is predicted to increase the exposure to aldosterone

antagonists

Study

(eplerenone). Adjust eplerenone dose, p. 193.r

▶ Crizotinib is predicted to increase the exposure to alpha

blockers (tamsulosin).oTheoretical

▶ Crizotinib

r

is predicted to increase the exposure to alprazolam.

Study

▶ Crizotinib is predicted to increase the exposure to

antiarrhythmics

o

(propafenone). Monitor and adjust dose.

Study

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to markedly decrease the

exposure to crizotinib. Avoid.rStudy

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

predicted to moderately increase the exposure to crizotinib.

Avoid.oStudy → Also see TABLE 9 p. 1377

▶ Crizotinib is predicted to increase the exposure to

antihistamines, non-sedating (mizolastine).rTheoretical

▶ Crizotinib is predicted to increase the exposure to

antihistamines, non-sedating (rupatadine). Avoid.oStudy

▶ Crizotinib is predicted to increase the concentration of

antimalarials (piperaquine).rTheoretical

▶ Crizotinib

o

is predicted to increase the exposure to axitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Crizotinib is predicted to increase the exposure to bedaquiline.

Avoid prolonged use.nTheoretical → Also see TABLE 9 p. 1377

▶ Bosentan is predicted to decrease the exposure to crizotinib.

Avoid.rTheoretical

▶ Crizotinib is predicted to increase the exposure to bosutinib.

Avoid or adjust dose.rTheoretical → Also see TABLE 15

p. 1378 → Also see TABLE 9 p. 1377

▶ Crizotinib is predicted to increase the exposure to buspirone.

Use with caution and adjust dose.oStudy

▶ Crizotinib is predicted to increase the exposure to

cabozantinib.oTheoretical → Also see TABLE 15 p. 1378 →

Also see TABLE 9 p. 1377

▶ Crizotinib is predicted to increase the exposure to calcium

channel blockers (amlodipine, felodipine, lacidipine,

lercanidipine, nicardipine, nifedipine, nimodipine). Monitor and

adjust dose.oStudy

▶ Crizotinib is predicted to increase the exposure to cariprazine.

Avoid.rStudy

▶ Crizotinib

o

is predicted to increase the exposure to ceritinib.

Theoretical → Also see TABLE 15 p. 1378 → Also see TABLE 9

p. 1377

▶ Crizotinib is predicted to increase the concentration of

ciclosporin.rStudy

▶ Cobicistat is predicted to moderately increase the exposure to

crizotinib. Avoid.oStudy

BNF 78 Coumarins — Crizotinib 1437

Interactions | Appendix 1

A1

Crizotinib (continued)

▶ Crizotinib

r

is predicted to increase the exposure to cobimetinib.

Theoretical

▶ Crizotinib is predicted to increase the exposure to colchicine.

Adjust colchicine dose with moderate inhibitors of CYP3A4,

p. 1120.rStudy

▶ Crizotinib is predicted to increase the exposure to

o

corticosteroids (methylprednisolone). Monitor and adjust dose.

Study

▶ Crizotinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Crizotinib is predicted to slightly increase the exposure to

darifenacin.oStudy

▶ Crizotinib

r

is predicted to increase the exposure to dasatinib.

Study → Also see TABLE 15 p. 1378 → Also see TABLE 9 p. 1377

▶ Crizotinib increases the risk of QT-prolongation when given

with domperidone. Avoid.rStudy

▶ Crizotinib is predicted to increase the exposure to dopamine

receptor agonists (bromocriptine).rTheoretical

▶ Crizotinib is predicted to increase the concentration of

dopamine receptor agonists (cabergoline).oAnecdotal

▶ Crizotinib is predicted to moderately increase the exposure to

dutasteride.nStudy

▶ Efavirenz is predicted to decrease the exposure to crizotinib.

Avoid.rTheoretical → Also see TABLE 9 p. 1377

▶ Crizotinib is predicted to increase the exposure to eliglustat.

Avoid or adjust dose—consult product literature.rStudy

▶ Crizotinib is predicted to moderately increase the exposure to

encorafenib.oStudy → Also see TABLE 9 p. 1377

▶ Enzalutamide is predicted to markedly decrease the exposure

to crizotinib. Avoid.rStudy

▶ Crizotinib is predicted to increase the risk of ergotism when

given with ergometrine.rTheoretical

▶ Crizotinib is predicted to increase the risk of ergotism when

given with ergotamine.rTheoretical

▶ Crizotinib

o

is predicted to increase the exposure to erlotinib.

Theoretical

▶ Crizotinib is predicted to increase the concentration of

everolimus. Avoid or adjust dose.oStudy → Also see

TABLE 15 p. 1378

▶ Crizotinib is predicted to increase the exposure to

fesoterodine. Adjust fesoterodine dose with moderate

inhibitors of CYP3A4 in hepatic and renal impairment, p. 777.

nStudy

▶ Crizotinib

o

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