1378 Appendix 1 Interactions BNF 78
Drugs that increase serum potassium
angiotensin-II receptor antagonists are given with spironolactone or eplerenone).
Drugs that reduce serum potassium
Drugs that cause hyponatraemia
more drugs from this list might increase the risk of hyponatraemia.
the list might increase this risk.
Drugs with neuromuscular blocking effects
more drugs from the list might increase this risk.
BNF 78 Appendix 1 Interactions 1379
The following is an alphabetical list of drugs and their
interactions; to avoid excessive cross-referencing each drug
or group is listed twice: in the alphabetical list and also
against the drug or group with which it interacts.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
▶ HIV-protease inhibitors (tipranavir) slightly decrease the
exposure to abacavir. Avoid.rStudy
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
abatacept. Public Health England advises avoid (refer to Green
▶ Abatacept is predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
monoclonal antibodies (golimumab). Avoid.rTheoretical
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to abemaciclib.oStudy
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to markedly decrease the
exposure to abemaciclib. Avoid.rStudy
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to abemaciclib. Avoid or
adjust abemaciclib dose, p. 967.rStudy
▶ Aprepitant is predicted to increase the exposure to
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to abemaciclib.oStudy
▶ Cobicistat is predicted to increase the exposure to abemaciclib.
Avoid or adjust abemaciclib dose, p. 967.rStudy
is predicted to increase the exposure to abemaciclib.
▶ Enzalutamide is predicted to markedly decrease the exposure
▶ Grapefruit juice is predicted to increase the exposure to
abemaciclib. Avoid.oTheoretical
▶ HIV-protease inhibitors are predicted to increase the exposure
abemaciclib. Avoid or adjust abemaciclib dose, p. 967.r
▶ Idelalisib is predicted to increase the exposure to abemaciclib.
Avoid or adjust abemaciclib dose, p. 967.rStudy
is predicted to increase the exposure to abemaciclib.
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to abemaciclib. Avoid or adjust abemaciclib dose,
▶ Macrolides (erythromycin) are predicted to increase the
exposure to abemaciclib.oStudy
▶ Mitotane is predicted to markedly decrease the exposure to
▶ Netupitant is predicted to increase the exposure to
is predicted to increase the exposure to abemaciclib.
▶ Rifampicin is predicted to markedly decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
GENERAL INFORMATION Caution with concurrent
chemotherapy—safety and efficacy not established.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
▶ Abiraterone is predicted to increase the exposure to beta
blockers, selective (metoprolol).oStudy
▶ Abiraterone is predicted to increase the exposure to eliglustat.
Avoid or adjust dose—consult product literature.rStudy
▶ Enzalutamide is predicted to decrease the exposure to
▶ Mitotane is predicted to decrease the exposure to abiraterone.
▶ Rifampicin is predicted to decrease the exposure to
Acarbose → see TABLE 14 p. 1378 (antidiabetic drugs)
ACE inhibitors → see TABLE 7 p. 1376 (first-dose hypotension), TABLE 8
p. 1376 (hypotension), TABLE 16 p. 1379 (increased serum potassium)
given with aliskiren. Use with caution or avoid aliskiren in
selected patients, p. 179.rStudy → Also see TABLE 8 p. 1376 →
▶ ACE inhibitors are predicted to increase the risk of
hypersensitivity and haematological reactions when given
▶ ACE inhibitors are predicted to increase the risk of anaemia
and/or leucopenia when given with azathioprine.r
▶ Everolimus potentially increases the risk of angioedema when
given with ACE inhibitors.rAnecdotal
▶ ACE inhibitors are predicted to decrease the efficacy of
icatibant and icatibant is predicted to decrease the efficacy of
ACE inhibitors. Avoid.oTheoretical
▶ ACE inhibitors are predicted to increase the concentration of
lithium. Monitor and adjust dose.rAnecdotal
▶ ACE inhibitors are predicted to increase the risk of
hypersensitivity when given with sodium aurothiomalate.
▶ Quinapril (tablet) decreases the absorption of oral tetracyclines
Acebutolol → see beta blockers, selective
▶ Acetazolamide potentially increases the risk of toxicity when
given with antiepileptics (valproate).rStudy
▶ Acetazolamide potentially increases the risk of overheating
and dehydration when given with antiepileptics (zonisamide).
Avoid in children.rTheoretical
▶ Acetazolamide increases the risk of severe toxic reaction when
given with aspirin (high-dose).rStudy
alters the concentration of lithium.r
▶ Acetazolamide is predicted to decrease the efficacy of
methenamine. Avoid.oTheoretical
▶ Acetazolamide increases the urinary excretion of
Aciclovir → see TABLE 2 p. 1375 (nephrotoxicity)
ROUTE-SPECIFIC INFORMATION Since systemic absorption can
follow topical application, the possibility of interactions
▶ Aciclovir increases the exposure to aminophylline. Monitor and
▶ Mycophenolate is predicted to increase the risk of
haematological toxicity when given with
aciclovir.o ▶ Aciclovir is predicted to increase the exposure to theophylline.
Monitor and adjust dose.rTheoretical
Aclidinium → see TABLE 10 p. 1377 (antimuscarinics)
Acrivastine → see antihistamines, non-sedating
Adalimumab → see monoclonal antibodies
Adefovir → see TABLE 2 p. 1375 (nephrotoxicity)
1380 Abacavir — Adefovir BNF 78
is predicted to increase the exposure to adefovir.
is predicted to increase the exposure to adefovir.
Adenosine → see antiarrhythmics
Adrenaline/epinephrine → see sympathomimetics, vasoconstrictor
Afatinib → see TABLE 15 p. 1378 (myelosuppression)
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
increase the exposure to afatinib. Separate administration by
▶ Antiepileptics (carbamazepine) are predicted to decrease the
▶ Antifungals, azoles (itraconazole, ketoconazole) are predicted to
increase the exposure to afatinib. Separate administration by
▶ Calcium channel blockers (verapamil) are predicted to increase
afatinib. Separate administration by 12 hours.
▶ Ciclosporin is predicted to increase the exposure to afatinib.
Separate administration by 12 hours.oStudy
▶ HIV-protease inhibitors (lopinavir, ritonavir, saquinavir) are
predicted to increase the exposure to afatinib. Separate
administration by 12 hours.oStudy
▶ Lapatinib is predicted to increase the exposure to afatinib.
Separate administration by 12 hours.oStudy
▶ Macrolides are predicted to increase the exposure to afatinib.
Separate administration by 12 hours.oStudy
▶ Ranolazine is predicted to increase the exposure to afatinib.
Separate administration by 12 hours.oStudy
is predicted to decrease the exposure to afatinib.
▶ St John’s Wort is predicted to decrease the exposure to
▶ Vemurafenib is predicted to increase the exposure to afatinib.
Separate administration by 12 hours.oStudy
Aflibercept → see TABLE 15 p. 1378 (myelosuppression)
ROUTE-SPECIFIC INFORMATION Interactions do not generally
apply to topical use unless specified.
▶ Aminoglycosides are predicted to decrease the effects of
agalsidase. Avoid.oTheoretical
▶ Antiarrhythmics (amiodarone) are predicted to decrease the
effects of agalsidase. Avoid.oTheoretical
▶ Antimalarials (chloroquine) are predicted to decrease the effects
of agalsidase. Avoid.oTheoretical
▶ Hydroxychloroquine is predicted to decrease the effects of
Agomelatine → see TABLE 11 p. 1377 (CNS depressant effects)
▶ Dose adjustment might be necessary if smoking started or
▶ Caution with concomitant use of drugs associated with
▶ Antiepileptics (fosphenytoin, phenytoin) are predicted to
decrease the exposure to agomelatine.oTheoretical
▶ Combined hormonal contraceptives are predicted to increase
the exposure to agomelatine.oStudy
▶ HIV-protease inhibitors (ritonavir) are predicted to decrease the
exposure to agomelatine.oTheoretical
▶ Leflunomide is predicted to decrease the exposure to
▶ Mexiletine is predicted to increase the exposure to
▶ Quinolones (ciprofloxacin) are predicted to increase the
exposure to agomelatine.oStudy
▶ Rifampicin is predicted to decrease the exposure to
▶ SSRIs (fluvoxamine) very markedly increase the exposure to
▶ Teriflunomide is predicted to decrease the exposure to
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) decrease the concentration of
▶ H2 receptor antagonists (cimetidine) decrease the clearance of
▶ HIV-protease inhibitors (ritonavir) decrease the exposure to
▶ Albendazole slightly decreases the exposure to levamisole and
moderately decreases the exposure to albendazole.
Alcohol (beverage) → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 8
p. 1376 (hypotension), TABLE 11 p. 1377 (CNS depressant effects)
▶ Alcohol (beverage) potentially increases the risk of visual
disturbances when given with antiepileptics (retigabine).
▶ Alcohol (beverage) potentially causes a disulfiram-like
reaction when given with antifungals, azoles (ketoconazole).
▶ Alcohol (beverage) causes serious, potentially fatal, CNS
▶ Alcohol (beverage) (in those who drink heavily) potentially
decreases the anticoagulant effect of coumarins.rStudy
▶ Alcohol (beverage) (excessive consumption) potentially
increases the risk of gastrointestinal side-effects when given
with dimethyl fumarate. Avoid.oTheoretical
▶ Alcohol (beverage) causes an extremely unpleasant systemic
reaction when given with disulfiram. Avoid for at least
24 hours before and up to 14 days after stopping treatment.
▶ Alcohol (beverage) potentially causes a disulfiram-like
reaction when given with griseofulvin.oAnecdotal
▶ Alcohol (beverage) potentially causes a disulfiram-like
reaction when given with levamisole.oStudy
▶ Alcohol (beverage) (excessive consumption) potentially
increases the risk of lactic acidosis when given with
. Avoid excessive alcohol consumption.o ▶ Alcohol (beverage) potentially causes a disulfiram-like
reaction when given with metronidazole. Avoid for at least
48 hours stopping treatment.oStudy
▶ Alcohol (beverage) causes rapid release of opioids
(hydromorphone, morphine) (from extended-release
preparations). Avoid.rStudy → Also see TABLE 11 p. 1377
▶ Alcohol (beverage) (in those who drink heavily) causes severe
liver damage when given with paracetamol.rStudy → Also
▶ Alcohol (beverage) increases the risk of facial flushing and skin
reaction when given with procarbazine.oAnecdotal
▶ Alcohol (beverage) potentially increases the concentration of
retinoids (acitretin). Avoid and for 2 months after stopping
▶ Alcohol (beverage) increases the risk of facial flushing and skin
irritation when given with topical tacrolimus.oStudy
▶ Alcohol (beverage) potentially causes a disulfiram-like
reaction when given with tinidazole. Avoid for 72 hours
stopping treatment.oTheoretical
Aldosterone antagonists → see TABLE 18 p. 1379 (hyponatraemia),
TABLE 8 p. 1376 (hypotension), TABLE 16 p. 1379 (increased serum
eplerenone . spironolactone. ▶ Antiarrhythmics (amiodarone) are predicted to increase the
eplerenone. Adjust eplerenone dose, p. 193.r
▶ Antiarrhythmics (dronedarone) are predicted to increase the
eplerenone. Adjust eplerenone dose, p. 193.r
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to eplerenone. Avoid.oTheoretical → Also see TABLE 18
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to eplerenone. Adjust
eplerenone dose, p. 193.rStudy
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