▶ HIV-protease inhibitors (tipranavir) decrease the exposure to

didanosine. Separate administration by 2 hours.oStudy

▶ Didanosine (buffered) decreases the exposure to HIV-protease

inhibitors (atazanavir). Didanosine should be taken 2 hours

after atazanavir.rStudy

▶ Didanosine (buffered) is predicted to decrease the exposure to

HIV-protease inhibitors (darunavir boosted with ritonavir).

Didanosine should be taken 1 hour before or 2 hours after

darunavir.oTheoretical

▶ Hydroxycarbamide increases the risk of toxicity when given

with didanosine. Avoid.rStudy

▶ Isoniazid is predicted to increase the risk of peripheral

neuropathy when given with didanosine.rTheoretical →

Also see TABLE 1 p. 1375 → Also see TABLE 12 p. 1378

▶ Didanosine is predicted to increase the risk of pancreatitis

when given with pentamidine. Avoid.rStudy

▶ Didanosine (buffered) is predicted to greatly decrease the

exposure to oral quinolones. Didanosine should be taken

2 hours after quinolones.oStudy

▶ Ribavirin is predicted to increase the exposure to didanosine.

Avoid.rStudy

▶ Didanosine increases the risk of toxicity when given with

stavudine. Avoid.rStudy → Also see TABLE 12 p. 1378

▶ Tenofovir disoproxil increases the risk of toxicity when given

with didanosine. Avoid.rStudy

▶ Valganciclovir is predicted to increase the exposure to

didanosine.oStudy

Digoxin → see TABLE 6 p. 1376 (bradycardia)

GENERAL INFORMATION Drugs that reduce serum potassium are

predicted to increase the risk of digoxin toxicity, see TABLE 17

p. 1379.

▶ Acarbose

Study

decreases the concentration of digoxin.o ▶ Aldosterone antagonists (eplerenone) very slightly increase the

exposure to digoxin.nStudy

▶ Aldosterone antagonists (spironolactone) increase the

concentration of

Study

digoxin. Monitor and adjust dose.o ▶ Aminoglycosides potentially increase the concentration of

digoxin. Monitor and adjust dose.nStudy

▶ Antacids decrease the absorption of digoxin. Separate

administration by 2 hours.nStudy

▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to

moderately increase the exposure to digoxin. Monitor and

adjust digoxin dose, p. 109.rStudy → Also see TABLE 6 p. 1376

▶ Antiarrhythmics (propafenone) increase the concentration of

digoxin. Monitor and adjust dose.rStudy

▶ Antiepileptics (fosphenytoin, phenytoin) are predicted to

decrease the concentration of digoxin.oAnecdotal

▶ Antifungals, azoles (isavuconazole) slightly increase the

exposure to digoxin. Monitor and adjust dose.oStudy

▶ Antifungals, azoles (itraconazole) are predicted to markedly

increase the concentration of digoxin. Monitor and adjust

dose.rStudy

▶ Antifungals, azoles (ketoconazole) are predicted to markedly

increase the concentration of digoxin.rStudy

▶ Antifungals, azoles (posaconazole) are predicted to increase the

concentration of digoxin.rStudy

▶ Antimalarials (mefloquine) are predicted to increase the risk of

bradycardia when given with digoxin.rTheoretical

1442 Desogestrel — Digoxin BNF 78

Interactions | Appendix 1

A1

▶ Antimalarials (quinine) increase the concentration of digoxin.

Monitor and adjust digoxin dose, p. 109.rAnecdotal

▶ Apalutamide is predicted to decrease the exposure to digoxin.

nStudy

▶ Balsalazide is predicted to decrease the concentration of

digoxin.oTheoretical

▶ Brigatinib

o

potentially increases the concentration of digoxin.

Theoretical

▶ Calcium channel blockers (diltiazem, verapamil) increase the

concentration of

Study → Also see TABLE 6

digoxin

p. 1376

. Monitor and adjust dose.r

▶ Intravenous calcium salts increase the concentration of

digoxin. Avoid.oAnecdotal

▶ Carbimazole affects the concentration of digoxin. Monitor and

adjust dose.oTheoretical

▶ Ceritinib is predicted to increase the risk of bradycardia when

given with digoxin. Avoid.rTheoretical

▶ Ciclosporin increases the concentration of digoxin. Monitor

and adjust dose.rTheoretical

▶ Eliglustat

o

increases the exposure to digoxin. Adjust dose.

Study

▶ Glecaprevir (with pibrentasvir) increases the exposure to

digoxin.oStudy

▶ HIV-protease inhibitors (ritonavir) increase the concentration of

digoxin. Adjust dose and monitor concentration.rStudy

▶ Ivacaftor

Study

slightly increases the exposure to digoxin.o ▶ Lapatinib

o

is predicted to increase the exposure to digoxin.

Theoretical

▶ Ledipasvir is predicted to increase the exposure to digoxin.

Monitor and adjust dose.oTheoretical

▶ Macrolides

Anecdotal

increase the concentration of digoxin.r

▶ Mirabegron slightly increases the exposure to digoxin. Monitor

concentration and adjust dose.rStudy

▶ Neomycin decreases the absorption of digoxin.oStudy

▶ Neuromuscular blocking drugs, non-depolarising (pancuronium)

are predicted to increase the risk of cardiovascular sideeffects when given with digoxin.rAnecdotal

▶ NSAID

rs (indometacin) increase the concentration of digoxin.

Study

▶ Paritaprevir (with ritonavir and ombitasvir) increases the

exposure to

o

digoxin. Monitor and adjust digoxin dose, p. 109.

Study

▶ Penicillamine potentially decreases the concentration of

digoxin. Separate administration by 2 hours.rAnecdotal

▶ Pibrentasvir (with glecaprevir) increases the exposure to

digoxin.oStudy

▶ Pitolisant is predicted to decrease the exposure to digoxin.

nTheoretical

▶ Ranolazine

Study

increases the concentration of digoxin.o ▶ Ribociclib

o

is predicted to increase the exposure to digoxin.

Theoretical

▶ Rifampicin

Study

decreases the concentration of digoxin.o ▶ Rolapitant

Study

slightly increases the exposure to digoxin.o ▶ St John

r’s Wort decreases the concentration of digoxin. Avoid.

Anecdotal

▶ Sucralfate decreases the absorption of digoxin. Separate

administration by 2 hours.rAnecdotal

▶ Sulfasalazine

Study

decreases the concentration of digoxin.o ▶ Suxamethonium is predicted to increase the risk of

cardiovascular side-effects when given with

Anecdotal

digoxin.r

▶ Thyroid hormones are predicted to affect the concentration of

digoxin. Monitor and adjust dose.oTheoretical

▶ Ticagrelor

Study

increases the concentration of digoxin.o ▶ Tolvaptan increases the concentration of digoxin.nStudy

▶ Trimethoprim

Study

increases the concentration of digoxin.o

▶ Vandetanib slightly increases the exposure to digoxin. Monitor

ECG and adjust dose.oStudy

▶ Velpatasvir

r

is predicted to increase the exposure to digoxin.

Study

▶ Venetoclax increases the exposure to digoxin. Avoid or adjust

dose.rStudy

▶ Vitamin D substances are predicted to increase the risk of

toxicity when given with digoxin.rTheoretical

▶ Voxilaprevir (with sofosbuvir and velpatasvir) is predicted to

increase the exposure to

r

digoxin. Monitor and adjust dose.

Theoretical

Dihydrocodeine → see opioids

Dihydrotachysterol → see vitamin D substances

Diltiazem → see calcium channel blockers

Dimenhydrinate → see TABLE 10 p. 1377 (antimuscarinics)

Dimethyl fumarate

▶ Alcohol (beverage)(excessive consumption) potentially

increases the risk of gastrointestinal side-effects when given

with dimethyl fumarate. Avoid.oTheoretical

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with dimethyl

fumarate. Public Health England advises avoid (refer to Green

Book).rTheoretical

Dinutuximab → see monoclonal antibodies

Diphenoxylate → see opioids

Dipipanone → see opioids

Dipyridamole → see TABLE 8 p. 1376 (hypotension), TABLE 4 p. 1375

(antiplatelet effects)

▶ Antacids are predicted to decrease the absorption of

dipyridamole (immediate release tablets).oTheoretical

▶ Dipyridamole increases the exposure to antiarrhythmics

(adenosine). Avoid or adjust dose.rStudy

▶ H2 receptor antagonists are predicted to decrease the

o

absorption of dipyridamole (immediate release tablets).

Theoretical

▶ Proton pump inhibitors are predicted to decrease the

absorption of

o

dipyridamole (immediate release tablets).

Theoretical

Disopyramide → see antiarrhythmics

Disulfiram → see TABLE 12 p. 1378 (peripheral neuropathy)

▶ 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.

rStudy

▶ Disulfiram increases the concentration of antiepileptics

(fosphenytoin, phenytoin). Monitor concentration and adjust

dose.rStudy → Also see TABLE 12 p. 1378

▶ Disulfiram increases the anticoagulant effect of coumarins.

Monitor and adjust dose.rStudy

▶ Disulfiram increases the risk of acute psychoses when given

with metronidazole.rStudy → Also see TABLE 12 p. 1378

▶ Disulfiram is predicted to increase the anticoagulant effect of

phenindione.rTheoretical

Dobutamine → see sympathomimetics, inotropic

Docetaxel → see taxanes

Docusate sodium

ROUTE-SPECIFIC INFORMATION Interactions do not generally

apply to topical use of docusate unless specified.

Dolutegravir

▶ Antacids moderately decrease the exposure to dolutegravir.

Dolutegravir should be taken 2 hours before or 6 hours after

antacids.oStudy

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) decrease the exposure to dolutegravir.

Adjust dose.rStudy

▶ Antiepileptics (oxcarbazepine) are predicted to decrease the

exposure to dolutegravir. Adjust dose.rTheoretical

▶ Bosentan

r

decreases the exposure to dolutegravir. Adjust dose.

Study

▶ Oral calcium salts decrease the absorption of dolutegravir.

Dolutegravir should be taken 2 hours before or 6 hours after

calcium salts.oStudy

▶ Dolutegravir is predicted to increase the exposure to dopamine

receptor agonists (pramipexole). Adjust dose.oStudy

BNF 78 Digoxin — Dolutegravir 1443

Interactions | Appendix 1

A1

Dolutegravir (continued)

▶ Efavirenz

r

decreases the exposure to dolutegravir. Adjust dose.

Study

▶ Encorafenib is predicted to increase the exposure to

dolutegravir.oTheoretical

▶ Enzalutamide decreases the exposure to dolutegravir. Adjust

dose.rStudy

▶ Etravirine moderately decreases the exposure to dolutegravir.

Avoid unless given with atazanavir, darunavir, or lopinavir (all

boosted with ritonavir).rStudy

▶ HIV-protease inhibitors (fosamprenavir boosted with ritonavir)

slightly decrease the exposure to dolutegravir. Avoid if

resistant to HIV-integrase inhibitors.rStudy

▶ HIV-protease inhibitors (tipranavir) moderately decrease the

exposure to

Study

dolutegravir. Refer to specialist literature.r

▶ Iron (oral) decreases the absorption of dolutegravir.

Dolutegravir should be taken 2 hours before or 6 hours after

iron (oral).oStudy

▶ Dolutegravir increases the exposure to metformin. Use with

caution and adjust dose.rStudy

▶ Mitotane

r

decreases the exposure to dolutegravir. Adjust dose.

Study

▶ Nevirapine decreases the exposure to dolutegravir. Adjust

dose.rStudy

▶ Rifampicin decreases the exposure to dolutegravir. Adjust

dose.rStudy

▶ St John’s Wort decreases the exposure to dolutegravir. Adjust

dose.rStudy

▶ Sucralfate

Study

decreases the absorption of dolutegravir.o

Domperidone → see TABLE 9 p. 1377 (QT-interval prolongation)

▶ Antiarrhythmics (dronedarone) increase the risk of QTprolongation when given with

Study

domperidone. Avoid.r

▶ Antifungals, azoles (fluconazole, isavuconazole, itraconazole,

ketoconazole, posaconazole, voriconazole) increase the risk of

QT-prolongation when given with

Study

domperidone. Avoid.r

▶ Aprepitant increases the risk of QT-prolongation when given

with domperidone. Avoid.rStudy

▶ Calcium channel blockers (diltiazem, verapamil) increase the risk

of QT-prolongation when given with

r

domperidone. Avoid.

Study

▶ Cobicistat increases the risk of QT-prolongation when given

with domperidone. Avoid.rStudy

▶ Crizotinib increases the risk of QT-prolongation when given

with domperidone. Avoid.rStudy

▶ Domperidone is predicted to decrease the prolactin-lowering

effect of dopamine receptor agonists (bromocriptine,

cabergoline).oTheoretical

▶ HIV-protease inhibitors increase the risk of QT-prolongation

when given with domperidone. Avoid.rStudy

▶ Idelalisib increases the risk of QT-prolongation when given

with domperidone. Avoid.rStudy

▶ Imatinib increases the risk of QT-prolongation when given

with domperidone. Avoid.rStudy

▶ Macrolides (clarithromycin, erythromycin) increase the risk of

QT-prolongation when given with

Study

domperidone. Avoid.r

▶ Netupitant increases the risk of QT-prolongation when given

with domperidone. Avoid.rStudy

▶ Nilotinib increases the risk of QT-prolongation when given

with domperidone. Avoid.rStudy

Donepezil → see anticholinesterases, centrally acting

Dopamine → see sympathomimetics, inotropic

Dopamine receptor agonists → see TABLE 8 p. 1376 (hypotension),

TABLE 9 p. 1377 (QT-interval prolongation), TABLE 10 p. 1377