increases the exposure to rupatadine. Avoid.
▶ HIV-protease inhibitors are predicted to increase the exposure
▶ HIV-protease inhibitors are predicted to increase the exposure
▶ Idelalisib is predicted to increase the exposure to mizolastine.
▶ Idelalisib is predicted to increase the exposure to rupatadine.
is predicted to increase the exposure to mizolastine.
▶ Imatinib is predicted to increase the exposure to rupatadine.
▶ Lapatinib is predicted to increase the exposure to
▶ Leflunomide is predicted to increase the exposure to
▶ Letermovir is predicted to increase the concentration of
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to mizolastine. Avoid.rStudy
▶ Macrolides (clarithromycin, erythromycin) are predicted to
increase the exposure to rupatadine. Avoid.oStudy
▶ Macrolides (erythromycin) are predicted to increase the
exposure to mizolastine.rTheoretical
▶ Mirabegron is predicted to increase the exposure to
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the risk of antimuscarinic side-effects
antihistamines, non-sedating. Avoid.r
is predicted to increase the exposure to mizolastine.
▶ Netupitant is predicted to increase the exposure to rupatadine.
is predicted to increase the exposure to mizolastine.
▶ Nilotinib is predicted to increase the exposure to rupatadine.
▶ Pibrentasvir (with glecaprevir) is predicted to increase the
exposure to fexofenadine.oStudy
▶ Pitolisant is predicted to decrease the exposure to
is predicted to decrease the exposure to bilastine.
increases the clearance of fexofenadine.o ▶ Teriflunomide is predicted to increase the exposure to
▶ Velpatasvir is predicted to increase the exposure to
▶ Venetoclax is predicted to increase the exposure to
BNF 78 Antifungals, azoles — Antihistamines, non-sedating 1407
Antihistamines, sedating → see TABLE 9 p. 1377 (QT-interval
prolongation), TABLE 11 p. 1377 (CNS depressant effects), TABLE 10 p. 1377
GENERAL INFORMATION Drugs with antimuscarinic effects
might reduce the absorption of levodopa, see TABLE 10 p. 1377.
ROUTE-SPECIFIC INFORMATION Since systemic absorption can
follow topical application of ketotifen, the possibility of
interactions should be borne in mind.
▶ Hydroxyzine potentially increases the risk of overheating and
dehydration when given with antiepileptics (zonisamide). Avoid
▶ Antihistamines, sedating are predicted to decrease the effects
decreases the effects of metyrapone. Avoid.
▶ Monoamine-oxidase A and B inhibitors, irreversible are
predicted to increase the risk of antimuscarinic side-effects
antihistamines, sedating. Avoid.r
▶ Antihistamines, sedating are predicted to decrease the efficacy
potentially decreases the effects of SSRIs.
Antimalarials → see TABLE 15 p. 1378 (myelosuppression), TABLE 9
p. 1377 (QT-interval prolongation)
PHARMACOLOGY Piperaquine has a long half-life; there is a
potential for drug interactions to occur for up to 3 months
after treatment has been stopped.
▶ Chloroquine is predicted to decrease the effects of agalsidase.
▶ Antimalarials (chloroquine, primaquine) are predicted to
increase the risk of methaemoglobinaemia when given with
topical anaesthetics, local (prilocaine). Use with caution or
▶ Antacids decrease the absorption of chloroquine. Separate
administration by at least 4 hours.oStudy
▶ Antacids are predicted to decrease the absorption of proguanil.
Separate administration by at least 2 hours.oStudy
▶ Antiarrhythmics (dronedarone) are predicted to increase the
concentration of piperaquine.rTheoretical
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to artemether (with lumefantrine). Avoid.rStudy
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the
concentration of piperaquine. Avoid.oTheoretical
▶ Antiepileptics (carbamazepine, phenobarbital, primidone)
potentially increase the risk of toxicity when given with
▶ Pyrimethamine increases the risk of haematological toxicity
antiepileptics (fosphenytoin, phenytoin).r
▶ Pyrimethamine is predicted to increase the risk of
haematological toxicity when given with antiepileptics
(phenobarbital, primidone).rTheoretical
▶ Antifungals, azoles (fluconazole, isavuconazole, itraconazole,
ketoconazole, posaconazole, voriconazole) are predicted to
increase the concentration of piperaquine.rTheoretical
▶ Antifungals, azoles (fluconazole, itraconazole, posaconazole,
voriconazole) are predicted to increase the exposure to
▶ Antifungals, azoles (ketoconazole) increase the exposure to
▶ Antimalarials (proguanil) are predicted to increase the risk of
antimalarials (pyrimethamine).
▶ Aprepitant is predicted to increase the concentration of
▶ Mefloquine is predicted to increase the risk of bradycardia
when given with beta blockers, non-selective.rTheoretical
▶ Mefloquine is predicted to increase the risk of bradycardia
when given with beta blockers, selective.rTheoretical
▶ Mefloquine is predicted to increase the risk of bradycardia
when given with calcium channel blockers.rTheoretical
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the concentration of piperaquine.rTheoretical
▶ Calcium salts (calcium carbonate) decrease the absorption of
. Separate administration by at least 4 hours.
▶ Calcium salts (calcium carbonate) are predicted to decrease the
absorption of proguanil. Separate administration by at least
decreases the efficacy of oral cholera vaccine.
▶ Cobicistat is predicted to increase the concentration of
▶ Crizotinib is predicted to increase the concentration of
▶ Antimalarials (chloroquine, primaquine) are predicted to
increase the risk of methaemoglobinaemia when given with
▶ Mefloquine is predicted to increase the risk of bradycardia
when given with digoxin.rTheoretical
▶ Quinine increases the concentration of digoxin. Monitor and
adjust digoxin dose, p. 109.rAnecdotal
decreases the concentration of
▶ Efavirenz moderately decreases the exposure to atovaquone.
affects the exposure to proguanil. Avoid.o ▶ Enzalutamide is predicted to decrease the exposure to
artemether (with lumefantrine). Avoid.rStudy
▶ Enzalutamide is predicted to decrease the concentration of
piperaquine. Avoid.oTheoretical
decreases the exposure to artemether.o ▶ Grapefruit juice
increases the exposure to artemether.
▶ Grapefruit juice is predicted to increase the concentration of
piperaquine. Avoid.rTheoretical
▶ H2 receptor antagonists (cimetidine) decrease the clearance of
▶ H2 receptor antagonists (cimetidine) slightly increase the
▶ HIV-protease inhibitors decrease the exposure to atovaquone.
Avoid if boosted with ritonavir.oStudy
▶ HIV-protease inhibitors are predicted to increase the
concentration of piperaquine.rTheoretical
▶ HIV-protease inhibitors are predicted to decrease the exposure
▶ HIV-protease inhibitors are predicted to affect the exposure to
quinine.rStudy → Also see TABLE 9 p. 1377
▶ Idelalisib is predicted to increase the concentration of
▶ Imatinib is predicted to increase the concentration of
▶ Lanthanum is predicted to decrease the absorption of
. Separate administration by at least 2 hours.
▶ Chloroquine is predicted to decrease the exposure to
. Avoid simultaneous administration.r
▶ Macrolides (clarithromycin, erythromycin) are predicted to
increase the concentration of piperaquine.rTheoretical
▶ Mepacrine is predicted to increase the concentration of
primaquine. Avoid.oTheoretical
▶ Pyrimethamine is predicted to increase the risk of side-effects
when given with methotrexate.rTheoretical → Also see
1408 Antihistamines, sedating — Antimalarials BNF 78
▶ Metoclopramide decreases the concentration of atovaquone.
▶ Mitotane is predicted to decrease the exposure to artemether
(with lumefantrine). Avoid.rStudy
▶ Mitotane is predicted to decrease the concentration of
piperaquine. Avoid.oTheoretical
▶ Netupitant is predicted to increase the concentration of
▶ Nilotinib is predicted to increase the concentration of
▶ Pyrimethamine is predicted to increase the risk of side-effects
when given with pemetrexed.rTheoretical → Also see
▶ Chloroquine is predicted to increase the risk of haematological
▶ Chloroquine moderately decreases the exposure to
praziquantel. Use with caution and adjust dose.oStudy
decreases the efficacy of rabies vaccine. Avoid.
▶ Rifabutin slightly decreases the exposure to atovaquone.
▶ Rifampicin is predicted to decrease the exposure to artemether
(with lumefantrine). Avoid.rStudy
▶ Rifampicin moderately decreases the exposure to atovaquone
and atovaquone slightly increases the exposure to rifampicin.
moderately decreases the exposure to mefloquine.
▶ Rifampicin is predicted to decrease the concentration of
piperaquine. Avoid.oTheoretical
▶ Rifampicin decreases the exposure to quinine.rStudy
▶ St John’s Wort is predicted to decrease the concentration of
piperaquine. Avoid.oTheoretical
▶ Pyrimethamine increases the risk of side-effects when given
with sulfonamides.rStudy → Also see TABLE 15 p. 1378
▶ Tetracyclines (tetracycline) decrease the concentration of
▶ Pyrimethamine increases the risk of side-effects when given
▶ Pyrimethamine is predicted to increase the risk of side-effects
when given with zidovudine.rTheoretical → Also see
Antithymocyte immunoglobulin (rabbit) → see immunoglobulins
Apalutamide → see TABLE 9 p. 1377 (QT-interval prolongation)
▶ Apalutamide is predicted to decrease the exposure to
(eplerenone). Avoid or monitor.
▶ Apalutamide potentially decreases the exposure to
antiepileptics (valproate).nTheoretical
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to apalutamide.n
Study → Also see TABLE 9 p. 1377
▶ Apalutamide slightly decreases the exposure to antihistamines,
non-sedating (fexofenadine).nStudy
▶ Apalutamide is predicted to decrease the exposure to beta2
agonists (salmeterol). Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to
bosutinib. Avoid or monitor.oStudy → Also see TABLE 9
▶ Apalutamide is predicted to decrease the exposure to
buspirone. Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to calcium
(felodipine, lercanidipine). Avoid or monitor.
▶ Clopidogrel is predicted to increase the exposure to
▶ Cobicistat is predicted to increase the exposure to
▶ Apalutamide is predicted to decrease the exposure to
▶ Apalutamide is predicted to decrease the exposure to
(budesonide, fluticasone). Avoid or monitor.
▶ Apalutamide is predicted to decrease the exposure to
coumarins. Avoid or monitor.nStudy
▶ Apalutamide is predicted to decrease the exposure to
▶ Apalutamide is predicted to decrease the exposure to
darifenacin. Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to
dasatinib. Avoid or monitor.oStudy → Also see TABLE 9
▶ Apalutamide is predicted to decrease the exposure to
diazepam. Avoid or monitor.nStudy
▶ Apalutamide is predicted to decrease the exposure to digoxin.
▶ Apalutamide is predicted to decrease the exposure to
everolimus. Avoid or monitor.oStudy
▶ Fibrates (gemfibrozil) are predicted to increase the exposure to
▶ HIV-protease inhibitors are predicted to increase the exposure
to apalutamide.nStudy → Also see TABLE 9 p. 1377
▶ Idelalisib is predicted to increase the exposure to apalutamide.
▶ Apalutamide is predicted to decrease the exposure to ivacaftor.
▶ Apalutamide is predicted to decrease the exposure to
lomitapide. Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to
lurasidone. Avoid or monitor.oStudy
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to apalutamide.nStudy → Also see TABLE 9 p. 1377
▶ Apalutamide is predicted to decrease the exposure to
maraviroc. Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to
▶ Apalutamide markedly decreases the exposure to midazolam.
▶ Apalutamide is predicted to decrease the exposure to
moclobemide. Avoid or monitor.nStudy
▶ Apalutamide is predicted to decrease the exposure to
naloxegol. Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to opioids
(alfentanil). Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to
phosphodiesterase type-5 inhibitors (avanafil, sildenafil,
vardenafil). Avoid or monitor.oStudy → Also see TABLE 9
▶ Apalutamide is predicted to decrease the exposure to proton
pump inhibitors (lansoprazole, rabeprazole). Avoid or monitor.
▶ Apalutamide markedly decreases the exposure to proton pump
inhibitors (omeprazole). Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to
quetiapine. Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to
sirolimus. Avoid or monitor.oStudy
▶ Apalutamide is predicted to decrease the exposure to SSRIs
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