Combined hormonal contraceptives (continued)
▶ Combined hormonal contraceptives increase the concentration
of clozapine. Monitor side effects and adjust dose.rStudy
▶ Cobicistat is predicted to decrease the efficacy of combined
hormonal contraceptives. Avoid.rStudy
▶ Combined hormonal contraceptives (containing
ethinylestradiol) increase the risk of increased ALT
concentrations when given with dasabuvir. Avoid.rStudy
▶ Combined hormonal contraceptives are predicted to increase
the exposure to dopamine receptor agonists (ropinirole). Adjust
▶ Efavirenz is predicted to decrease the efficacy of combined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactions p. 794.rStudy
▶ Encorafenib is predicted to affect the exposure to combined
hormonal contraceptives.rTheoretical
▶ Combined hormonal contraceptives slightly increase the
erlotinib. Monitor side effects and adjust dose.
▶ Fosaprepitant is predicted to decrease the efficacy of combined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactions p. 794.rStudy
▶ Combined hormonal contraceptives (containing
ethinylestradiol) are predicted to increase the risk of
increased ALT concentrations when given with glecaprevir.
▶ Griseofulvin potentially decreases the efficacy of combined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactions p. 794.rAnecdotal
▶ HIV-protease inhibitors (atazanavir) (unboosted) increase the
combined hormonal contraceptives. Adjust dose.
▶ HIV-protease inhibitors (ritonavir) are predicted to decrease the
efficacy of combined hormonal contraceptives. For FSRH
guidance, see Contraceptives, interactions p. 794.rStudy
▶ Combined hormonal contraceptives are predicted to increase
the risk of venous thromboembolism when given with
lenalidomide. Avoid.rTheoretical
▶ Oral combined hormonal contraceptives slightly increase the
lomitapide. Separate administration by 12 hours.
▶ Combined hormonal contraceptives are predicted to increase
the exposure to loxapine. Avoid.qTheoretical
▶ Lumacaftor is predicted to decrease the efficacy of combined
hormonal contraceptives. Use additional contraceptive
▶ Combined hormonal contraceptives are predicted to increase
the exposure to melatonin.oTheoretical
▶ Combined hormonal contraceptives decrease the effects of
metyrapone. Avoid.oTheoretical
▶ Modafinil is predicted to decrease the efficacy of combined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactions p. 794.rStudy
▶ Combined hormonal contraceptives slightly increase the
monoamine-oxidase B inhibitors (rasagiline).
▶ Combined hormonal contraceptives increase the exposure to
monoamine-oxidase B inhibitors (selegiline). Avoid.rStudy
▶ Monoclonal antibodies (sarilumab) potentially decrease the
combined hormonal contraceptives.r
▶ Nevirapine is predicted to decrease the efficacy of combined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactions p. 794.rStudy
▶ NSAIDs (etoricoxib) slightly increase the exposure to combined
hormonal contraceptives.oStudy
▶ Combined hormonal contraceptives potentially oppose the
effects of ospemifene. Avoid.rTheoretical
▶ Combined hormonal contraceptives (containing
ethinylestradiol) are predicted to increase the risk of
increased ALT concentrations when given with paritaprevir
(with ritonavir and ombitasvir). Avoid.rStudy
▶ Combined hormonal contraceptives (containing
ethinylestradiol) are predicted to increase the risk of
increased ALT concentrations when given with pibrentasvir.
▶ Combined hormonal contraceptives are predicted to increase
pirfenidone. Use with caution and adjust dose.
▶ Pitolisant is predicted to decrease the efficacy of combined
hormonal contraceptives. Avoid.rTheoretical
▶ Combined hormonal contraceptives are predicted to increase
the risk of venous thromboembolism when given with
pomalidomide. Avoid.rTheoretical
▶ Combined hormonal contraceptives potentially oppose the
effects of raloxifene. Avoid.rTheoretical
▶ Rifabutin is predicted to decrease the efficacy of combined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactions p. 794.rStudy
▶ Rifampicin is predicted to decrease the efficacy of combined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactions p. 794.rStudy
▶ Combined hormonal contraceptives are predicted to increase
the exposure to roflumilast.oTheoretical
▶ St John’s Wort decreases the efficacy of combined hormonal
contraceptives. MHRA advises avoid. For FSRH guidance, see
Contraceptives, interactions p. 794.rAnecdotal
▶ Sugammadex is predicted to decrease the exposure to oral
combined hormonal contraceptives. Refer to patient
information leaflet for missed pill advice.rTheoretical
▶ Combined hormonal contraceptives are predicted to increase
the risk of venous thromboembolism when given with
▶ Combined hormonal contraceptives are predicted to increase
theophylline. Monitor and adjust dose.
▶ Combined hormonal contraceptives increase the exposure to
▶ Ulipristal is predicted to decrease the efficacy of combined
hormonal contraceptives. Avoid.rTheoretical
▶ Combined hormonal contraceptives (containing
ethinylestradiol) are predicted to increase the risk of
increased ALT concentrations when given with voxilaprevir
(with sofosbuvir and velpatasvir). Avoid.rStudy
▶ Combined hormonal contraceptives are predicted to increase
zolmitriptan. Adjust zolmitriptan dose, p. 482.
Corticosteroids → see TABLE 17 p. 1379 (reduced serum potassium)
▶ Interactions do not generally apply to corticosteroids used
for topical action (including inhalation) unless specified.
▶ With intravitreal use of dexamethasone in adults: caution
with concurrent administration of anticoagulant or
antiplatelet drugs—increased risk of haemorrhagic events.
▶ Antacids are predicted to decrease the absorption of
. Separate administration by 2 hours.o ▶ Antacids
methylprednisolone. Monitor and adjust dose.
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
to corticosteroids (budesonide, deflazacort, dexamethasone,
fludrocortisone, hydrocortisone, methylprednisolone,
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to methylprednisolone.
Monitor and adjust dose.oStudy
1434 Combined hormonal contraceptives — Corticosteroids BNF 78
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to beclometasone (risk with
beclometasone is likely to be lower than with other
▶ Antifungals, azoles (miconazole) are predicted to increase the
concentration of methylprednisolone. Monitor and adjust
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to corticosteroids
(betamethasone, budesonide, ciclesonide, deflazacort,
dexamethasone, fludrocortisone, fluticasone, hydrocortisone,
methylprednisolone, mometasone, prednisolone,
triamcinolone). Avoid or monitor side effects.rStudy
▶ Apalutamide is predicted to decrease the exposure to
(budesonide, fluticasone). Avoid or monitor.
▶ Aprepitant is predicted to increase the exposure to oral
▶ Aprepitant moderately increases the exposure to
dexamethasone. Monitor and adjust dose.oStudy
is predicted to increase the exposure to fluticasone.
▶ Aprepitant is predicted to increase the exposure to
methylprednisolone. Monitor and adjust dose.oStudy
▶ Corticosteroids are predicted to decrease the concentration of
aspirin (high-dose) and aspirin (high-dose) increases the risk
of gastrointestinal bleeding when given with
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to methylprednisolone. Monitor and
▶ Dexamethasone is predicted to decrease the concentration of
. Adjust caspofungin dose, p. 592.o ▶ Corticosteroids are predicted to decrease the concentration of
▶ Cobicistat is predicted to increase the exposure to
beclometasone (risk with beclometasone is likely to be lower
than with other corticosteroids).oTheoretical
▶ Cobicistat is predicted to increase the exposure to
corticosteroids (betamethasone, budesonide, ciclesonide,
deflazacort, dexamethasone, fludrocortisone, fluticasone,
hydrocortisone, methylprednisolone, mometasone,
. Avoid or monitor side effects.
▶ Corticosteroids are predicted to increase the effects of
▶ Crizotinib is predicted to increase the exposure to
methylprednisolone. Monitor and adjust dose.oStudy
▶ Enzalutamide is predicted to decrease the exposure to
corticosteroids (budesonide, deflazacort, dexamethasone,
fludrocortisone, hydrocortisone, methylprednisolone,
▶ Enzalutamide is predicted to decrease the exposure to
▶ Corticosteroids increase the risk of gastrointestinal
perforation when given with erlotinib.rTheoretical
▶ Corticosteroids potentially oppose the effects of glycerol
▶ Grapefruit juice moderately increases the exposure to oral
▶ HIV-protease inhibitors are predicted to increase the exposure
to beclometasone (risk with beclometasone is likely to be
lower than with other corticosteroids).oTheoretical
▶ HIV-protease inhibitors are predicted to increase the exposure
to corticosteroids (betamethasone, budesonide, ciclesonide,
deflazacort, dexamethasone, fludrocortisone, fluticasone,
hydrocortisone, methylprednisolone, mometasone,
. Avoid or monitor side effects.
▶ Idelalisib is predicted to increase the exposure to
beclometasone (risk with beclometasone is likely to be lower
than with other corticosteroids).oTheoretical
▶ Idelalisib is predicted to increase the exposure to
corticosteroids (betamethasone, budesonide, ciclesonide,
deflazacort, dexamethasone, fludrocortisone, fluticasone,
hydrocortisone, methylprednisolone, mometasone,
. Avoid or monitor side effects.
▶ Imatinib is predicted to increase the exposure to
methylprednisolone. Monitor and adjust dose.oStudy
▶ Corticosteroids are predicted to increase the risk of
gastrointestinal bleeding when given with iron chelators
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
corticosteroids (high-dose). Public Health England advises
avoid (refer to Green Book).rTheoretical
▶ Lumacaftor is predicted to decrease the exposure to
methylprednisolone. Adjust dose.rTheoretical
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to beclometasone (risk with beclometasone is likely
to be lower than with other corticosteroids).
o ▶ Macrolides (erythromycin) are predicted to increase the
methylprednisolone. Monitor and adjust dose.
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to corticosteroids (betamethasone, budesonide,
ciclesonide, deflazacort, dexamethasone, fludrocortisone,
fluticasone, hydrocortisone, methylprednisolone, mometasone,
. Avoid or monitor side effects.
▶ Corticosteroids are predicted to decrease the efficacy of
mifamurtide. Avoid.rTheoretical
▶ Mifepristone is predicted to decrease the efficacy of
. Use with caution and adjust dose.o ▶ Mitotane is predicted to decrease the exposure to
corticosteroids (budesonide, deflazacort, dexamethasone,
fludrocortisone, hydrocortisone, methylprednisolone,
is predicted to decrease the exposure to fluticasone.
▶ Corticosteroids (betamethasone, deflazacort, dexamethasone,
hydrocortisone, methylprednisolone, prednisolone) are
predicted to decrease the efficacy of monoclonal antibodies
(atezolizumab, ipilimumab, nivolumab, pembrolizumab). Use
with caution or avoid.rTheoretical
▶ Monoclonal antibodies (tocilizumab) are predicted to decrease
the exposure to corticosteroids (dexamethasone,
. Monitor and adjust dose.o ▶ Corticosteroids are predicted to increase the risk of
immunosuppression when given with monoclonal antibodies
. Avoid except in life-threatening situations.
▶ Netupitant is predicted to increase the exposure to oral
▶ Netupitant is predicted to increase the exposure to
dexamethasone. Adjust dose.oStudy
is predicted to increase the exposure to fluticasone.
▶ Netupitant is predicted to increase the exposure to
methylprednisolone. Monitor and adjust dose.oStudy
▶ Corticosteroids are predicted to decrease the effects of
neuromuscular blocking drugs, non-depolarising
▶ Corticosteroids increase the risk of gastrointestinal
perforation when given with nicorandil.rAnecdotal
▶ Nilotinib is predicted to increase the exposure to
methylprednisolone. Monitor and adjust dose.oStudy
▶ NSAIDs increase the risk of gastrointestinal bleeding when
given with corticosteroids.rStudy
▶ Corticosteroids are predicted to increase the effects of
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