Interactions | Appendix 1

A1

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

dose.oStudy

▶ 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

exposure to

o

erlotinib. Monitor side effects and adjust dose.

Study

▶ 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.

Avoid.rStudy

▶ 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

exposure to

r

combined hormonal contraceptives. Adjust dose.

Study

▶ 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

exposure to

o

lomitapide. Separate administration by 12 hours.

Theoretical

▶ 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

precautions.rTheoretical

▶ 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

exposure to

o

monoamine-oxidase B inhibitors (rasagiline).

Study

▶ Combined hormonal contraceptives increase the exposure to

monoamine-oxidase B inhibitors (selegiline). Avoid.rStudy

▶ Monoclonal antibodies (sarilumab) potentially decrease the

exposure to

Theoretical

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.

Avoid.rStudy

▶ Combined hormonal contraceptives are predicted to increase

the exposure to

o

pirfenidone. Use with caution and adjust dose.

Study

▶ 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

thalidomide. Avoid.rStudy

▶ Combined hormonal contraceptives are predicted to increase

the exposure to

o

theophylline. Monitor and adjust dose.

Theoretical

▶ Combined hormonal contraceptives increase the exposure to

tizanidine. Avoid.oStudy

▶ 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

the exposure to

o

zolmitriptan. Adjust zolmitriptan dose, p. 482.

Theoretical

Corticosteroids → see TABLE 17 p. 1379 (reduced serum potassium)

beclometasone . betamethasone . budesonide . ciclesonide . deflazacort . dexamethasone . fludrocortisone . fluticasone . hydrocortisone . methylprednisolone . mometasone . prednisolone . triamcinolone.

▶ 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

deflazacort

Theoretical

. Separate administration by 2 hours.o ▶ Antacids

Study

decrease the absorption of dexamethasone.o ▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to

o

methylprednisolone. Monitor and adjust dose.

Study

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to fluticasone.qTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to corticosteroids (budesonide, deflazacort, dexamethasone,

fludrocortisone, hydrocortisone, methylprednisolone,

prednisolone, triamcinolone)

o

. Monitor and adjust dose.

Study

▶ 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

Interactions | Appendix 1

A1

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

predicted to increase the exposure to beclometasone (risk with

beclometasone is likely to be lower than with other

corticosteroids).oTheoretical

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

concentration of methylprednisolone. Monitor and adjust

dose.oTheoretical

▶ 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

corticosteroids

o

(budesonide, fluticasone). Avoid or monitor.

Study

▶ Aprepitant is predicted to increase the exposure to oral

budesonide.oStudy

▶ Aprepitant moderately increases the exposure to

dexamethasone. Monitor and adjust dose.oStudy

▶ Aprepitant

o

is predicted to increase the exposure to fluticasone.

Study

▶ 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

o

corticosteroids.

Study

▶ Calcium channel blockers (diltiazem, verapamil) are predicted to

increase the exposure to methylprednisolone. Monitor and

adjust dose.oStudy

▶ Dexamethasone is predicted to decrease the concentration of

caspofungin

Theoretical

. Adjust caspofungin dose, p. 592.o ▶ Corticosteroids are predicted to decrease the concentration of

choline salicylate.oStudy

▶ 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,

prednisolone, triamcinolone)

r

. Avoid or monitor side effects.

Study

▶ Corticosteroids are predicted to increase the effects of

coumarins.oStudy

▶ 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,

prednisolone, triamcinolone)

o

. Monitor and adjust dose.

Study

▶ Enzalutamide is predicted to decrease the exposure to

fluticasone.qTheoretical

▶ Corticosteroids increase the risk of gastrointestinal

perforation when given with erlotinib.rTheoretical

▶ Corticosteroids potentially oppose the effects of glycerol

phenylbutyrate.oTheoretical

▶ Grapefruit juice moderately increases the exposure to oral

budesonide. Avoid.oStudy

▶ 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,

prednisolone, triamcinolone)

r

. Avoid or monitor side effects.

Study

▶ 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,

prednisolone, triamcinolone)

r

. Avoid or monitor side effects.

Study

▶ 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

(deferasirox).rTheoretical

▶ 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).

Theoretical

o ▶ Macrolides (erythromycin) are predicted to increase the

exposure to

o

methylprednisolone. Monitor and adjust dose.

Study

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to corticosteroids (betamethasone, budesonide,

ciclesonide, deflazacort, dexamethasone, fludrocortisone,

fluticasone, hydrocortisone, methylprednisolone, mometasone,

prednisolone, triamcinolone)

r

. Avoid or monitor side effects.

Study

▶ Corticosteroids are predicted to decrease the efficacy of

mifamurtide. Avoid.rTheoretical

▶ Mifepristone is predicted to decrease the efficacy of

corticosteroids

Theoretical

. Use with caution and adjust dose.o ▶ Mitotane is predicted to decrease the exposure to

corticosteroids (budesonide, deflazacort, dexamethasone,

fludrocortisone, hydrocortisone, methylprednisolone,

prednisolone, triamcinolone)

o

. Monitor and adjust dose.

Study

▶ Mitotane

q

is predicted to decrease the exposure to fluticasone.

Theoretical

▶ 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,

methylprednisolone)

Theoretical

. Monitor and adjust dose.o ▶ Corticosteroids are predicted to increase the risk of

immunosuppression when given with monoclonal antibodies

(dinutuximab)

r

. Avoid except in life-threatening situations.

Theoretical

▶ Netupitant is predicted to increase the exposure to oral

budesonide.oStudy

▶ Netupitant is predicted to increase the exposure to

dexamethasone. Adjust dose.oStudy

▶ Netupitant

o

is predicted to increase the exposure to fluticasone.

Study

▶ 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

Anecdotal

.r

▶ 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

phenindione.oAnecdotal

BNF 78 Corticosteroids — Corticosteroids 1435

Interactions | Appendix 1

A1

Corticosteroids (continued)

▶ Dexamethasone

o

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