is predicted to increase the exposure to sunitinib.

Theoretical

▶ Aprepitant is predicted to increase the concentration of

tacrolimus.rStudy

▶ Aprepitant is predicted to increase the exposure to taxanes

(cabazitaxel).oTheoretical

▶ Aprepitant is predicted to increase the concentration of

temsirolimus.oTheoretical

▶ Aprepitant is predicted to increase the exposure to tezacaftor.

Adjust tezacaftor with ivacaftor p. 295 dose with moderate

inhibitors of CYP3A4.rStudy

▶ Aprepitant given with a potent CYP2C19 inhibitor is predicted

to increase the exposure to tofacitinib. Adjust tofacitinib dose,

p. 1105.oStudy

▶ Aprepitant is predicted to increase the exposure to tolterodine.

nTheoretical

▶ Aprepitant is predicted to increase the exposure to tolvaptan.

Manufacturer advises caution or adjust tolvaptan dose with

moderate inhibitors of CYP3A4, p. 669.oStudy

▶ Aprepitant

o

is predicted to increase the exposure to trazodone.

Theoretical

BNF 78 Aprepitant — Aprepitant 1411

Interactions | Appendix 1

A1

Aprepitant (continued)

▶ Aprepitant decreases the efficacy of ulipristal. For FSRH

guidance, see

Anecdotal

Contraceptives, interactions p. 794.r

▶ Aprepitant is predicted to increase the exposure to venetoclax.

Avoid or adjust dose—consult product literature.rStudy

▶ Aprepitant is predicted to increase the exposure to vinca

alkaloids.rTheoretical

▶ Aprepitant is predicted to increase the exposure to zopiclone.

Adjust dose.oStudy

Argatroban → see TABLE 3 p. 1375 (anticoagulant effects)

▶ Ranibizumab is predicted to increase the risk of bleeding

events when given with argatroban.rTheoretical

Aripiprazole → see TABLE 8 p. 1376 (hypotension), TABLE 11 p. 1377 (CNS

depressant effects)

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to moderately decrease

the exposure to

o

aripiprazole. Adjust aripiprazole dose, p. 395.

Study → Also see TABLE 11 p. 1377

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

predicted to slightly increase the exposure to aripiprazole.

Adjust aripiprazole dose, p. 395.oStudy

▶ Bupropion is predicted to moderately increase the exposure to

aripiprazole. Adjust aripiprazole dose, p. 395.oStudy

▶ Cinacalcet is predicted to moderately increase the exposure to

aripiprazole. Adjust aripiprazole dose, p. 395.oStudy

▶ Cobicistat is predicted to slightly increase the exposure to

aripiprazole. Adjust aripiprazole dose, p. 395.oStudy

▶ Aripiprazole is predicted to decrease the effects of dopamine

receptor agonists.oTheoretical → Also see TABLE 8 p. 1376

▶ Enzalutamide is predicted to moderately decrease the

o

exposure to aripiprazole. Adjust aripiprazole dose, p. 395.

Study

▶ HIV-protease inhibitors are predicted to slightly increase the

exposure to

o

aripiprazole. Adjust aripiprazole dose, p. 395.

Study

▶ Idelalisib is predicted to slightly increase the exposure to

aripiprazole. Adjust aripiprazole dose, p. 395.oStudy

▶ Aripiprazole

r

is predicted to decrease the effects of levodopa.

Theoretical → Also see TABLE 8 p. 1376

▶ Macrolides (clarithromycin) are predicted to slightly increase

the exposure to

o

aripiprazole. Adjust aripiprazole dose, p. 395.

Study

▶ Mitotane is predicted to moderately decrease the exposure to

aripiprazole. Adjust aripiprazole dose, p. 395.oStudy

▶ Rifampicin is predicted to moderately decrease the exposure

to aripiprazole. Adjust aripiprazole dose, p. 395.oStudy

▶ SSRIs (fluoxetine, paroxetine) are predicted to moderately

increase the exposure to aripiprazole. Adjust aripiprazole dose,

p. 395.oStudy

▶ Terbinafine is predicted to moderately increase the exposure

to aripiprazole. Adjust aripiprazole dose, p. 395.oStudy

Arsenic trioxide → see TABLE 15 p. 1378 (myelosuppression), TABLE 9

p. 1377 (QT-interval prolongation)

Artemether → see antimalarials

Artenimol → see antimalarials

Articaine → see TABLE 11 p. 1377 (CNS depressant effects)

Ascorbic acid

▶ Ascorbic acid is predicted to increase the risk of cardiovascular

side-effects when given with deferiprone.rTheoretical

▶ Ascorbic acid is predicted to increase the risk of cardiovascular

r

side-effects when given with iron chelators (desferrioxamine).

Theoretical

Asenapine → see TABLE 8 p. 1376 (hypotension), TABLE 11 p. 1377 (CNS

depressant effects)

▶ Asenapine is predicted to decrease the effects of dopamine

receptor agonists. Adjust dose.oTheoretical → Also see

TABLE 8 p. 1376

▶ Asenapine is predicted to decrease the effects of levodopa.

Adjust dose.rTheoretical → Also see TABLE 8 p. 1376

▶ SSRI

os (fluvoxamine) increase the exposure to asenapine.

Study

▶ SSRIs (paroxetine) moderately increase the exposure to

asenapine.oStudy

Asparaginase → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 15 p. 1378

(myelosuppression)

▶ Asparaginase is predicted to increase the risk of hepatotoxicity

when given with imatinib.rTheoretical → Also see TABLE 15

p. 1378

▶ Asparaginase

Anecdotal → Also see

affects the ef

TABLE 1 p. 1375

ficacy of

→ Also see

methotrexate

TABLE 15

.r

p. 1378

▶ Asparaginase potentially increases the risk of neurotoxicity

when given with vinca alkaloids (vincristine).Vincristine should

be taken 3 to 24 hours before

Anecdotal → Also see TABLE 1 p. 1375

asparaginase

→ Also see

,

TABLE 15

p. 933.r

p. 1378

Aspirin → see TABLE 4 p. 1375 (antiplatelet effects)

▶ Acetazolamide increases the risk of severe toxic reaction when

given with aspirin (high-dose).rStudy

▶ Antacids

o

decrease the absorption of aspirin (high-dose).

Study

▶ Aspirin (high-dose) is predicted to increase the risk of

gastrointestinal irritation when given with bisphosphonates

(alendronic acid, ibandronic acid).oStudy

▶ Aspirin (high-dose) is predicted to increase the risk of renal

impairment when given with bisphosphonates (sodium

clodronate).rTheoretical

▶ 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

▶ Aspirin (high-dose) increases the risk of renal impairment

when given with daptomycin.oTheoretical

▶ Erlotinib is predicted to increase the risk of gastrointestinal

perforation when given with

Theoretical

aspirin (high-dose).r

▶ Aspirin (high-dose) is predicted to increase the risk of

gastrointestinal bleeds when given with iron chelators

(deferasirox).rTheoretical

▶ Aspirin (high-dose) is predicted to increase the risk of toxicity

when given with methotrexate.rStudy

▶ Aspirin is predicted to increase the risk of gastrointestinal

perforation when given with nicorandil.rTheoretical

▶ Aspirin (high-dose) potentially increases the exposure to

pemetrexed. Use with caution or avoid.rTheoretical

▶ Aspirin (high-dose) increases the risk of acute renal failure

when given with thiazide diuretics.rTheoretical

▶ Zidovudine increases the risk of haematological toxicity when

given with aspirin (high-dose).rStudy

Ataluren

▶ Ataluren is predicted to increase the risk of nephrotoxicity

when given with intravenous

Study

aminoglycosides. Avoid.r

▶ Rifampicin decreases the exposure to ataluren.oStudy

Atazanavir → see HIV-protease inhibitors

Atenolol → see beta blockers, selective

Atezolizumab → see monoclonal antibodies

Atomoxetine

▶ Amfetamines are predicted to increase the risk of side-effects

when given with atomoxetine.rTheoretical

▶ Atomoxetine is predicted to increase the risk of cardiovascular

side-effects when given with

o

beta2 agonists (high-dose).

Study

▶ Bupropion is predicted to markedly increase the exposure to

atomoxetine. Adjust dose.rStudy

▶ Cinacalcet is predicted to markedly increase the exposure to

atomoxetine. Adjust dose.rStudy

▶ Eliglustat is predicted to increase the exposure to atomoxetine.

Adjust dose.oTheoretical

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of side-effects when given with

atomoxetine

r

. Avoid and for 2 weeks after stopping the MAOI.

Theoretical

▶ Panobinostat is predicted to increase the exposure to

atomoxetine. Monitor and adjust dose.rTheoretical

▶ SSRIs (fluoxetine, paroxetine) are predicted to markedly

increase the exposure to

Study

atomoxetine. Adjust dose.r

▶ Terbinafine is predicted to markedly increase the exposure to

atomoxetine. Adjust dose.rStudy

1412 Aprepitant — Atomoxetine BNF 78

Interactions | Appendix 1

A1

Atorvastatin → see statins

Atovaquone → see antimalarials

Atracurium → see neuromuscular blocking drugs, non-depolarising

Atropine → see TABLE 10 p. 1377 (antimuscarinics)

ROUTE-SPECIFIC INFORMATION Since systemic absorption can

follow topical application, the possibility of interactions

should be borne in mind.

▶ Atropine increases the risk of severe hypertension when given

with

Study

sympathomimetics, vasoconstrictor (phenylephrine).r

Avanafil → see phosphodiesterase type-5 inhibitors

Avelumab → see monoclonal antibodies

Axitinib → see TABLE 15 p. 1378 (myelosuppression)

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to axitinib.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to axitinib. Avoid or adjust dose.oStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Theoretical

axitinib.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to axitinib. Avoid or adjust

dose.oStudy

▶ Aprepitant

o

is predicted to increase the exposure to axitinib.

Theoretical

▶ Bosentan

o

is predicted to decrease the exposure to axitinib.

Theoretical

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

increase the exposure to axitinib.oTheoretical

▶ Cobicistat is predicted to increase the exposure to axitinib.

Avoid or adjust dose.oStudy

▶ Axitinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Crizotinib

o

is predicted to increase the exposure to axitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Efavirenz

o

is predicted to decrease the exposure to axitinib.

Theoretical

▶ Enzalutamide is predicted to decrease the exposure to axitinib.

Avoid or adjust dose.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

axitinib.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to axitinib. Avoid or adjust dose.oStudy

▶ Idelalisib is predicted to increase the exposure to axitinib.

Avoid or adjust dose.oStudy → Also see TABLE 15 p. 1378

▶ Imatinib

o

is predicted to increase the exposure to axitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to axitinib. Avoid or adjust dose.oStudy

▶ Macrolides (erythromycin) are predicted to increase the

exposure to axitinib.oTheoretical

▶ Mitotane is predicted to decrease the exposure to axitinib.

Avoid or adjust dose.oStudy → Also see TABLE 15 p. 1378

▶ Netupitant

o

is predicted to increase the exposure to axitinib.

Theoretical

▶ Nevirapine

o

is predicted to decrease the exposure to axitinib.

Theoretical

▶ Nilotinib

o

is predicted to increase the exposure to axitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Axitinib is predicted to increase the risk of bleeding events

when given with phenindione.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to axitinib.

Avoid or adjust dose.oStudy

▶ St John

o’s Wort is predicted to decrease the exposure to axitinib.

Theoretical

Azacitidine → see TABLE 15 p. 1378 (myelosuppression)

Azathioprine → see TABLE 15 p. 1378 (myelosuppression)

▶ ACE inhibitors are predicted to increase the risk of anaemia

Anecdotal

and/or leucopenia when given with azathioprine.r

▶ Allopurinol potentially increases the risk of haematological

toxicity when given with azathioprine. Adjust azathioprine

dose, p. 836.rStudy

▶ Azathioprine

o

decreases the anticoagulant effect of coumarins.

Study

▶ Febuxostat is predicted to increase the exposure to

azathioprine. Avoid.rTheoretical

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

azathioprine (high-dose). Public Health England advises avoid

(refer to Green Book).rTheoretical

Azelastine → see antihistamines, non-sedating

Azilsartan → see angiotensin-II receptor antagonists

Azithromycin → see macrolides

Bacillus Calmette-Guérin vaccine → see live vaccines

Bacitracin → see TABLE 2 p. 1375 (nephrotoxicity)

Baclofen → see TABLE 8 p. 1376 (hypotension), TABLE 11 p. 1377 (CNS

depressant effects), TABLE 10 p. 1377 (antimuscarinics)

▶ Baclofen is predicted to increase the risk of side-effects when

given with levodopa.rAnecdotal → Also see TABLE 8 p. 1376

Balsalazide → see TABLE 15 p. 1378 (myelosuppression)

▶ Balsalazide is predicted to decrease the concentration of

digoxin.oTheoretical

Bambuterol → see beta2 agonists

Baricitinib

▶ Leflunomide

o

potentially increases the exposure to baricitinib.

Theoretical

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

baricitinib. Avoid.rTheoretical

▶ Teriflunomide

o

potentially increases the exposure to baricitinib.

Theoretical

Basiliximab → see monoclonal antibodies

Bazedoxifene

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to bazedoxifene.oTheoretical

▶ Rifampicin is predicted to decrease the exposure to

bazedoxifene.oTheoretical

Beclometasone → see corticosteroids

Bedaquiline → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 9 p. 1377 (QTinterval prolongation)

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to bedaquiline. Avoid prolonged use.n Theoretical → Also see TABLE 9 p. 1377

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) decrease the exposure to bedaquiline.

Avoid.rStudy → Also see TABLE 1 p. 1375

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to bedaquiline. Avoid

prolonged use.nTheoretical → Also see TABLE 1 p. 1375 → Also

see TABLE 9 p. 1377

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

predicted to increase the exposure to bedaquiline. Avoid

prolonged use.nStudy → Also see TABLE 1 p. 1375 → Also see

TABLE 9 p. 1377

▶ Aprepitant is predicted to increase the exposure to

bedaquiline. Avoid prolonged use.nTheoretical

▶ Bosentan is predicted to decrease the exposure to bedaquiline.

Avoid.rStudy

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

increase the exposure to bedaquiline. Avoid prolonged use.

nTheoretical

▶ Clofazimine potentially increases the risk of QT-prolongation

when given with bedaquiline.rStudy

▶ Cobicistat is predicted to increase the exposure to bedaquiline.

Avoid prolonged use.nStudy

▶ Crizotinib is predicted to increase the exposure to bedaquiline.

Avoid prolonged use.nTheoretical → Also see TABLE 9 p. 1377

▶ Efavirenz is predicted to decrease the exposure to bedaquiline.

Avoid.rStudy → Also see TABLE 9 p. 1377

▶ Enzalutamide

r

decreases the exposure to bedaquiline. Avoid.

Study

▶ Etravirine is predicted to decrease the exposure to bedaquiline.

Avoid.rTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to bedaquiline. Avoid prolonged use.nStudy → Also see

TABLE 9 p. 1377

BNF 78 Atorvastatin — Bedaquiline 1413

Interactions | Appendix 1

A1

Bedaquiline (continued)

▶ Idelalisib is predicted to increase the exposure to bedaquiline.

Avoid prolonged use.nStudy

▶ Imatinib is predicted to increase the exposure to bedaquiline.

Avoid prolonged use.nTheoretical

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to bedaquiline. Avoid prolonged use.nStudy →

Also see TABLE 9 p. 1377

▶ Macrolides (erythromycin) are predicted to increase the

exposure to bedaquiline. Avoid prolonged use.n Theoretical → Also see TABLE 9 p. 1377

▶ Mitotane

Study

decreases the exposure to bedaquiline. Avoid.r

▶ Netupitant is predicted to increase the exposure to

bedaquiline. Avoid prolonged use.nTheoretical

▶ Nevirapine is predicted to decrease the exposure to

bedaquiline. Avoid.rStudy

▶ Nilotinib is predicted to increase the exposure to bedaquiline.

Avoid prolonged use.nTheoretical → Also see TABLE 9 p. 1377

▶ Rifampicin

r

decreases the exposure to bedaquiline. Avoid.

Study

▶ St John’s Wort is predicted to decrease the exposure to

bedaquiline. Avoid.rStudy

Bee venom extract

GENERAL INFORMATION Desensitising vaccines should be

avoided in patients taking beta-blockers (adrenaline might be

ineffective in case of a hypersensitivity reaction) or ACE

inhibitors (risk of severe anaphylactoid reactions).

Belatacept

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

belatacept. Public Health England advises avoid (refer to

Green Book).rTheoretical

Belimumab → see monoclonal antibodies

Bendamustine → see alkylating agents

Bendroflumethiazide → see thiazide diuretics

Benperidol → see TABLE 8 p. 1376 (hypotension), TABLE 11 p. 1377 (CNS

depressant effects)

▶ Benperidol is predicted to decrease the effects of dopamine

receptor agonists. Avoid.oTheoretical → Also see TABLE 8

p. 1376

▶ Benperidol

o

is predicted to decrease the effects of guanethidine.

Theoretical → Also see TABLE 8 p. 1376

▶ Benperidol

r

is predicted to decrease the effects of levodopa.

Study → Also see TABLE 8 p. 1376

Benzydamine → see NSAIDs

Benzylpenicillin → see penicillins

Beta blockers, non-selective → see TABLE 6 p. 1376 (bradycardia),

TABLE 8 p. 1376 (hypotension), TABLE 9 p. 1377 (QT-interval prolongation)

carvedilol . labetalol . levobunolol . nadolol . pindolol . propranolol . sotalol .timolol.

ROUTE-SPECIFIC INFORMATION Since systemic absorption can

follow topical application of levobunolol and timolol, the

possibility of interactions should be borne in mind.

▶ Beta blockers, non-selective are predicted to increase the risk

r

of bronchospasm when given with aminophylline. Avoid.

Theoretical

▶ Antiarrhythmics (amiodarone, disopyramide, dronedarone,

flecainide, lidocaine) are predicted to increase the risk of

cardiovascular side-effects when given with beta blockers,

non-selective. Use with caution or avoid.rStudy → Also see

TABLE 6 p. 1376 → Also see TABLE 9 p. 1377

▶ Antiarrhythmics (propafenone) increase the risk of

cardiovascular side-effects when given with propranolol. Use

with caution or avoid.rStudy

▶ Antiarrhythmics (propafenone) are predicted to increase the

exposure to timolol and timolol is predicted to increase the risk

of cardiodepression when given with antiarrhythmics

(propafenone).rAnecdotal

▶ Antiarrhythmics (propafenone) are predicted to increase the risk

of cardiovascular side-effects when given with beta blockers,

non-selective (labetalol, levobunolol, nadolol, pindolol, sotalol).

Use with caution or avoid.rStudy

▶ Anticholinesterases, centrally acting are predicted to increase

the risk of bradycardia when given with beta blockers, nonselective.oAnecdotal → Also see TABLE 6 p. 1376

▶ Antiepileptics (phenobarbital, primidone) are predicted to

decrease the exposure to propranolol.oStudy

▶ Antiepileptics (phenobarbital, primidone) are predicted to

decrease the exposure to beta blockers, non-selective (carvedilol,

labetalol).oTheoretical

▶ Antifungals, azoles (itraconazole, ketoconazole) are predicted to

increase the exposure to nadolol.oStudy

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

bradycardia when given with

r

beta blockers, non-selective.

Theoretical

▶ Calcium channel blockers (diltiazem) are predicted to increase

the risk of cardiodepression when given with beta blockers,

non-selective.rStudy → Also see TABLE 6 p. 1376 → Also see

TABLE 8 p. 1376

▶ Intravenous calcium channel blockers (verapamil) increase the

risk of cardiovascular side-effects when given with beta

blockers, non-selective. Avoid.rStudy → Also see TABLE 6