is predicted to increase the exposure to aliskiren.

Theoretical

▶ Antacids are predicted to decrease the absorption of lapatinib.

Avoid.oTheoretical

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to lapatinib.oStudy → Also see TABLE 9 p. 1377

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to lapatinib. Avoid.rStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Study → Also see TABLE 9 p. 1377

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

predicted to increase the exposure to

o

lapatinib. Avoid.

Study → Also see TABLE 9 p. 1377

▶ Lapatinib is predicted to increase the exposure to

antihistamines, non-sedating (fexofenadine).oTheoretical

▶ Aprepitant

o

is predicted to increase the exposure to lapatinib.

Study

▶ Lapatinib is predicted to increase the exposure to beta blockers,

non-selective (nadolol).oStudy

▶ Lapatinib is predicted to increase the exposure to bictegravir.

Use with caution or avoid.oTheoretical

▶ Bosentan is predicted to decrease the exposure to lapatinib.

Avoid.rStudy

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

increase the exposure to lapatinib.oStudy

▶ Lapatinib

o

is predicted to increase the exposure to ceritinib.

Theoretical → Also see TABLE 9 p. 1377

▶ Cobicistat is predicted to increase the exposure to lapatinib.

Avoid.oStudy

▶ Lapatinib is predicted to increase the exposure to colchicine.

Avoid or adjust colchicine dose, p. 1120.oTheoretical

▶ Lapatinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Crizotinib

o

is predicted to increase the exposure to lapatinib.

Study → Also see TABLE 9 p. 1377

▶ Lapatinib

r

is predicted to increase the exposure to dabigatran.

Theoretical

▶ Lapatinib

o

is predicted to increase the exposure to digoxin.

Theoretical

▶ Lapatinib is predicted to slightly increase the exposure to

edoxaban.rTheoretical

▶ Efavirenz is predicted to decrease the exposure to lapatinib.

Avoid.rStudy → Also see TABLE 9 p. 1377

▶ Enzalutamide is predicted to decrease the exposure to

lapatinib. Avoid.rStudy

▶ Lapatinib

o

is predicted to increase the exposure to erlotinib.

Theoretical

▶ Lapatinib

o

is predicted to increase the exposure to everolimus.

Theoretical

▶ Lapatinib is predicted to increase the exposure to fidaxomicin.

Avoid.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

lapatinib. Avoid.oTheoretical

▶ H2 receptor antagonists are predicted to decrease the

absorption of lapatinib. Avoid.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to lapatinib. Avoid.oStudy → Also see TABLE 9 p. 1377

▶ Idelalisib is predicted to increase the exposure to lapatinib.

Avoid.oStudy

▶ Imatinib

o

is predicted to increase the exposure to lapatinib.

Study

▶ Lapatinib is predicted to increase the exposure to lomitapide.

Separate administration by 12 hours.oTheoretical

▶ Lapatinib

o

is predicted to increase the exposure to loperamide.

Theoretical

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to lapatinib. Avoid.oStudy → Also see TABLE 9

p. 1377

▶ Macrolides (erythromycin) are predicted to increase the

exposure to lapatinib.oStudy → Also see TABLE 9 p. 1377

▶ Mitotane is predicted to decrease the exposure to lapatinib.

Avoid.rStudy

▶ Netupitant

o

is predicted to increase the exposure to lapatinib.

Study

▶ Nevirapine is predicted to decrease the exposure to lapatinib.

Avoid.rStudy

▶ Nilotinib

o

is predicted to increase the exposure to lapatinib.

Study → Also see TABLE 9 p. 1377

▶ Lapatinib

o

is predicted to increase the exposure to nintedanib.

Study

▶ Lapatinib is predicted to increase the exposure to

panobinostat. Adjust dose.oTheoretical → Also see

TABLE 9 p. 1377

▶ Lapatinib is predicted to increase the risk of bleeding events

when given with phenindione.rTheoretical

▶ Lapatinib

o

is predicted to increase the exposure to pibrentasvir.

Theoretical

▶ Pitolisant is predicted to decrease the exposure to lapatinib.

Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to lapatinib.

Avoid.rStudy

▶ Lapatinib

o

is predicted to increase the exposure to sirolimus.

Theoretical

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

lapatinib. Avoid.rStudy

▶ Lapatinib slightly increases the exposure to taxanes

(paclitaxel).rStudy

▶ Tedizolid is predicted to increase the exposure to lapatinib.

Avoid.oTheoretical

▶ Lapatinib

r

is predicted to increase the exposure to topotecan.

Study

▶ Lapatinib is predicted to increase the concentration of

trametinib.oTheoretical

▶ Lapatinib is predicted to increase the exposure to venetoclax.

Avoid or monitor for toxicity.rTheoretical

Laronidase

▶ Antimalarials (chloroquine) are predicted to decrease the

exposure to

r

laronidase. Avoid simultaneous administration.

Theoretical

▶ Hydroxychloroquine is predicted to decrease the exposure to

laronidase

Theoretical

. Avoid simultaneous administration.r

1476 Lamivudine — Laronidase BNF 78

Interactions | Appendix 1

A1

Ledipasvir

▶ Antacids are predicted to decrease the exposure to ledipasvir.

Separate administration by 4 hours.oTheoretical

▶ Ledipasvir increases the risk of severe bradycardia or heart

block when given with antiarrhythmics (amiodarone). Refer to

specialist literature.rAnecdotal

▶ Antiepileptics (carbamazepine) are predicted to decrease the

exposure to ledipasvir. Avoid.rStudy

▶ Antiepileptics (fosphenytoin, oxcarbazepine, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to ledipasvir. Avoid.rTheoretical

▶ Calcium salts (calcium carbonate) are predicted to decrease the

exposure to

o

ledipasvir. Separate administration by 4 hours.

Theoretical

▶ Ledipasvir

o

is predicted to increase the exposure to dabigatran.

Theoretical

▶ Ledipasvir is predicted to increase the exposure to digoxin.

Monitor and adjust dose.oTheoretical

▶ H2 receptor antagonists are predicted to decrease the exposure

oto ledipasvir. Adjust dose, see ledipasvir with sofosbuvir p. 628.

Study

▶ HIV-protease inhibitors (tipranavir boosted with ritonavir) are

predicted to decrease the exposure to

Theoretical

ledipasvir. Avoid.r

▶ Proton pump inhibitors are predicted to decrease the exposure

oto ledipasvir. Adjust dose, see ledipasvir with sofosbuvir p. 628.

Theoretical

▶ Rifabutin is predicted to decrease the exposure to ledipasvir.

Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to ledipasvir.

Avoid.rStudy

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

ledipasvir. Avoid.rStudy

▶ Ledipasvir is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, pravastatin, simvastatin). Monitor

and adjust dose.oTheoretical

▶ Ledipasvir is predicted to increase the exposure to statins

(rosuvastatin). Avoid.rTheoretical

▶ Ledipasvir (with sofosbuvir) slightly increases the exposure to

tenofovir disoproxil.oStudy

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

(myelosuppression)

PHARMACOLOGY Leflunomide has a long half-life; washout

procedure recommended before switching to other DMARDs

(consult product literature).

▶ Leflunomide

o

is predicted to increase the exposure to adefovir.

Theoretical

▶ Leflunomide is predicted to decrease the exposure to

agomelatine.oTheoretical

▶ Leflunomide decreases the exposure to aminophylline. Adjust

dose.oStudy

▶ Leflunomide is predicted to decrease the exposure to

anaesthetics, local (ropivacaine).oTheoretical

▶ Leflunomide is predicted to increase the exposure to

anthracyclines

o

(daunorubicin, doxorubicin, mitoxantrone).

Theoretical → Also see TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to

antihistamines, non-sedating (fexofenadine).oStudy

▶ Leflunomide

o

potentially increases the exposure to baricitinib.

Theoretical

▶ Leflunomide

o

is predicted to increase the exposure to bosentan.

Study

▶ Leflunomide is predicted to moderately increase the clearance

of caffeine citrate. Monitor and adjust dose.oStudy

▶ Leflunomide is predicted to increase the exposure to

cephalosporins (cefaclor).oTheoretical

▶ Leflunomide

o

is predicted to decrease the exposure to clozapine.

Theoretical → Also see TABLE 15 p. 1378

▶ Leflunomide

r

increases the anticoagulant effect of coumarins.

Anecdotal

▶ Leflunomide is predicted to decrease the exposure to

duloxetine.oTheoretical

▶ Leflunomide is predicted to increase the exposure to

ganciclovir.oTheoretical → Also see TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to H2

receptor antagonists

Theoretical

(cimetidine, famotidine).o ▶ Leflunomide is predicted to increase the concentration of

letermovir.oStudy

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

leflunomide. Public Health England advises avoid (refer to

Green Book).rTheoretical

▶ Leflunomide is predicted to increase the exposure to loop

diuretics (furosemide).oTheoretical

▶ Leflunomide is predicted to decrease the exposure to

melatonin.oTheoretical

▶ Leflunomide is predicted to increase the exposure to

methotrexate.oTheoretical → Also see TABLE 1 p. 1375 →

Also see TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the clearance of

mexiletine. Monitor and adjust dose.oStudy

▶ Leflunomide is predicted to increase the exposure to

montelukast.oTheoretical

▶ Leflunomide is predicted to increase the exposure to

nateglinide.oTheoretical

▶ Leflunomide is predicted to increase the exposure to NSAIDs

(indometacin, ketoprofen).oTheoretical

▶ Leflunomide is predicted to decrease the exposure to

olanzapine. Monitor and adjust dose.oStudy → Also see

TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to

oseltamivir.oTheoretical

▶ Leflunomide is predicted to increase the exposure to penicillins

(benzylpenicillin).oTheoretical

▶ Leflunomide is predicted to increase the exposure to

pioglitazone.oStudy

▶ Leflunomide is predicted to decrease the exposure to

pirfenidone.oTheoretical

▶ Leflunomide is predicted to increase the exposure to quinolones

(ciprofloxacin).oTheoretical

▶ Leflunomide is predicted to increase the exposure to

repaglinide.oStudy

▶ Leflunomide is predicted to increase the exposure to

rifampicin.oTheoretical

▶ Leflunomide is predicted to increase the exposure to selexipag.

Adjust dose.oTheoretical

▶ Leflunomide is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, pravastatin, simvastatin)

Study → Also see TABLE 1 p. 1375

.o ▶ Leflunomide is predicted to increase the exposure to statins

(rosuvastatin). Adjust dose.oStudy → Also see TABLE 1

p. 1375

▶ Leflunomide is predicted to increase the exposure to

sulfasalazine.oStudy → Also see TABLE 1 p. 1375 → Also see

TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to

sulfonylureas (glibenclamide).oStudy

▶ Leflunomide is predicted to increase the concentration of

taxanes (paclitaxel).rAnecdotal → Also see TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to tenofovir

alafenamide.oTheoretical

▶ Leflunomide is predicted to increase the exposure to tenofovir

disoproxil.oTheoretical

▶ Leflunomide is predicted to decrease the exposure to

theophylline. Adjust dose.oStudy

▶ Leflunomide moderately decreases the exposure to tizanidine.

nStudy

▶ Leflunomide is predicted to increase the exposure to

topotecan.oStudy → Also see TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to

zidovudine.oTheoretical → Also see TABLE 15 p. 1378

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

(myelosuppression), TABLE 5 p. 1375 (thromboembolism)

▶ Combined hormonal contraceptives are predicted to increase

the risk of venous thromboembolism when given with

lenalidomide. Avoid.rTheoretical

BNF 78 Ledipasvir — Lenalidomide 1477

Interactions | Appendix 1

A1

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